Juvenile arthropathies (JIA, e/s JIA and sJIA) Programs in Pharmaceutical Benefits Scheme (PBS) 012-18051123

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

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

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
Grandfather	Telephone Electronic S100: adalimumab	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

Enthesitis/spondylitis related juvenile idiopathic arthritis (e/s JIA) quick reference

Table 4

Restrictions	Authority level and section	PA assessment	Processing system	Prescriber type	Prescriber self-serve
Initial	Telephone Electronic S85: adalimumab	No	OPA	Must be treated by a: paedriatic rheumatologist, or under the supervision of paediatric rheumatology treatment centre	Yes
Grandfather	Telephone Electronic S85: adalimumab	No	OPA	Must be treated by a: paedriatic rheumatologist, or under the supervision of paediatric rheumatology treatment centre	Yes
Continuing	Streamlined S85: adalimumab	No	OPA	Must be treated by a: paedriatic rheumatologist, or under the supervision of paediatric rheumatology treatment centre	N/A
Balance of supply: for initial only	Telephone Electronic S85: adalimumab	No	OPA	Must be treated by a: paedriatic 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 5: 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.

Operational Information

Juvenile arthropathies (JIA, e/s JIA and sJIA) Programs in Pharmaceutical Benefits Scheme (PBS) 012-18051123

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