PBS forms
PBS forms
Forms that may be required by the Department of Health and Ageing to list a medicine on the Pharmaceutical Benefits Scheme.
Application to list a Drug or Medicinal Preparation as a Pharmaceutical Benefit (PB11)
This application is to be completed and submitted to the Pharmaceutical Benefits Advisory Committee (PBAC) secretariat. For more information, please refer to the PBAC guidelines .
Request for Approved Price to Pharmacists (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.
For any questions relating to completion of the PB11a form, please contact the Pricing Section, Pharmaceutical Evaluation
Branch, pbspricing@health.gov.au or Ph 02 6289 8759.
Cost Information (PB11b)
Submit this form to the PBPA when making a request to list a drug on the PBS, or to apply for a price increase for a product already listed on the PBS.
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.
Responsible Person
This form confirms with the Department of Health and Ageing those brands of items on the PBS a particular Responsible Person will be supplying.
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.