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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
Prescriber code Item code Name, manner of administration and form & strength Max qty
packs
Max qty
units
No. of
repeats
MP 6289B PAMIDRONATE DISODIUMpamidronate disodium 90 mg/10 mL injection, 10 mL vial 1 1 11
MP 6286W PAMIDRONATE DISODIUMpamidronate disodium 15 mg/5 mL injection, 5 mL vial 4 4 2
MP 6288Y PAMIDRONATE DISODIUMpamidronate disodium 60 mg/10 mL injection, 10 mL vial 1 1 2
MP 6287X PAMIDRONATE DISODIUMpamidronate disodium 30 mg/10 mL injection, 10 mL vial 2 2 2
MP 10887B PASIREOTIDEpasireotide 60 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack 2 2 5
MP 10884W PASIREOTIDEpasireotide 40 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack 2 2 5
MP 10880P PASIREOTIDEpasireotide 20 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack 2 2 5
MP 6363X PEGFILGRASTIMpegfilgrastim 6 mg/0.6 mL injection, 0.6 mL syringe 1 1 11
MPNP 6439X PEGINTERFERON ALFA-2Apeginterferon alfa-2a 135 microgram/0.5 mL injection, 4 x 0.5 mL syringes 2 8 5
MPNP 6449K PEGINTERFERON ALFA-2Apeginterferon alfa-2a 180 microgram/0.5 mL injection, 4 x 0.5 mL syringes 2 8 5
MP 11167R PEGVISOMANTpegvisomant 10 mg injection [30 vials] (&) inert substance diluent [30 syringes], 1 pack 1 1 5
MP 11172B PEGVISOMANTpegvisomant 15 mg injection [30 vials] (&) inert substance diluent [30 syringes], 1 pack 1 1 5
MP 11174D PEGVISOMANTpegvisomant 20 mg injection [30 vials] (&) inert substance diluent [30 syringes], 1 pack 1 1 5
MP 11166Q PEGVISOMANTpegvisomant 20 mg injection [1 vial] (&) inert substance diluent [1 syringe], 1 pack 4 4 0
MP 10084R PLERIXAFORplerixafor 24 mg/1.2 mL injection, 1.2 mL vial 1 1 1
MP 10386P POMALIDOMIDEpomalidomide 4 mg capsule, 21 1 21 0
MP 10417G POMALIDOMIDEpomalidomide 3 mg capsule, 21 1 21 0