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.