Eye (CNV DMO RVO) Programs in Pharmaceutical Benefits Scheme (PBS) 012-18032900

Eye programs restriction and item codes

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$\\INTERNAL.DEPT.LOCAL\Shared\NAT\SERDELEXCEL\WORKPRODIMP\Operation Blueprint Migration\RDT Release Icons\32w\icon-hidden-attachment.png$ PBS CNV restriction and item codes
$\\INTERNAL.DEPT.LOCAL\Shared\NAT\SERDELEXCEL\WORKPRODIMP\Operation Blueprint Migration\RDT Release Icons\32w\icon-hidden-attachment.png$ PBS DMO and RVO restriction and item codes

Contact details

PBS Complex Drugs Programs

Forms

Subfoveal choroidal neovascularisation - initial authority application (PB072)

Subfoveal choroidal neovascularisation - aflibercept - initial grandfather authority application (PB377)

Diabetic macular oedema - initial authority application (PB155)

Diabetic macular oedema - aflibercept - initial grandfather authority application (PB378)

Retinal vein occlusion - initial authority application (PB154)

Services Australia website

Subfoveal choroidal neovascularisation (CNV)

Diabetic macular oedema (DMO)

Retinal vein occlusion (RVO)

External websites

PBS schedule for Complex Eye Programs drugs

FAQs from Service Officers

In this table 'I' and 'you' refers to the Service Officers.

Table 1: see Table 2 in Processing Complex Authority Required Listings for FAQs about all Complex programs.

Item	Description
1	An application was approved yesterday, can the prescriber self-serve a continuing script today? Yes. There is no 'too soon' rule for the Eye Program.
2	Can I approve 2 prescriptions for the same drug and condition on the same day? No. Same day prescribing rule applies.
3	If I receive an authority request stating 'initial treatment' but no application form has been submitted, what do I do? Reject the application, an authority application form must be submitted for an initial authority request.
4	If an authority request states multiple conditions, what do I do? Reject as the prescriber must state the condition they are requesting authority approval for.
5	If the authority request states both eyes and the quantity is only '1', what do I do? Approve the authority request as quantity '1'. Complete OPA Q&A as 'both eyes'.
6	An authority request states the following abbreviations OU, OS or OD. How do I proceed? OU (oculus uterque) is both (bilateral) eyes OS (oculus sinister) is left eye OD (oculus dextrus) is right eye
7	If I get the same request twice in HPOS, do I need to respond? Reply to the first request. A second response is not required.
8	Can I approve increased repeats? No. Maximum repeats are on the item code sheets.
9	The prescriber has written 'diabetic retinopathy', can I accept this as DMO? No. This is a different condition from DMO.
10	The prescriber has written 'diabetic maculopathy', can I accept this as DMO? No. This can be caused by DMO. However, the prescriber must confirm that the patient has DMO.
11	I have received an authority request for aflibercept (Eylea®) with a strength of 4 mg/0.1 mL vial, what do I do? If an Authority request is written as 4 mg/0.1 mL vial, approve as 2 mg/0.05 mL vial. Make sure to approve under the correct restriction and form type.
12	I have received an authority request for aflibercept (Eylea®) with a strength of 3.6 mg/0.09 mL syringe, what do I do? If an Authority request is written as 3.6 mg/0.09 mL syringe, approve as 2 mg/0.05 mL syringe. Make sure to approve under the correct restriction and form type.
13	I have received an authority request for aflibercept (Eylea®) with a strength of 2 mg/0.05 mL and the prescriber did not specify the form type (vial or syringe), what do I do? Reject the authority request if the form type has not been specified.
14	I have received an authority request for aflibercept (Eylea®) with a strength of 30.1 mg/0.263 mL or 114.3 mg/mL, what do I do? Approve the authority request. 30.1 mg/0.263 mL or 114.3 mg/mL is also referred to as 8 mg/0.07 mL.
15	I have received an authority request for brolucizumab (Beovu®) with a strength of 120 mg/mL, what do I do? Approve the authority request.120 mg/mL is also referred to as 6 mg/0.05 mL.
16	I have received an authority request for brolucizumab (Beovu®) with a strength of 19.8 mg/0.165mL, what do I do? Approve the authority request. 19.8 mg/0.165 mL is also referred to 6 mg/0.05 mL.
17	I have received an authority request for faricimab (Vabysmo®) with a strength of 120 mg/mL, what do I do? Approve the prescription. 120 mg/mL is also referred to 6 mg/0.05 mL.
18	I have received an authority request for faricimab (Vabysmo®) with a strength of 28.8 mg/0.24 mL, what do I do? Approve the prescription. 28.8 mg/0.24 mL is also referred to 6 mg/0.05 mL.
19	Does the initial form have to include the unique identifier or provider number, and the date of report? Yes. These details need to be completed to address the Q&A.
20	The prescriber submits a request for continuing treatment for aflibercept (Eylea®) for a quantity of 1. How do I action? Return to the prescriber. Generate a rejection letter and select the ‘streamlined authority’ option.
21	The prescriber requests an approval for a quantity of 2 for ranibizumab (Lucentis®) over the phone, how do I action? Issue an approval with the prescriber. Remind the prescriber that they can self-serve electronically. Due to the increase quantity, it is not available as a streamlined item.
22	The prescriber has written 'pseudophakic' on an authority request for dexamethasone/Ozurdex®, for having had cataract surgery. Can I accept this? Yes. Pseudophakic means the patient has had cataract surgery.
23	Can I accept monotherapy to also mean sole PBS therapy? Yes. However, you cannot accept sole PBS therapy to mean monotherapy.