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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 6109M CICLOSPORINciclosporin 50 mg/mL injection, 10 x 1 mL ampoules 1 10 0
MP 6125J CICLOSPORINciclosporin 100 mg/mL oral liquid, 50 mL 4 4 5
MP 6352H CICLOSPORINciclosporin 25 mg capsule, 30 4 120 5
MP 6353J CICLOSPORINciclosporin 50 mg capsule, 30 4 120 5
MP 6232B CICLOSPORINciclosporin 10 mg capsule, 60 2 120 5
MP 6354K CICLOSPORINciclosporin 100 mg capsule, 30 4 120 5
MP 11889R CINACALCETcinacalcet 60 mg tablet, 28 2 56 5
MP 9626P CINACALCETcinacalcet 60 mg tablet, 28 2 56 5
MP 11888Q CINACALCETcinacalcet 90 mg tablet, 28 2 56 5
MP 9627Q CINACALCETcinacalcet 90 mg tablet, 28 2 56 5
MP 11891W CINACALCETcinacalcet 30 mg tablet, 28 2 56 5
MP 9625N CINACALCETcinacalcet 30 mg tablet, 28 2 56 5
MP 6102E CLOZAPINEclozapine 100 mg tablet, 100 2 200 0
MP 6101D CLOZAPINEclozapine 25 mg tablet, 100 2 200 0
MP 6418T CLOZAPINEclozapine 200 mg tablet, 100 2 200 0
MP 11415T CLOZAPINEclozapine 50 mg/mL oral liquid, 100 mL 1 1 0
MP 9632Y CLOZAPINEclozapine 50 mg/mL oral liquid, 100 mL 1 1 0
MP 6417R CLOZAPINEclozapine 50 mg tablet, 100 2 200 0