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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 11237K OCRELIZUMABocrelizumab 300 mg/10 mL injection, 10 mL vial 2 2 0
MP 6227R OCTREOTIDEoctreotide 50 microgram/mL injection, 5 x 1 mL ampoules 18 90 11
MP 6229W OCTREOTIDEoctreotide 500 microgram/mL injection, 5 x 1 mL ampoules 18 90 11
MP 10549F OCTREOTIDEoctreotide 20 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack 2 2 5
MP 10566D OCTREOTIDEoctreotide 10 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack 2 2 5
MP 10558Q OCTREOTIDEoctreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack 2 2 5
MP 11894B OCTREOTIDEoctreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack 2 2 5
MP 6228T OCTREOTIDEoctreotide 100 microgram/mL injection, 5 x 1 mL ampoules 18 90 11
MP 10122R OMALIZUMABomalizumab 150 mg/mL injection, 1 mL syringe 1 1 7
MP 10968G OMALIZUMABomalizumab 150 mg/mL injection, 1 mL syringe 1 1 6
MP 11163M OMALIZUMABomalizumab 150 mg/mL injection, 1 mL syringe 2 2 5
MP 11175E OMALIZUMABomalizumab 150 mg/mL injection, 1 mL syringe 2 2 2
MP 11825J OMALIZUMABomalizumab 150 mg/mL injection, 1 mL syringe 1 1 0
MP 11864K OMALIZUMABomalizumab 150 mg/mL injection, 1 mL syringe 1 1 5
MP 11932B OMALIZUMABomalizumab 150 mg/mL injection, 1 mL syringe 1 1 0
MP 11953D OMALIZUMABomalizumab 150 mg/mL injection, 1 mL syringe 1 1 5
MP 10110D OMALIZUMABomalizumab 75 mg/0.5 mL injection, 0.5 mL syringe 1 1 7
MP 10956P OMALIZUMABomalizumab 75 mg/0.5 mL injection, 0.5 mL syringe 1 1 6
MP 11826K OMALIZUMABomalizumab 75 mg/0.5 mL injection, 0.5 mL syringe 1 1 0
MP 11840E OMALIZUMABomalizumab 75 mg/0.5 mL injection, 0.5 mL syringe 1 1 5
MP 11952C OMALIZUMABomalizumab 75 mg/0.5 mL injection, 0.5 mL syringe 1 1 5
MP 11958J OMALIZUMABomalizumab 75 mg/0.5 mL injection, 0.5 mL syringe 1 1 0