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Highly Specialised Drugs Program (Private Hospital)

For Pharmaceutical Benefits Scheme (PBS) Highly Specialised Drugs prescribed through private hospitals, claiming and approval of authority prescriptions is administered by Services Australia. Highly Specialised Drugs prescribed in private hospitals are Authority Required items. Application for authorisation can be made by either:

  • posting an Authority Prescription form and other application form(s), where applicable to Services Australia
  • using the form upload facility in Health Professional Online Services (HPOS)
  • using the Online PBS Authorities system (see www.servicesaustralia.gov.au/HPOS)
  • using the Services Australia free-call service for PBS Complex Drugs Programs enquiries (1800 700 270) or
  • using the appropriate Streamlined code.

Prescribers must quote the provider number of the hospital when applying. Maximum quantities and repeats for Highly Specialised Drugs are listed in the PBS Schedule. Authority approvals are required for prescriptions where the dose is above the determined maximum quantity and/or number of repeats.

Private hospital prescriptions for Highly Specialised Drugs can be dispensed by an approved private hospital dispensary or by a community pharmacy. A patient will be required to pay a contribution for each supply of a highly specialised drug at the same rate as the PBS.

The remuneration rates for Highly Specialised Drugs prescribed through private hospitals comprise the normal PBS ready-prepared dispensing fee plus a mark-up ascertained as follows:

  • 10% for drugs with an ex-manufacturer price of less than $40
  • $4 for drugs with an ex-manufacturer price of between $40 and $100
  • 4% for drugs with an ex-manufacturer price of between $100.01 and $1000
  • $40 for drugs with an ex-manufacturer price of greater than $1000.

Reciprocal Health Care Agreement – Where a patient is entitled to be treated as an eligible person as a visitor from a country with which Australia has entered into a Reciprocal Health Care Agreement, the supply will be limited to the original prescription only. Repeat prescriptions for these patients are not permitted.

  • Legend
  • MPMedical Practitioner
Prescriber code Item code Name, manner of administration and form & strength Max qty
packs
Max qty
units
No. of
repeats
MP 13820J NATALIZUMABnatalizumab 150 mg/mL injection, 2 x 1 mL syringes 1 2 5
MP 9624M NATALIZUMABnatalizumab 300 mg/15 mL injection, 15 mL vial 1 1 5
MP 13826Q NIVOLUMAB + RELATLIMABnivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial 2 2 8
MP 13829W NIVOLUMAB + RELATLIMABnivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial 2 2 11
MP 11472T NUSINERSENnusinersen 12 mg/5 mL intrathecal injection, 5 mL vial 1 1 3
MP 11476B NUSINERSENnusinersen 12 mg/5 mL intrathecal injection, 5 mL vial 1 1 0
MP 12176W NUSINERSENnusinersen 12 mg/5 mL intrathecal injection, 5 mL vial 1 1 3
MP 13045N NUSINERSENnusinersen 12 mg/5 mL intrathecal injection, 5 mL vial 1 1 0
MP 13064N NUSINERSENnusinersen 12 mg/5 mL intrathecal injection, 5 mL vial 1 1 3
MP 13091B NUSINERSENnusinersen 12 mg/5 mL intrathecal injection, 5 mL vial 1 1 0
MP 13111C NUSINERSENnusinersen 12 mg/5 mL intrathecal injection, 5 mL vial 1 1 3
MP 14090N NUSINERSENnusinersen 12 mg/5 mL intrathecal injection, 5 mL vial 1 1 0
MP 14096X NUSINERSENnusinersen 12 mg/5 mL intrathecal injection, 5 mL vial 1 1 3