Severe aplastic anaemia - eltrombopag - initial authority application form (PB362)

Use this form to apply for PBS-subsidised first-line treatment with eltrombopag for patients with severe aplastic anaemia.

You must download our forms and fill them in so they are processed quickly. You can also electronically sign some of our forms. We have help available if you use assistive technology.

You can upload this form in HPOS.

You can also use this form for initial PBS-subsidised second-line treatment with eltrombopag for patients with the same condition.

Please note: You don’t need to complete this form if you use the Online PBS Authorities system.

Download and complete the severe aplastic anaemia - eltrombopag - initial authority application form.

Page last updated: 18 June 2024.
QC 65881