Eye programs restriction and item codes
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PBS CNV restriction and item codes
PBS DMO PDR and RVO restriction and item codes
Contact details
PBS Complex Drugs Programs
Forms
Subfoveal choroidal neovascularisation - initial authority application form (PB072)
Retinal vein occlusion - initial authority application (PB154)
Services Australia website
Eye - subfoveal choroidal neovascularisation
Eye - proliferative diabetic retinopathy and/or diabetic macular oedema
Eye - retinal vein occlusion
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 with a strength of 4 mg/0.1 mL, 3.6 mg/0.09 mL, or 40 mg/mL vial or syringe | 2 mg/0.05 mL vial or syringe, approve under correct item code |
Aflibercept (Eylea) with a strength of 30.1 mg/0.263 mL, 21mg/0.184mL or 114.3 mg/mL vial or syringe | 8 mg/0.07 mL vial or syringe, 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) with a strength of 28.8 mg/0.24 mL, 21 mg/0.175 mL or 120 mg/mL vial or syringe | 6 mg/0.05 mL vial or 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. Both authority requests must be keyed into OPA. |
3 | What is the process if an initial prescription is received without an application form? - CNV or RVO: reject any initial prescriptions if no application form is included
- DMO or PDR: there is no application form for these indications. Initial treatment is obtained by telephone or 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
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4 | Does a prescriber need to send in a second initial request for the second eye? Yes, process the application. Staff do not need to review the patient's history. |
5 | 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. |
6 | 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'. |
7 | Do patient comments need to be checked? No. Patient comments no longer need to be checked. |
8 | Prescriber only stated they want the Aflibercept 2 mg/0.05 mL syringe. Which item do I select? Check NDRD. If the items are bioequivalent, staff can select either Afqlir® or Eylea® 2 mg/0.05 mL syringe. |
FAQs for Eye Program conditions and abbreviations
Table 3
Item | Description |
1 | Can 'diabetic retinopathy' be accepted as DMO? No. This is a different condition from DMO. |
2 | 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. |
3 | Can 'pseudophakic' on an application for dexamethasone/Ozurdex®, for having had cataract surgery be accepted? Yes. Pseudophakic means the patient has had cataract surgery. |
4 | An authority request states the following abbreviations. What do the abbreviations mean?- OU (oculus uterque) or BE is both (bilateral) eyes
- OS (oculus sinister) is left eye
- OD (oculus dextrus) is right eye
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