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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 11920J TACROLIMUStacrolimus 3 mg modified release capsule, 50 2 100 3
MP 9682N TACROLIMUStacrolimus 1 mg modified release capsule, 60 2 120 5
MP 9681M TACROLIMUStacrolimus 500 microgram modified release capsule, 30 2 60 5
MP 10875J TACROLIMUStacrolimus 750 microgram capsule, 100 2 200 5
MP 6216E TACROLIMUStacrolimus 1 mg capsule, 100 2 200 5
MP 6217F TACROLIMUStacrolimus 5 mg capsule, 50 2 100 5
MP 6328C TACROLIMUStacrolimus 500 microgram capsule, 100 2 200 5
MP 10879N TACROLIMUStacrolimus 2 mg capsule, 100 2 200 5
MP 9683P TACROLIMUStacrolimus 5 mg modified release capsule, 30 2 60 5
MP 12150L TADALAFILtadalafil 20 mg tablet, 56 1 56 5
MP 1304P TADALAFILtadalafil 20 mg tablet, 56 1 56 5
MP 11795T TEDUGLUTIDEteduglutide 5 mg injection [28 vials] (&) inert substance diluent [28 x 0.5 mL syringes], 1 pack 1 28 11
MP 11806J TEDUGLUTIDEteduglutide 5 mg injection [28 vials] (&) inert substance diluent [28 x 0.5 mL syringes], 1 pack 1 28 5
MP 11812Q TEDUGLUTIDEteduglutide 5 mg injection [28 vials] (&) inert substance diluent [28 x 0.5 mL syringes], 1 pack 1 28 0
MP 11833T TEZACAFTOR + IVACAFTOR (&) IVACAFTORtezacaftor 100 mg + ivacaftor 150 mg tablet [28] (&) ivacaftor 150 mg tablet [28], 56 1 1 5
MP 11834W TEZACAFTOR + IVACAFTOR (&) IVACAFTORtezacaftor 100 mg + ivacaftor 150 mg tablet [28] (&) ivacaftor 150 mg tablet [28], 56 1 1 5
MP 6469L THALIDOMIDEthalidomide 50 mg capsule, 28 4 112 0
MP 9684Q THALIDOMIDEthalidomide 100 mg capsule, 28 2 56 0
MP 10068X TOCILIZUMABtocilizumab 80 mg/4 mL injection, 4 mL vial 1 1 0
MP 10073E TOCILIZUMABtocilizumab 80 mg/4 mL injection, 4 mL vial 1 1 0
MP 1419Q TOCILIZUMABtocilizumab 80 mg/4 mL injection, 4 mL vial 1 1 0
MP 9671B TOCILIZUMABtocilizumab 80 mg/4 mL injection, 4 mL vial 1 1 0
MP 10071C TOCILIZUMABtocilizumab 200 mg/10 mL injection, 10 mL vial 1 1 0
MP 10079L TOCILIZUMABtocilizumab 200 mg/10 mL injection, 10 mL vial 1 1 0
MP 1423X TOCILIZUMABtocilizumab 200 mg/10 mL injection, 10 mL vial 1 1 0
MP 9672C TOCILIZUMABtocilizumab 200 mg/10 mL injection, 10 mL vial 1 1 0
MP 10060L TOCILIZUMABtocilizumab 400 mg/20 mL injection, 20 mL vial 1 1 0
MP 10078K TOCILIZUMABtocilizumab 400 mg/20 mL injection, 20 mL vial 1 1 0
MP 1464C TOCILIZUMABtocilizumab 400 mg/20 mL injection, 20 mL vial 1 1 0
MP 9673D TOCILIZUMABtocilizumab 400 mg/20 mL injection, 20 mL vial 1 1 0