Complex Authority Required Highly Specialised Drugs (CAR HSD)

Prescribing CAR HSD

All Commonwealth funded supply of CAR HSD and PBS trastuzumab (Herceptin®) requires an authority approval from Medicare Australia before dispensing. Failure to gain prior approval will result in non-payment for that medication. No retrospective approval will be permitted.

More information on authority approvals for these medicines is available on our website or by calling 1800 700 270*

• Specialised drugs (PBS) A-I
• Specialised drugs (PBS) J-Z

When applying to Medicare Australia for authority approval, public hospital medical practitioners must use a Medicare Australia authority prescription form or a form approved by Medicare Australia. If a signatory to the pharmaceutical reforms, then a public participating prescription can be used in place of these forms.

The process for submitting the appropriate CAR HSD and PBS trastuzumab application form and supporting information together with a Medicare Australia authority prescription is:

• The medical practitioner indicates on the Medicare Australia authority prescription form whether the approved prescription is to be returned to the medical practitioner or the patient.
• The medical practitioner sends the completed and signed PBS authority application supporting information, Medicare Australia authority prescription and patient declaration forms to Medicare Australia by mail.
• When approved, Medicare Australia stamps the form with a HSD approval stamp and returns the prescription to the medical practitioner or patient by mail (as indicated on the form).
• If the program has allowances for applications to be made by phone, the medical practitioner must enter the relevant approval number, as provided by the Medicare Australia service officer, on the Medicare Australia authority prescription.
• The format for phone approval numbers starts with the letter "Z" and is followed by four digits and two alphas. The approval number may be preceded by the letters "HSD". For example Z1234AB or HSDZ1234AB.

Dispensing CAR HSD

The Medicare Australia authority prescription with approval number or approval stamp, for a CAR HSD and PBS trastuzumab, can be dispensed by a public hospital pharmacy, participating public hospital or a community pharmacy.

Dispensing repeats from public hospital pharmacies

• Repeats on CAR HSD and PBS trastuzumab can be dispensed up to the maximum number which has been approved by Medicare Australia and shown on the Medicare Australia authority approval.
• Repeats are to be identified on hospital pharmacy records by the Medicare Australia authority prescription number.
• Patient contribution will be the same as for other HSD.

Payment for approved CAR HSD dispensed by public hospital pharmacies

State and territory health department claims to Medicare Australia must include the following information on the claim form.

Heading >	Month	State	Item Code	Hospital Provider Number	Medicare Australia Prescription Authority Number	Original Supply or Repeat No.	Supply Date	Packs Dispensed
Abatacept
Adalimumab
Ambrisentan
Azacitidine
Bosentan
Eltrombopag
Epoprostenol
Etanercept
Iloprost
Infliximab
Lenalidomide
Omalizumab
Rituximab
Romiplostim
Sildenafil
Tocilizumab
Trastuzumab

The Medicare Australia prescription authority number is found printed on the authority prescription or hospital prescription and is in a numeric format only.

CAR HSD and PBS trastuzumab form prescribing criteria

All CAR HSD and PBS trastuzumab require prior approval from Medicare Australia before dispensing. CAR HSD and PBS trastuzumab that are not approved or have not been approved before dispensing cannot be claimed.

For more information about the Schedule of Pharmaceutical Benefits go to www.pbs.gov.au

Download the application forms for CAR HSD and PBS trastuzumab:

• Specialised drugs (PBS) A-I
• Specialised drugs (PBS) J-Z

Last updated: 25 October, 2011

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