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

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JIA and sJIA restriction and item codes

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Contact details

PBS Complex Drugs Programs

Forms

Juvenile idiopathic arthritis - for adult patients with onset prior to age 18 - initial authority application (PB062)

Juvenile idiopathic arthritis - for adult patients with onset prior to age 18 - continuing authority application (PB063)

Juvenile idiopathic arthritis - for adult patients with onset prior to age 18 - change or recommencement authority application (PB282)

Juvenile idiopathic arthritis - change of treatment after resolution of critical shortage of tocilizumab authority application (PB323)

Services Australia website

Juvenile idiopathic arthritis

Systemic juvenile idiopathic arthritis

External websites

PBS schedule for juvenile arthropathies (JIA) <18

PBS schedule for juvenile arthropathies (JIA) >18

PBS schedule for systemic juvenile arthropathies (sJIA)

FAQs from Service Officers

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

Item

Description

1

What’s the difference between JIA>18 and JIA<18?

  • JIA>18 refers to a patient starting PBS treatment as an adult (>18 years) but was diagnosed with JIA as a child, with joint count and blood markers (ESR and/or CRP) as baseline. With the exception of balance of supply and subsequent continuing for biosimilars, applications for all treatment phases must be made:
    • in writing, or
    • using the Online PBS Authorities system
  • JIA<18 refers to a patient starting PBS treatment as a child (<18 years). Joint count is the only baseline for these patients. No written applications are required. Initial, change or recommencement of treatment can be requested in real time using the Online PBS Authorities (OPA) system or by phone, and the continuing treatment is streamlined

2

What are the similarities and the differences between JIA and rheumatoid arthritis (RA)?

  • JIA>18 patients are adults, but they were diagnosed with JIA as a child
  • RA patients are adults with the diagnosis of RA as an adult
  • Initial criteria is the same for JIA>18 and RA with joint count and blood markers as baseline
  • JIA patients who turn 18 years can continue on the JIA<18 program until they are reclassified as RA adult where there are far more biological medicines to choose from. The <18 and >18 refers to when PBS treatment started
  • JIA>18 patients can also continue on the JIA>18 program until the prescriber wishes to reclassify as RA adult

3

Can a patient change from JIA or sJIA to the adult RA program?

  • Yes, prescribers can submit a change application to transition patient from sJIA or JIA to RA after they turn 18 for a different drug or the same medication
  • Only the initial quantity and repeats can be requested even if the patient has been on the same medication under the JIA or sJIA program
  • OPA will reject these requests as it is not able to recognise prior JIA or sJIA treatment
  • Providing this is the only rejection reason, staff should perform a history check and override if there have been any previous approvals under the JIA or sJIA program