PBS updates

Lucentis (Ranibizumab)

ranibizumab 2.3 mg/0.23 mL injection, 0.23 mL vial · INJECTION · PBS code 11981N

AUTHORITY_REQUIRED

• • First listed on the PBS: 2020-05-01.
• • Repeats: 2.
• • PBS program: GE.

Eligibility criteria for subsidised access

The following is the government's own wording from the PBS Schedule, shown unchanged.

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

Branch retinal vein occlusion with macular oedema

Initial treatment

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

Patient must have visual impairment due to macular oedema secondary to branched retinal vein occlusion (BRVO); AND

Patient must have documented visual impairment defined as a best corrected visual acuity score between 73 and 20 letters based on the early treatment diabetic retinopathy study chart administered at a distance of 4 metres (approximate Snellen equivalent 20/40 to 20/400), in the eye proposed for treatment; AND

The condition must be diagnosed by optical coherence tomography; or

The condition must be diagnosed by fluorescein angiography; AND

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

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

The first authority application for each eye must be made via the Online PBS Authorities System (real time assessment) or in writing via HPOS form upload or mail and must include:

(1) Details (date, unique identifying number/code or provider number) of the optical coherence tomography or fluorescein angiogram report.

If the application is submitted through HPOS form upload or mail, it must include:

(a) details of the proposed prescription; and

(b) a completed authority application form relevant to the indication and treatment phase (the latest version is located on the website specified in the Administrative Advice).

All reports must be documented in the patient's medical records.

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

Central retinal vein occlusion with macular oedema

Initial treatment

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

Patient must have visual impairment due to macular oedema secondary to central retinal vein occlusion (CRVO); AND

Patient must have documented visual impairment defined as a best corrected visual acuity score between 73 and 24 letters based on the early treatment diabetic retinopathy study chart administered at a distance of 4 metres (approximate Snellen equivalent 20/40 to 20/320), in the eye proposed for treatment; AND

The condition must be diagnosed by optical coherence tomography; or

The condition must be diagnosed by fluorescein angiography; AND

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

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

The first authority application for each eye must be made via the Online PBS Authorities System (real time assessment) or in writing via HPOS form upload or mail and must include:

(1) Details (date, unique identifying number/code or provider number) of the optical coherence tomography or fluorescein angiogram report.

If the application is submitted through HPOS form upload or mail, it must include:

(a) details of the proposed prescription; and

(b) a completed authority application form relevant to the indication and treatment phase (the latest version is located on the website specified in the Administrative Advice).

All reports must be documented in the patient's medical records.

Not medical advice. Voxsanity republishes public PBS data in plain English. PBS listing status and criteria can change; always confirm current subsidised availability with your doctor or pharmacist.

Source: Pharmaceutical Benefits Scheme (PBS), © Commonwealth of Australia. Data used and redistributed under permission; not modified from its original wording where displayed verbatim.