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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 9619G IBANDRONATEibandronate 6 mg/6 mL injection, 6 mL vial 1 1 11
MP 6456T ILOPROSTiloprost 20 microgram/2 mL inhalation solution, 30 x 2 mL ampoules 1 30 5
MP 10057H INFLIXIMABinfliximab 100 mg injection, 1 vial 5 5 1
MP 10184B INFLIXIMABinfliximab 100 mg injection, 1 vial 1 1 0
MP 11396T INFLIXIMABinfliximab 100 mg injection, 1 vial 5 5 2
MP 11399Y INFLIXIMABinfliximab 100 mg injection, 1 vial 1 1 0
MP 11412P INFLIXIMABinfliximab 100 mg injection, 1 vial 1 1 0
MP 11432Q INFLIXIMABinfliximab 100 mg injection, 1 vial 5 5 2
MP 11445J INFLIXIMABinfliximab 100 mg injection, 1 vial 1 1 0
MP 11450P INFLIXIMABinfliximab 100 mg injection, 1 vial 5 5 2
MP 11483J INFLIXIMABinfliximab 100 mg injection, 1 vial 3 3 2
MP 11487N INFLIXIMABinfliximab 100 mg injection, 1 vial 1 1 0
MP 11488P INFLIXIMABinfliximab 100 mg injection, 1 vial 5 5 3
MP 11489Q INFLIXIMABinfliximab 100 mg injection, 1 vial 1 1 0
MP 11498E INFLIXIMABinfliximab 100 mg injection, 1 vial 1 1 0
MP 11515C INFLIXIMABinfliximab 100 mg injection, 1 vial 5 5 2
MP 11590B INFLIXIMABinfliximab 100 mg injection, 1 vial 1 1 0
MP 11595G INFLIXIMABinfliximab 100 mg injection, 1 vial 5 5 2
MP 11796W INFLIXIMABinfliximab 100 mg injection, 1 vial 5 5 2
MP 11797X INFLIXIMABinfliximab 100 mg injection, 1 vial 1 1 0
MP 6397Q INFLIXIMABinfliximab 100 mg injection, 1 vial 1 1 0
MP 6448J INFLIXIMABinfliximab 100 mg injection, 1 vial 1 1 0
MP 6496X INFLIXIMABinfliximab 100 mg injection, 1 vial 1 1 0
MP 9612X INFLIXIMABinfliximab 100 mg injection, 1 vial 1 1 0
MP 9613Y INFLIXIMABinfliximab 100 mg injection, 1 vial 1 1 0
MP 9617E INFLIXIMABinfliximab 100 mg injection, 1 vial 1 1 0
MP 9674E INFLIXIMABinfliximab 100 mg injection, 1 vial 1 1 0
MP 6210W INTERFERON ALFA-2Ainterferon alfa-2a 3 million units (11.111 microgram)/0.5 mL injection, 0.5 mL syringe 30 30 5
MP 6213B INTERFERON ALFA-2Ainterferon alfa-2a 9 million units (33.333 microgram)/0.5 mL injection, 0.5 mL syringe 30 30 5
MP 6148N INTERFERON GAMMA-1Binterferon gamma-1b 2 million units (100 microgram)/0.5 mL injection, 6 x 0.5 mL vials 2 12 11
MP 10175M IVACAFTORivacaftor 150 mg tablet, 56 1 56 5
MP 11097C IVACAFTORivacaftor 50 mg granules, 56 sachets 1 56 5
MP 11109Q IVACAFTORivacaftor 75 mg granules, 56 sachets 1 56 5