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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 6332G LANREOTIDElanreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL ampoule], 1 pack 2 2 11
MP 11527Q LANREOTIDElanreotide 120 mg/0.5 mL injection, 0.5 mL syringe 2 2 5
MP 6425E LANREOTIDElanreotide 120 mg/0.5 mL injection, 0.5 mL syringe 2 2 5
MP 6423C LANREOTIDElanreotide 60 mg/0.5 mL injection, 0.5 mL syringe 2 2 5
MP 6424D LANREOTIDElanreotide 90 mg/0.5 mL injection, 0.5 mL syringe 2 2 5
MP 9636E LANTHANUMlanthanum 750 mg chewable tablet, 6 x 15 2 180 5
MP 9635D LANTHANUMlanthanum 500 mg chewable tablet, 2 x 45 2 180 5
MP 9637F LANTHANUMlanthanum 1 g chewable tablet, 6 x 15 2 180 5
MPNP 10653Q LEDIPASVIR + SOFOSBUVIRledipasvir 90 mg + sofosbuvir 400 mg tablet, 28 1 28 1
MPNP 10672Q LEDIPASVIR + SOFOSBUVIRledipasvir 90 mg + sofosbuvir 400 mg tablet, 28 1 28 2
MPNP 10679C LEDIPASVIR + SOFOSBUVIRledipasvir 90 mg + sofosbuvir 400 mg tablet, 28 1 28 5
MP 12018M LENALIDOMIDElenalidomide 25 mg capsule, 14 1 14 3
MP 11042E LENALIDOMIDElenalidomide 15 mg capsule, 21 1 21 0
MP 12011E LENALIDOMIDElenalidomide 15 mg capsule, 21 1 21 1
MP 12020P LENALIDOMIDElenalidomide 15 mg capsule, 21 1 21 3
MP 9644N LENALIDOMIDElenalidomide 15 mg capsule, 21 1 21 0
MP 11036W LENALIDOMIDElenalidomide 5 mg capsule, 21 1 21 0
MP 12038N LENALIDOMIDElenalidomide 5 mg capsule, 21 1 21 1
MP 12071H LENALIDOMIDElenalidomide 5 mg capsule, 21 1 21 3
MP 2798G LENALIDOMIDElenalidomide 5 mg capsule, 21 1 21 3
MP 9642L LENALIDOMIDElenalidomide 5 mg capsule, 21 1 21 0
MP 12069F LENALIDOMIDElenalidomide 15 mg capsule, 14 1 14 3
MP 11969Y LENALIDOMIDElenalidomide 10 mg capsule, 28 1 28 2
MP 11965R LENALIDOMIDElenalidomide 15 mg capsule, 28 1 28 2
MP 12058P LENALIDOMIDElenalidomide 5 mg capsule, 14 1 14 3
MP 11966T LENALIDOMIDElenalidomide 5 mg capsule, 28 1 28 2
MP 12004T LENALIDOMIDElenalidomide 10 mg capsule, 14 1 14 3
MP 11063G LENALIDOMIDElenalidomide 10 mg capsule, 21 1 21 0
MP 12050F LENALIDOMIDElenalidomide 10 mg capsule, 21 1 21 1
MP 12060R LENALIDOMIDElenalidomide 10 mg capsule, 21 1 21 3
MP 2796E LENALIDOMIDElenalidomide 10 mg capsule, 21 1 21 3
MP 9643M LENALIDOMIDElenalidomide 10 mg capsule, 21 1 21 0
MP 11055W LENALIDOMIDElenalidomide 25 mg capsule, 21 1 21 0
MP 12037M LENALIDOMIDElenalidomide 25 mg capsule, 21 1 21 1
MP 12068E LENALIDOMIDElenalidomide 25 mg capsule, 21 1 21 3
MP 9645P LENALIDOMIDElenalidomide 25 mg capsule, 21 1 21 0
MP 11517E LENOGRASTIMlenograstim 13.4 million units (105 microgram) injection, 1 vial 2 20 11
MP 11530W LENOGRASTIMlenograstim 33.6 million units (263 microgram) injection, 1 vial 2 20 11
MP 11910W LEVODOPA + CARBIDOPAlevodopa 20 mg/mL + carbidopa monohydrate 5 mg/mL intestinal gel, 7 x 100 mL 4 28 5
MP 9744W LEVODOPA + CARBIDOPAlevodopa 20 mg/mL + carbidopa monohydrate 5 mg/mL intestinal gel, 7 x 100 mL 8 56 5
MP 10931H LIPEGFILGRASTIMlipegfilgrastim 6 mg/0.6 mL injection, 0.6 mL syringe 1 1 11
MP 11841F LUMACAFTOR + IVACAFTORlumacaftor 100 mg + ivacaftor 125 mg granules, 56 sachets 1 56 5
MP 11464J LUMACAFTOR + IVACAFTORlumacaftor 100 mg + ivacaftor 125 mg tablet, 112 1 112 5
MP 11848N LUMACAFTOR + IVACAFTORlumacaftor 150 mg + ivacaftor 188 mg granules, 56 sachets 1 56 5
MP 11463H LUMACAFTOR + IVACAFTORlumacaftor 200 mg + ivacaftor 125 mg tablet, 112 1 112 5