Eye (CNV DMO PDR RVO) Programs in Pharmaceutical Benefits Scheme (PBS) 012-18032900
Expand allEye programs restriction and item codes
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PBS CNV restriction and item codesPBS DMO PDR and RVO restriction and item codes
Details for drug items and dosing
Table 1: this table details how to approve eye program drugs written with various strength and form type.
|
Drug written as |
Approve as |
|
Aflibercept (Eylea) with a strength of 4 mg/0.1 mL vial |
2 mg/0.05 mL vial, approve under correct item code |
|
Aflibercept (Eylea) with a strength of 3.6 mg/0.09 mL syringe |
2 mg/0.05 mL syringe, approve under correct item code |
|
Aflibercept (Eylea) with a strength of 30.1 mg/0.263 mL vial or 114.3 mg/mL |
8 mg/0.07 mL vial, make sure to select the correct item code |
|
Brolucizumab (Beovu) with a strength of 120 mg/mL or 19.8 mg/0.165 mL |
6 mg/0.05 mL |
|
Faricimab (Vabysmo) syringe or vial with a strength of 120 mg/mL |
6 mg/0.05 mL syringe or vial, make sure to select the correct item code |
|
Faricimab (Vabysmo) vial with a strength of 28.8 mg/0.24 mL |
6 mg/0.05 mL vial, make sure to select the correct item code |
|
Faricimab (Vabysmo) syringe with strength of 21 mg/0.175 mL |
6 mg/0.05 mL syringe, make sure to select the correct item code |
FAQs from Service Officers processing applications
Table 2: see Table 2 in Processing Complex Authority Required Listings for FAQs about all Complex programs.
|
Item |
Description |
|
1 |
Is there a too soon rule for the eye program? No. If an initial is approved today, a continuing can be approved tomorrow. |
|
2 |
Does same day prescribing apply for the eye program? Yes, 2 prescriptions cannot be approved for the same drug and condition on the same day even if they are for different eyes. |
|
3 |
Initial prescription received without an application form. What is the process? Reject. An application form must be submitted. |
|
4 |
Do patient comments need to be checked? No. Patient comments no longer need to be checked. |
|
5 |
The prescriber has sent a second initial application. What is the process? Process the application. Online Pharmaceutical Benefits Scheme (PBS) Authorities System (OPA System) will complete the assessment. Staff do not need to review the patient's history. |
|
6 |
How to process a request to change drug (same condition) or treatment for other eye (if not previously requested) or change of condition? Changes of drug or condition require an initial application form. |
|
7 |
Can 'pseudophakic' on an application for dexamethasone/Ozurdex®, for having had cataract surgery be accepted? Yes. Pseudophakic means the patient has had cataract surgery. |
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8 |
Can 'diabetic maculopathy' be accepted as Diabetic macular oedema (DMO)? No. This can be caused by DMO. The prescriber must confirm that the patient has DMO. |
|
9 |
Can 'diabetic retinopathy' be accepted as DMO? No. This is a different condition from DMO. |
|
10 |
The authority request states both eyes and the quantity on the prescription is only '1'. What is the process? Approve the authority request as quantity '1'. Complete OPA Q&A as 'both eyes'. |
|
11 |
An authority request states the following abbreviations OU, OS or OD. What do the abbreviations mean?
|
|
12 |
Where is the application form for DMO or PDR +/- DMO located? There is no application form for these indications as initial treatment is obtained by telephone or by electronic approval. If an old application form or HPOS upload with criteria specified is provided and all Q+As can be answered, do not reject these requests. |