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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
  • NPNurse Practitioner
  • SO
    Products that are in a Supply Only state will be available for dispensing, but not for prescribing. PBS Prescriptions written prior to the Supply Only period are able to be dispensed using either the Supply Only product where available, or an equivalent product as specified on the PBS schedule.
    Supply Only
Prescriber code Item code Name, manner of administration and form & strength Max qty
packs
Max qty
units
No. of
repeats
MP 10182X ECULIZUMABeculizumab 300 mg/30 mL injection, 30 mL vial 1 1 0
MP 10192K ECULIZUMABeculizumab 300 mg/30 mL injection, 30 mL vial 1 1 4
MP 10194M ECULIZUMABeculizumab 300 mg/30 mL injection, 30 mL vial 1 1 5
MP 10521R ECULIZUMABeculizumab 300 mg/30 mL injection, 30 mL vial 1 1 6
MPNP 10979W ELBASVIR + GRAZOPREVIRelbasvir 50 mg + grazoprevir 100 mg tablet, 28 1 28 2
MPNP 10991L ELBASVIR + GRAZOPREVIRelbasvir 50 mg + grazoprevir 100 mg tablet, 28 1 28 3
MP 5827Q ELTROMBOPAGeltrombopag 25 mg tablet, 28 1 28 5
MP 5828R ELTROMBOPAGeltrombopag 50 mg tablet, 28 1 28 5
MP 6205N EPOETIN ALFAepoetin alfa 3000 units/0.3 mL injection, 6 x 0.3 mL syringes 2 12 5
MP 6251B EPOETIN ALFAepoetin alfa 1000 units/0.5 mL injection, 6 x 0.5 mL syringes 2 12 5
MP 6303R EPOETIN ALFAepoetin alfa 6000 units/0.6 mL injection, 6 x 0.6 mL syringes 2 12 5
MP 6204M EPOETIN ALFAepoetin alfa 2000 units/0.5 mL injection, 6 x 0.5 mL syringes 2 12 5
MP 6207Q EPOETIN ALFAepoetin alfa 10 000 units/mL injection, 6 x 1 mL syringes 2 12 5
MP 6206P EPOETIN ALFAepoetin alfa 4000 units/0.4 mL injection, 6 x 0.4 mL syringes 2 12 5
MP 6302Q EPOETIN ALFAepoetin alfa 5000 units/0.5 mL injection, 6 x 0.5 mL syringes 2 12 5
MP 6305W EPOETIN ALFAepoetin alfa 8000 units/0.8 mL injection, 6 x 0.8 mL syringes 2 12 5
MP 6339P EPOETIN ALFAepoetin alfa 40 000 units/mL injection, 1 mL syringe 2 2 5
MP 6434P EPOETIN ALFAepoetin alfa 20 000 units/0.5 mL injection, 6 x 0.5 mL syringes 2 12 5
MP 6485H EPOETIN BETAepoetin beta 10 000 units/0.6 mL injection, 6 x 0.6 mL syringes 2 12 5
MP 6481D EPOETIN BETAepoetin beta 3000 units/0.3 mL injection, 6 x 0.3 mL syringes 2 12 5
MP 6480C EPOETIN BETAepoetin beta 2000 units/0.3 mL injection, 6 x 0.3 mL syringes 2 12 5
MP 6483F EPOETIN BETAepoetin beta 5000 units/0.3 mL injection, 6 x 0.3 mL syringes 2 12 5
MP 6484G EPOETIN BETAepoetin beta 6000 units/0.3 mL injection, 6 x 0.3 mL syringes 2 12 5
MP 6482E EPOETIN BETAepoetin beta 4000 units/0.3 mL injection, 6 x 0.3 mL syringes 2 12 5
MP 9686T EPOETIN LAMBDAepoetin lambda 2000 units/mL injection, 6 x 1 mL syringes 2 12 5
MP 9593X EPOETIN LAMBDAepoetin lambda 8000 units/0.8 mL injection, 6 x 0.8 mL syringes 2 12 5
MP 9685R EPOETIN LAMBDAepoetin lambda 1000 units/0.5 mL injection, 6 x 0.5 mL syringes 2 12 5
MP 9688X EPOETIN LAMBDAepoetin lambda 4000 units/0.4 mL injection, 6 x 0.4 mL syringes 2 12 5
MP 9687W EPOETIN LAMBDAepoetin lambda 3000 units/0.3 mL injection, 6 x 0.3 mL syringes 2 12 5
MP 9588P EPOETIN LAMBDAepoetin lambda 5000 units/0.5 mL injection, 6 x 0.5 mL syringes 2 12 5
MP 9590R EPOETIN LAMBDAepoetin lambda 6000 units/0.6 mL injection, 6 x 0.6 mL syringes 2 12 5
MP 9595B EPOETIN LAMBDAepoetin lambda 10 000 units/mL injection, 6 x 1 mL syringes 2 12 5
MP 10111E EPOPROSTENOLepoprostenol 500 microgram injection, 1 vial 30 30 5
MP 10129D EPOPROSTENOLepoprostenol 1.5 mg injection, 1 vial 30 30 5
MP 11082G EPOPROSTENOLepoprostenol 1.5 mg injection [1 vial] (&) inert substance diluent [2 x 50 mL vials], 1 pack 30 30 5
MP 11069N EPOPROSTENOLepoprostenol 500 microgram injection [1 vial] (&) inert substance diluent [2 x 50 mL vials], 1 pack 30 30 5
MP 9615C ETANERCEPTetanercept 50 mg/mL injection, 4 x 1 mL syringes 1 1 0
MP 9641K ETANERCEPTetanercept 50 mg/mL injection, 4 x 1 mL pen devices 1 1 0
MP 6367D ETANERCEPTetanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack 1 1 0
MP 6461C EVEROLIMUSeverolimus 750 microgram tablet, 60 4 240 5
MP 9582H EVEROLIMUSeverolimus 1 mg tablet, 60 4 240 5
MP 6459Y EVEROLIMUSeverolimus 250 microgram tablet, 60 2 120 5
MP 6460B EVEROLIMUSeverolimus 500 microgram tablet, 60 2 120 5