Breast cancer Programs in Pharmaceutical Benefits Scheme (PBS) 012-18051106

Breast cancer 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 Breast cancer restriction and item codes

Contact details

PBS Complex Drugs Programs

Forms

Early HER2 positive breast cancer - trastuzumab emtansine - initial authority application (PB289)

Metastatic HER2 positive breast cancer - lapatinib - initial authority application (PB099)

Services Australia website

Breast cancer

External websites

PBS schedule for:

FAQs from Service Officers

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

Item	Description
1	Is trastuzumab emtansine commonly referred to by an abbreviation? Yes. The common abbreviation is T-DM1. Prescribers may write this on the authority request.
2	Is trastuzumab deruxtecan commonly referred to by an abbreviation? Yes. The common abbreviation is T-DXd. Prescribers may write this on the authority request.
3	What is the maximum amount of PBS treatment that can be approved for trastuzumab emtansine (TDM-1) for early HER2 positive breast cancer? Treatment must not exceed 42 weeks (14 cycles) under the initial and continuing treatment restrictions combined. This consists of one initial and one continuing PBS approval (6 repeats on each script). If there are dose changes, lost scripts, or insufficient repeats, another approval may be required and overridden in OPA, provided the total PBS treatment does not exceed 14 cycles. Escalate to a PA for help, if needed.
4	Is a new prescription required for Efficient Funding of Chemotherapy (EFC) items (weight based) if there is a dose change? If the dose change (increase or decrease) is more than 10%, a new prescription is required.
5	Can a prescriber request a reload with pertuzumab if there has been a break in therapy? No. Current PBS restrictions do not allow for a reload with pertuzumab. Escalate any queries regarding reloading to a PA.
6	Can patients change between PBS listed medications for metastatic breast cancer? There are no specific change restrictions. However, patients may switch agents provided all initial PBS criteria are met at the time of application.