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Juvenile arthropathies (JIA and sJIA) Program in Pharmaceutical Benefits Scheme (PBS) 012-18051123

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This document outlines details of PBS-subsidised biological medicines for patients with juvenile arthropathies (JIA and sJIA).

For information on how to process a PBS Authority, see Processing Complex Authority Required Listings.

On this page:

Juvenile idiopathic arthritis (JIA) <18 years quick reference

Juvenile idiopathic arthritis (JIA) >18 years quick reference

Systemic juvenile idiopathic arthritis (sJIA) quick reference

Delayed assessment

Juvenile idiopathic arthritis (JIA) <18 years quick reference

Table 1

Restrictions

Authority level and section

PA assessment

Processing system

Prescriber type

Prescriber self-serve

Initial

Telephone

Electronic

S85:

tocilizumab s.c.

tofacitinib

S100:

adalimumab

etanercept

tocilizumab i.v.

No

OPA

Must be treated by a:

  • paediatric rheumatologist, or under the supervision of paediatric rheumatology treatment centre

Yes

Continuing

Streamlined

S85:

tocilizumab s.c.

tofacitinib

S100:

adalimumab

etanercept

tocilizumab i.v.

(Telephone for increased quantities of tocilizumab i.v. if required – check dosage calculator)

No

N/A

Must be treated by a:

  • rheumatologist, or under the supervision of paediatric rheumatology treatment centre

 

N/A

Change

or

recommencement

Telephone

Electronic

S85:

tocilizumab s.c.

tofacitinib

S100:

adalimumab

etanercept

tocilizumab i.v.

No

OPA

Must be treated by a:

  • paediatric rheumatologist, or under the supervision of paediatric rheumatology treatment centre

 

Yes

Balance of supply:

for initial only

Telephone

Electronic

S85:

tocilizumab s.c.

tofacitinib

S100:

adalimumab

etanercept

tocilizumab i.v.

No

OPA

Must be treated by a:

  • paediatric rheumatologist, or under the supervision of paediatric rheumatology treatment centre

 

Yes

Juvenile idiopathic arthritis (JIA) >18 years quick reference

Table 2

Restrictions

Authority level and section

PA assessment

Processing system

Prescriber type

Prescriber self-serve

Initial

PB062 form

Written

Electronic

S85:

adalimumab

etanercept

tocilizumab s.c.

S100:

tocilizumab i.v.

No

OPA

Must be treated by a:

  • rheumatologist
  • clinical immunologist with expertise in the management of rheumatoid arthritis

Yes – immediate or delayed assessment (delayed if any free text option used)

First Continuing

PB063 form

Written

Electronic

S85:

adalimumab

etanercept

tocilizumab s.c.

S100:

tocilizumab i.v.

No

OPA

Must be treated by a:

  • rheumatologist
  • clinical immunologist with expertise in the management of rheumatoid arthritis

Yes

Subsequent continuing

PB063 form

Written

Electronic

S85:

adalimumab

etanercept

tocilizumab s.c.

S100:

tocilizumab i.v.

No

OPA

Must be treated by a:

  • rheumatologist
  • clinical immunologist with expertise in the management of rheumatoid arthritis

Yes

Subsequent continuing:

biosimilar

Streamlined

S85:

adalimumab

No

N/A

Must be treated by a:

  • rheumatologist
  • clinical immunologist with expertise in the management of rheumatoid arthritis

N/A

Change

or

recommencement

PB282 form

Written

Electronic

S85:

adalimumab

etanercept

tocilizumab s.c.

S100:

tocilizumab i.v.

No

OPA

Must be treated by a:

  • rheumatologist
  • clinical immunologist with expertise in the management of rheumatoid arthritis

Yes – immediate or delayed assessment (delayed if any free text option used)

Balance of supply

Telephone

Electronic

S85:

adalimumab

etanercept

tocilizumab s.c.

S100:

tocilizumab i.v.

No

OPA

Must be treated by a:

  • rheumatologist
  • clinical immunologist with expertise in the management of rheumatoid arthritis

Yes

Systemic juvenile idiopathic arthritis (sJIA) quick reference

Table 3

Restrictions

Authority level and section

PA assessment

Processing system

Prescriber type

Prescriber self-serve

Initial

Telephone

Electronic

S85:

tocilizumab s.c.

S100:

tocilizumab i.v.

No

OPA

Must be treated by a:

  • rheumatologist, or under the supervision of paediatric rheumatology treatment centre

 

Yes

Continuing

Streamlined

S85:

tocilizumab s.c.

S100:

tocilizumab i.v.

(Telephone for increased quantities of tocilizumab i.v. if required – check dosage calculator)

No

N/A

Must be treated by a:

  • rheumatologist, or under the supervision of paediatric rheumatology treatment centre

 

N/A

Recommencement

Telephone

Electronic

S85:

tocilizumab s.c.

S100:

tocilizumab i.v.

No

OPA

Must be treated by a:

  • rheumatologist, or under the supervision of paediatric rheumatology treatment centre

 

Yes

Balance of supply:

for initial only

Telephone

Electronic

S85:

tocilizumab s.c.

S100:

tocilizumab i.v.

No

OPA

Must be treated by a:

  • rheumatologist, or under the supervision of paediatric rheumatology treatment centre

Yes

Delayed assessment

Delayed assessment due to contraindication and/or intolerance to prior DMARD therapy or reason for bloods not being elevated (JIA >18).

Table 4: this table lists the details of what to check for the delayed assessment and common acronyms.

Service Officers to assess free text is:

Example

Outcome

Relevant to the question
  • Hypersensitivity to any components of the formulation
  • Gastrointestinal adverse reactions

Approve

Random text
  • Happy Birthday
  • Patient did not want to take
  • Ikasditbn

Reject

Non-descriptive
  • Toxicity

Reject

If the text is for:

Example

Outcome

Bloods not elevated
  • Treatment with prednisolone dosed at 7.5 mg or higher daily (or equivalent)
  • Steroid injection in the past month

Approve

Common acronyms

  • LFT - Liver function tests
  • GI toxicity - Gastrointestinal
  • N+V - Nausea and vomiting

Escalate to a Pharmaceutical Adviser (PA) by phone if unsure of acronym used.