Page last updated: 13 December 2018
This page contains forms that may be required by the Department of Health to list a medicine on the Pharmaceutical Benefits Scheme.
Forms relating to processing claims, paying benefits, or PBS stationery order forms can be found on the Department of Human Services website.
The documents on this page may not be accessible. If you need assistance please email the PBS Web team.
Application to list a Drug or Medicinal Preparation as a Pharmaceutical Benefit (PB11)
- Application to list a Drug or Medicinal Preparation as a Pharmaceutical Benefit (PDF 56 KB)
- Application to list a Drug or Medicinal Preparation as a Pharmaceutical Benefit (Word 39 KB)
Request for Approved Ex-Manufacturer Price (PB11a)
The PB11a is a form that sponsors need to submit to reflect the listing price sought for their product on the Pharmaceutical Benefits Scheme (PBS) or when requesting a price or related alteration for a product already listed on the PBS.
The PB11a form has been updated to reflect the new legislation changes commencing 1 October 2012. All price agreements, new listings, changes to pack sizes and brand premiums must use the new PB11a form for all price agreements from 1 October 2012.
For any questions relating to completion of the PB11a form, please email the Pricing Section, Pharmaceutical Evaluation Branch.
- Request for Approved Ex-Manufacturer Price PB11a - Instructions (PDF 50KB)
- Request for Approved Ex-Manufacturer PB11a - Form (RTF 194KB)
A new PB11a form is required for the purpose of a new price agreement where the Responsible Person changes their details including:
- the registered company name and ABN
- Brand names for which they are the Responsible Person
- Responsible Person
Cost Information (PB11b)
Guarantee of Supply
This form is to be used when a Responsible Person wishes to advise a failure to supply a brand of an item listed on the PBS, or a belief that a failure to supply is likely to occur.
- Guarantee of Supply (PDF 44 KB)
- Guarantee of Supply (Word 276 KB)
- Details and conditions of guarantee of supply requirements
Please email the completed form to PBS Listings.
This form confirms with the Department of Health those brands of items on the PBS a particular Responsible Person will be supplying.
Please email the completed Responsible Person form to PBS Listings.
Service fee application form: to accompany PBAC submission
This application form must be completed by the applicant, signed by an authorised person, and lodged with the submission to the PBAC Secretariat.