Document ID: chunk:federal_register_of_legislation:F2025C00158:clause:4_1:p97
Version: federal_register_of_legislation:F2025C00158
Segment Type: clause
Provision Reference: sch 4 cl 1 (pt 97/161)
Character Range: 14317108–14323213

the early treatment diabetic retinopathy study chart administered at a distance of 4 metres (approximate Snellen equivalent 20/32 to 20/160), in the eye proposed for treatment; AND
                                                                                   The condition must be diagnosed by optical coherence tomography; or
                                                                                   The condition must be diagnosed by fluorescein angiography; AND
                                                                                   The treatment must be as monotherapy; or
                                                                                   The treatment must be in combination with laser photocoagulation; AND
                                                                                   The treatment must be the sole PBS-subsidised therapy for this condition.
                                                                                   Authority approval for initial treatment of each eye must be sought.
                                                                                   The first authority application for each eye must be made via the Online PBS Authorities System (real time assessment) or in writing via HPOS form upload or mail and must include
                                                                                   (1) Details (date, unique identifying number/code or provider number) of the optical coherence tomography or fluorescein angiogram report.
                                                                                   (a) A completed authority prescription form; and
                                                                                   (b) A completed authority application form relevant to the indication and treatment phase (the latest version is located on the website specified in the Administrative Advice).
                                                                                   If the application is submitted through HPOS form upload or mail, it must include
                                                                                   (a) A completed authority prescription form; and
                                                                                   (b) A completed authority application form relevant to the indication and treatment phase (the latest version is located on the website specified in the Administrative Advice).
                                                                                   All reports must be documented in the patient's medical records.
C13390              P13390         CN13390          Aflibercept                    Central retinal vein occlusion with macular oedema                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Compliance with Written Authority Required procedures
                                                                                   Initial treatment
                                                    Ranibizumab                    Must be treated by an ophthalmologist or by an accredited ophthalmology registrar in consultation with an ophthalmologist; AND
                                                                                   Patient must have visual impairment due to macular oedema secondary to central retinal vein occlusion (CRVO); AND
                                                                                   Patient must have documented visual impairment defined as a best corrected visual acuity score between 73 and 24 letters based on the early treatment diabetic retinopathy study chart administered at a distance of 4 metres (approximate Snellen equivalent 20/40 to 20/320), in the eye proposed for treatment; AND
                                                                                   The condition must be diagnosed by optical coherence tomography; or
                                                                                   The condition must be diagnosed by fluorescein angiography; AND
                                                                                   The treatment must be the sole PBS-subsidised therapy for this condition.
                                                                                   Authority approval for initial treatment of each eye must be sought.
                                                                                   The first authority application for each eye must be made via the Online PBS Authorities System (real time assessment) or in writing via HPOS form upload or mail and must include
                                                                                   (1) Details (date, unique identifying number/code or provider number) of the optical coherence tomography or fluorescein angiogram report.
                                                                                   (a) A completed authority prescription form; and
                                                                                   (b) A completed authority application form relevant to the indication and treatment phase (the latest version is located on the website specified in the Administrative Advice).