Listing of Pharmaceutical Benefits (NHL) - Schedule 4 part 1

Proliferative diabetic retinopathy (PDR) and/or Diabetic macular oedema (DMO)

Initial treatment

Patient must have documented visual impairment defined as a best corrected visual acuity score between 78 and 39 letters based on the early treatment diabetic retinopathy study chart administered at a distance of 4 metres (approximate Snellen equivalent 20/32 to 20/160), in the eye proposed for treatment. This is only a requirement for patients being treated for DMO; AND

The condition must be diagnosed by an ophthalmologist or by an accredited ophthalmology registrar in consultation with an ophthalmologist; AND

The condition must be diagnosed by optical coherence tomography; or

The condition must be diagnosed by fluorescein angiography; or

The condition must be diagnosed by retinal photography; AND

The treatment must be the sole PBS-subsidised therapy for this condition; AND

The treatment must be as monotherapy; or

The treatment must be in combination with laser photocoagulation; AND

Patient must not have previously received PBS-subsidised treatment with this drug for this indication for the same eye; AND

Must be treated by an ophthalmologist or by an accredited ophthalmology registrar in consultation with an ophthalmologist.

Authority approval for initial treatment of each eye must be sought.

Details (date, unique identifying number/code or provider number) of one of the following diagnostic reports for each eye must be documented in the patient's medical records:

(i) fluorescein angiogram report;

(ii) optical coherence tomography report;

(iii) retinal photography report.