Arthritis - rheumatoid arthritis

The PBS subsidises biological agents for patients with severe active rheumatoid arthritis.

Patient eligibility

The Pharmaceutical Benefits Scheme (PBS) subsidises treatment with biological agents under the National Health Act 1953, sections 85 and 100 for patients with severe active rheumatoid arthritis.

Where the term biological agent appears, it refers to:

  • abatacept
  • adalimumab
  • baritcitinib
  • certolizumab
  • etanercept
  • golimumab
  • infliximab
  • rituximab
  • tocilizumab
  • tofacitinib.

Patients must be eligible for the PBS and meet the relevant restriction criteria.

The Schedule of Pharmaceutical Benefits on the PBS website outlines the restrictions for prescribing biological agents.

Section 100 arrangements

Abatacept, infliximab, rituximab and tocilizumab

These items are only PBS subsidised for a day admitted patient, non-admitted patient, or patients on discharge attending either:

  • an approved private hospital
  • a public participating hospital
  • a public hospital.

You must include the hospital name and provider number on the authority application form. These items aren't PBS subsidised for hospital in-patients.

Toxicity and severity descriptors

When demonstrating a patient’s intolerance to prior treatment, use the rheumatoid arthritis toxicity and severity descriptors with the authority application.

Treatment specifics

To be eligible for PBS subsidised treatment with biological agents, patients must be treated by a rheumatologist or by a clinical immunologist with expertise in the management of rheumatoid arthritis.

Applications

Initial treatment

Apply for authority approval to prescribe initial PBS subsidised biological agents to treat severe active rheumatoid arthritis in writing and either:

All applications must include the completed:

Initial grandfather treatment

For patients who received non-PBS subsidised baricitinib treatment before 1 September 2018 for severe active rheumatoid arthritis, apply for initial grandfather authority approval in writing and either:

All applications must include the completed:

Changing or recommencing treatment

Apply for authority approval to change and recommence PBS subsidised biological agents to treat severe active rheumatoid arthritis in writing and either:

All applications must include the completed:

Continuing treatment

Apply for authority approval to continue PBS subsidised biological agents to treat severe active rheumatoid arthritis in writing and either:

All applications must include the completed:

After we approve the first application for continuing treatment, subsequent continuing treatment with PBS subsidised biosimilar brands of biological agents are Authority Required (Streamlined). They don’t need prior authority approval from us for the listed quantity and repeats.

More information

Call the PBS Complex Drugs Programs enquiry line for more information.

Page last updated: 27 September 2019