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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
MPNP 10637W RIBAVIRINribavirin 600 mg tablet, 28 1 28 5
MPNP 10675W RIBAVIRINribavirin 600 mg tablet, 28 1 28 2
MPNP 10623D RIBAVIRINribavirin 400 mg tablet, 28 1 28 2
MPNP 10635R RIBAVIRINribavirin 400 mg tablet, 28 1 28 5
MPNP 6195C RIFABUTINrifabutin 150 mg capsule, 30 4 120 5
MP 11010L RIOCIGUATriociguat 1 mg tablet, 84 1 84 0
MP 11060D RIOCIGUATriociguat 1 mg tablet, 84 1 84 5
MP 11017W RIOCIGUATriociguat 2 mg tablet, 84 1 84 0
MP 11030M RIOCIGUATriociguat 2 mg tablet, 84 1 84 5
MP 10975P RIOCIGUATriociguat 1.5 mg tablet, 84 1 84 0
MP 11061E RIOCIGUATriociguat 1.5 mg tablet, 84 1 84 5
MP 11009K RIOCIGUATriociguat 500 microgram tablet, 42 1 42 0
MP 11031N RIOCIGUATriociguat 500 microgram tablet, 42 1 42 0
MP 11008J RIOCIGUATriociguat 500 microgram tablet, 84 1 84 0
MP 11058B RIOCIGUATriociguat 500 microgram tablet, 84 1 84 5
MP 10990K RIOCIGUATriociguat 1 mg tablet, 42 1 42 0
MP 11028K RIOCIGUATriociguat 1 mg tablet, 42 1 42 0
MP 10985E RIOCIGUATriociguat 2.5 mg tablet, 42 1 42 0
MP 11052Q RIOCIGUATriociguat 2.5 mg tablet, 42 1 42 0
MP 11012N RIOCIGUATriociguat 2 mg tablet, 42 1 42 0
MP 11045H RIOCIGUATriociguat 2 mg tablet, 42 1 42 0
MP 11018X RIOCIGUATriociguat 2.5 mg tablet, 84 1 84 0
MP 11035T RIOCIGUATriociguat 2.5 mg tablet, 84 1 84 5
MP 10974N RIOCIGUATriociguat 1.5 mg tablet, 42 1 42 0
MP 11046J RIOCIGUATriociguat 1.5 mg tablet, 42 1 42 0
MP 10583B RITUXIMABrituximab 100 mg/10 mL injection, 2 x 10 mL vials 1 2 0
MP 11810N RITUXIMABrituximab 100 mg/10 mL injection, 2 x 10 mL vials 3 6 0
MP 10576P RITUXIMABrituximab 500 mg/50 mL injection, 50 mL vial 1 1 0
MP 11790M RITUXIMABrituximab 500 mg/50 mL injection, 50 mL vial 2 2 1
MP 11804G RITUXIMABrituximab 500 mg/50 mL injection, 50 mL vial 4 4 0
MP 9611W RITUXIMABrituximab 500 mg/50 mL injection, 50 mL vial 1 1 0
MP 9699L ROMIPLOSTIMromiplostim 500 microgram injection, 1 vial 1 1 0
MP 9697J ROMIPLOSTIMromiplostim 250 microgram injection, 1 vial 1 1 0