Interactive eligibility checker, product comparison, and PBS prescribing guide for Australian GPs
Documented intolerance to oral iron (GI side effects, nausea, constipation, abdominal pain) is a clear PBS-supported indication. Document that oral iron was trialled and not tolerated. A short trial of a different formulation (e.g. ferrous glycine sulphate, liquid iron) may be appropriate first but is not mandatory if intolerance is clear.
PBS criterion: "oral iron preparations are ineffective or cannot be used." Source: PBS Schedule March 2026.
Malabsorption syndromes (coeliac disease, inflammatory bowel disease, post-bariatric surgery, gastric bypass, short bowel syndrome) impair oral iron absorption. IV iron bypasses the gut and is the appropriate route. Document the underlying diagnosis. Coeliac disease must be treated (gluten-free diet) alongside iron replacement.
Pre-operative iron deficiency anaemia requiring rapid correction before surgery is a clear indication — "clinical need to deliver iron rapidly." IV iron raises haemoglobin faster than oral. Optimally given 2–4 weeks before surgery to allow erythropoiesis time to respond. Document the surgical date and clinical need for rapid correction.
PBS criterion: "clinical need to deliver iron rapidly." Source: PBS Schedule March 2026.
IV iron in pregnancy is appropriate when oral iron is insufficient, not tolerated, or correction is needed rapidly (e.g. 3rd trimester IDA). Ferinject is now TGA-approved in children aged ≥1 year and adults; PBS eligibility applies to adults and children ≥1 year. Avoid IV iron in the first trimester unless benefits outweigh risks — discuss with obstetric team.
Iron deficiency in CKD is common and oral iron is often poorly absorbed and tolerated. IV iron is standard of care in CKD patients on dialysis. In non-dialysis CKD, IV iron is appropriate when oral is ineffective or not tolerated. Erythropoiesis-stimulating agents (ESAs) require adequate iron stores. Usually co-managed with nephrology in CKD Stages 4–5.
Consult nephrologist for CKD Stage 4–5 or dialysis patients before initiating IV iron in GP.
In active inflammatory bowel disease, IV iron is preferred over oral — oral iron may exacerbate GI symptoms, is poorly absorbed during active inflammation, and may worsen mucosal disease. Even in remission, IV iron is appropriate if oral was not tolerated. Document disease activity status and prior oral iron trial.
Iron deficiency (defined as ferritin <100 μg/L, OR ferritin 100–299 with transferrin saturation <20%) in heart failure with reduced ejection fraction (HFrEF) — IV iron (Ferinject) has Level I evidence for improving symptoms and reducing hospitalisation (AFFIRM-AHF trial). This is a recognised indication. Discuss with cardiology for complex patients.
AFFIRM-AHF: Ponikowski P et al. Lancet. 2020. Iron deficiency definition in HF: ferritin <100 μg/L OR ferritin 100–299 + TSAT <20%.
If oral iron has not been trialled, is being tolerated, and is correcting iron stores — IV iron is not routinely indicated on patient preference alone. IV iron carries small but real risks (anaphylaxis ~1:200,000, hypophosphataemia with Ferinject) and has a cost premium over oral iron. The PBS criterion requires that oral preparations are "ineffective or cannot be used."
Ensure the patient has trialled oral iron adequately (at least 4–8 weeks) before considering IV. If ineffective, document the ferritin trajectory and establish why oral is failing.
| Feature | Ferinject (ferric carboxymaltose) | Monofer (ferric derisomaltose) |
|---|---|---|
| PBS code | 3557K | 14081B |
| PBS cost (500mg) | $54.63 PBS Mar 2026 | $122.74 PBS Mar 2026 |
| PBS cost (1000mg) | $109.25 | $245.48 |
| Max single dose | 1000mg (or 20mg/kg) — hard limit | No single-dose limit — total dose in one session |
| Infusion time | 15 min (500mg), 30 min (1000mg) | 20 min (any dose) |
| Doses >1000mg | Split doses at least 7 days apart | Single session — practical advantage |
| Hypophosphataemia risk | Higher — monitor in at-risk patients | Lower risk |
| Age range (TGA) | ≥1 year (updated 2024) | Adults only (≥18 years) |
| Preferred for | Standard GP infusion, <1000mg required, paediatric (≥1yr) | High total dose (>1000mg), convenience, bone disease |
| RACGP guidance (AJGP May 2025) | Primary agent in AJGP practical guide | Noted as alternative for high-dose GP setting |
Both products share the same PBS criterion: Treatment of iron deficiency in adults (and children ≥1 year for Ferinject) when oral iron preparations are ineffective or cannot be used, or when there is a clinical need to deliver iron rapidly. The diagnosis must be confirmed by laboratory tests.
Concession patient copay: $7.70. General patient copay: $25.00. Pharmacy dispenses from stock or orders in advance — confirm availability when booking. Source: PBS Schedule March 2026.
Ferritin, serum iron, transferrin saturation (TSAT), Hb. Document the result. PBS requires laboratory confirmation. Iron deficiency: ferritin <30 μg/L (or <100 μg/L in chronic disease/HF with TSAT <20%).
Document why oral iron is not appropriate: intolerance, malabsorption, rapid correction needed, CKD, IBD, cardiac. Record in notes — this supports the PBS authority claim.
Simplified method (most GPs): if Hb ≥10 g/dL → 1000mg. If Hb <10 g/dL → 1500mg (given as two infusions ≥7 days apart). If Hb >14 g/dL → 500mg. Use our Iron Infusion Dosing Calculator for Ganzoni method or weight-based dosing.
Write PBS authority prescription. Patient fills at pharmacy before appointment — not every pharmacy stocks IV iron. Advise patient to call ahead. Most stock within 24–48 hours.
There is currently no dedicated MBS item for IV iron administration in general practice. Bill: standard consultation item (23/36/44 based on time) + private procedure fee (typically $80–$150). The drug itself is PBS-funded. Source: MBS Book July 2026.
Ferinject: 500mg over 15 min, 1000mg over 15–30 min. Anaphylaxis kit must be on hand. Observe for at least 30 minutes after infusion. Document batch numbers and reaction status.
Recheck ferritin and Hb to confirm response. Ferritin typically rises within 2 weeks. Hb response may take 4–8 weeks. Investigate if response is inadequate (ongoing blood loss, B12/folate deficiency, thalassaemia).