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HIGHLY SPECIALISED DRUGS PROGRAM (Private Hospital)

For 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. Medical practitioners must seek approval to prescribe these items as pharmaceutical benefits prior to their dispensing under the PBS. Approval of authority prescriptions by Services Australia may be obtained either by posting an Authority Prescription Form to Services Australia, or by using the Services Australia Authority free-call service (1800 888 333). Prescribers must quote the provider number of the hospital when applying. Maximum quantities and repeats for Highly Specialised Drugs are listed in the Schedule.

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 Pharmaceutical Benefits Scheme. Commonwealth subsidy is not available for hospital in-patients.

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 a price ex-manufacturer of less than $40;
  • $4 for drugs with a price ex-manufacturer of between $40 and $100;
  • 4% for drugs with a price ex-manufacturer of between $100.01 and $1000;
  • $40 for drugs with a price ex-manufacturer 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 6284R BACLOFENbaclofen 10 mg/5 mL intrathecal injection, 5 mL ampoule 10 10 0
MP 11128Q BACLOFENbaclofen 10 mg/5 mL intrathecal injection, 10 x 5 mL ampoules 1 10 0
MP 11194E BACLOFENbaclofen 40 mg/20 mL intrathecal injection, 20 mL ampoule 2 2 0
MP 11420C BACLOFENbaclofen 10 mg/5 mL intrathecal injection, 5 x 5 mL ampoules 2 10 0
MP 11504L BENRALIZUMABbenralizumab 30 mg/mL injection, 1 mL syringe 1 1 2
MP 11523L BENRALIZUMABbenralizumab 30 mg/mL injection, 1 mL syringe 1 1 4
MP 11847M BENRALIZUMABbenralizumab 30 mg/mL injection, 1 mL syringe 1 1 0
MP 11996J BENRALIZUMABbenralizumab 30 mg/mL injection, 1 mL pen device 1 1 2
MP 11997K BENRALIZUMABbenralizumab 30 mg/mL injection, 1 mL pen device 1 1 4
MP 11999M BENRALIZUMABbenralizumab 30 mg/mL injection, 1 mL pen device 1 1 0
MP 12139X BOSENTANbosentan 62.5 mg tablet, 60 1 60 5
MP 12143D BOSENTANbosentan 62.5 mg tablet, 60 1 60 0
MP 12148J BOSENTANbosentan 62.5 mg tablet, 60 1 60 5
MP 6429J BOSENTANbosentan 62.5 mg tablet, 60 1 60 5
MP 12146G BOSENTANbosentan 125 mg tablet, 60 1 60 5
MP 6430K BOSENTANbosentan 125 mg tablet, 60 1 60 5