Pharmaceutical Benefits Scheme (PBS)
Continuation Rules for PBS-listed drugs
For some authority-required drugs available on the PBS, patients must meet continuation criteria in order to continue treatment with the subsidised drug.
Continuation Rules for PBS-listed Drugs
When a drug is listed on the Pharmaceutical Benefits Scheme (PBS), certain restrictions or conditions may apply to ensure that the product is subsidised in situations where treatment has been proved to be both medically effective and cost-effective. This is especially the case with high-cost drugs which may only be effective in specific patient groups.Access to PBS-subsidised drugs falls into three broad categories:
- unrestricted benefits – where the doctor can prescribe through the PBS without restrictions on therapeutic use;
- restricted benefits – where the doctor can prescribe through the PBS when satisfied that the patient’s clinical condition matches the approved therapeutic uses, as determined by the Pharmaceutical Benefits Advisory Committee (PBAC); and
- authority-required benefits – where the doctor can prescribe through the PBS when satisfied that the patient’s clinical condition matches the approved therapeutic restrictions, as determined by the PBAC and prior approval from Medicare Australia has been obtained.
For some authority-required drugs available on the PBS, patients must meet continuation criteria in order to continue treatment with the subsidised drug. These restrictions are a way of ensuring that PBS drugs are used in a way that represents good value for taxpayers’ money.
“Continuation” rules apply to drugs such as ENBREL and REMICADE, which are used in the treatment of conditions such as rheumatoid arthritis; ARICEPT and REMINYL, which are used to treat Alzheimer’s disease; GLIVEC, for the treatment of chronic myeloid leukaemia; and other drugs.
