Use this form to apply for initial grandfathered PBS-subsidised treatment with etrasimod for patients with moderate to severe ulcerative colitis.
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.
Download and the complete the ulcerative colitis - etrasimod - initial grandfather authority application form.
This information was printed 3 January 2025 from https://www.servicesaustralia.gov.au/pb376. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/site-notices when using this material.