Department of Health

Pharmacotherapy – forms, applications and Pharmacotherapy Networks

There are several types of forms to submit if you are an approved pharmacotherapy prescriber or pharmacy. 

For forms relating to termination of pharmacotherapy, see 'Pharmacotherapy termination'.

Victorian Area-Based Pharmacotherapy Networks

Pharmacotherapy represents an important part of the Victorian Government's community response to the treatment of drugs and alcohol in the state. Medical professionals, pharmacists and the Victorian Department of Health and Human Services work together to make pharmacotherapy available to clients in the community.

In 2014, five area-based pharmacotherapy networks were established throughout Victoria to ensure a more local approach in connecting care, driving best practice and improving pharmacotherapy client outcomes. The three regional Networks (Barwon South West Pharmacotherapy Network, Grampians and Loddon Malleee Pharmacotherapy Network, Gippsland and Hume Pharmacotherapy Network) and the two metropolitan Melbourne Networks (South and Eastern Metropolitan Pharmacotherapy Network and North and West Metropolitan Pharmacotherapy Network) will develop strategic approaches to addressing needs in their Areas, work with other services in the Area to form partnerships to facilitate treatment referral pathways, intervention, ongoing support and wrap around support and mentoring to providers, attract and retain pharmacotherapy providers to relieve pressure to existing services and facilitate access to ongoing training for pharmacotherapy providers.

For more information about the Area-Based Pharmacotherapy Networks and for contacts please download the factsheet.

Permit to treat an opioid-dependent person – application form

Approved medical practitioners or nurse practitioners need to apply for a permit to treat an opioid-dependent person with methadone or buprenorphine.

Use either the Application for a permit to treat an opioid dependent person with methadone or buprenorphine or the online smart form to apply.

Approved pharmacotherapy prescriber or supplier – application forms

Medical practitioners, nurse practitioners and community pharmacies may use the Application for approval as a pharmacotherapy prescriber or Application for permission to supply pharmacotherapies in Victoria to apply to become a pharmacotherapy prescriber or pharmacotherapy supplier.

Pharmacotherapy pharmacists – self-assessment

The Self-assessment form for pharmacists helps pharmacists to assess their compliance with key regulatory and policy requirements associated with the safe, appropriate and lawful provision of opioid replacement therapy (ORT).

Note that the form does not address all aspects of the requirements. Pharmacists should refer to the Drugs, Poisons and Controlled Substances Regulations 2006 and the Policy for maintenance pharmacotherapy for opioid dependence for full details.

Pharmacotherapy dispensing support program – tax invoice

If a client is eligible for pharmacotherapy dispensing support, the department issues a letter to the dosing pharmacy confirming details of dispensing support. If a client who is eligible for dispensing support has transferred to your pharmacy, but you have not received the letter from the department, the prescriber may need to notify the department in writing of the change of pharmacy details and include the start date at your pharmacy.

Victorian Community-Based Pharmacotherapy System

Download Enhancing the Victorian Community-Based Pharmacotherapy System: directions paper 2013 for more information.

Prescribing and Dispensing Suboxone®

Suboxone is a sublingual film that contains the active ingredients buprenorphine and naloxone and is registered with the Therapeutic Goods Administration for use in Australia for the treatment of opioid dependence. Through the Section 100 Opiate Dependence Treatment Program established under the National Health Act 1953, Suboxone is fully subsidised by the Commonwealth government under the Pharmaceutical Benefits Scheme (PBS) for opioid replacement therapy. 

There has been some confusion about the legality and practicalities of prescribing and dispensing Suboxone for purposes other than opioid replacement therapy (off-label use).

Further information can be found in the Suboxone® factsheet attached to this webpage. 

Reviewed 20 December 2021


Contact details

Postal address: Medicines and Poisons Regulation Department of Health GPO Box 4057 Melbourne VIC 3001

Medicines and Poisons Regulation Department of Health

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