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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 12251T SELEXIPAGselexipag 1.4 mg tablet, 60 1 60 5
MP 12242H SELEXIPAGselexipag 200 microgram tablet, 60 1 60 5
MP 12260G SELEXIPAGselexipag 400 microgram tablet, 60 1 60 5
MP 12246M SELEXIPAGselexipag 800 microgram tablet, 60 1 60 5
MP 12253X SELEXIPAGselexipag 800 microgram tablet, 60 1 60 3
MP 12241G SELEXIPAGselexipag 200 microgram tablet, 140 1 140 2
MP 12257D SELEXIPAGselexipag 1.2 mg tablet, 60 1 60 5
MP 12264L SELEXIPAGselexipag 1.6 mg tablet, 60 1 60 5
MP 12248P SELEXIPAGselexipag 600 microgram tablet, 60 1 60 5
MP 12245L SELEXIPAGselexipag 1 mg tablet, 60 1 60 5
MP 9620H SEVELAMERsevelamer hydrochloride 800 mg tablet, 180 2 360 5
MP 11838C SEVELAMERsevelamer carbonate 800 mg tablet, 180 2 360 5
MP 12138W SILDENAFILsildenafil 20 mg tablet, 90 1 90 5
MP 9605M SILDENAFILsildenafil 20 mg tablet, 90 1 90 5
MP 6436R SIROLIMUSsirolimus 1 mg tablet, 100 2 200 5
MP 6457W SIROLIMUSsirolimus 2 mg tablet, 100 2 200 5
MP 6437T SIROLIMUSsirolimus 1 mg/mL oral liquid, 60 mL 2 2 5
MP 9748C SIROLIMUSsirolimus 500 microgram tablet, 100 2 200 5
MPNP 11144M SOFOSBUVIR + VELPATASVIRsofosbuvir 400 mg + velpatasvir 100 mg tablet, 28 1 28 2
MPNP 11659P SOFOSBUVIR + VELPATASVIR + VOXILAPREVIRsofosbuvir 400 mg + velpatasvir 100 mg + voxilaprevir 100 mg tablet, 28 1 28 2
MP 10230K SUCROFERRIC OXYHYDROXIDEsucroferric oxyhydroxide 2.5 g (iron 500 mg) chewable tablet, 90 2 180 5