Co-payment waiver for HIV medication

Queensland Health has introduced initiatives for people with HIV, regardless of their Medicare status, by waiving the co-payment and providing access to antiretroviral medication directly related to their HIV treatment for free.

To be eligible, patients must be:

  • a resident of Queensland (this means they must have lived here for at least 3 months)
  • treated by an authorised prescriber
  • prescribed HIV medications under Section 100 (S100) of the National Health Act 1953.

People enrolled in Medicare can get their prescription dispensed at any pharmacy in Queensland. People not enrolled in Medicare can only get their prescription dispensed at a Queenland public hospital pharmacy.

Please note: The co-payment waiver is only for HIV medication for treatment of people with HIV. It does not extend to HIV medication for HIV-negative people for the purpose of PrEP.

Prescriber guidance

Prescribing to people with Medicare

Medicare patients who are eligible for the co-payment waiver can get their prescriptions from:

  • any S100 HIV community prescriber
  • any eligible public hospital prescriber.

Any patients who are not enrolled in Medicare should be referred to their local sexual health clinic or infectious diseases outpatient clinic, where they can access this program.

When you are prescribing HIV medication for eligible patients, make sure that:

  • the medication you prescribe is on the PBS list
  • the amount you prescribe is no more than the PBS authorized maximum quantity and number of repeats to reflect the recommended review cycle for people with HIV (2 months of medication with up to 5 repeats).

In cases where your patient is leaving Queensland to travel/live elsewhere in Australia, you can provide a bridging supply of 2 months’ medication to ensure your patient has sufficient time to engage with local healthcare services.

Make sure your patient knows that:

  • HIV medications made available under this initiative are to be used only for the purpose of treating their HIV
  • there are risks associated with HIV treatment and any costs incurred for services involving comorbidities or any health condition arising from taking HIV medications is not covered by this initiative and may incur a fee
  • when they have their prescription filled at a community pharmacy, they will need to consent to and sign a patient consent form before they are given their medication. If they do not want to consent to this, they can get their medication from a public hospital pharmacy without signing a patient consent form.

Please ensure that any patients with English as a second language understand the information provided to them.

Prescribing to people without Medicare

Free HIV-related medical care, pathology testing and treatment is available to people ineligible for Medicare at public health facilities, such as sexual health clinics or public hospital outpatient clinics. This Program cannot be accessed through S100 community prescribers. To access this service, patients must be:

  • ineligible for Medicare
  • living with HIV in Australia beyond a short-term stay (longer than 3 months).

At each medical review, you should ask your patient about their Medicare status. Once they transition to Medicare, they will be able to access their medication through the Medicare pathway.

For patients without Medicare, make sure that:

  • the medication you prescribe is on the PBS list and available through the Queensland Health List of Approved Medicines (LAM)
  • the amount you prescribe is no more than the PBS authorized maximum quantity and number of repeats to reflect the recommended review cycle for people with HIV (2 months of medication with up to 5 repeats)
  • you mark the script with ‘HIV Medicare Ineligible OUTP’ and instruct the patient to present the prescription at a public hospital pharmacy to receive the medication for free.

Please also make sure your patient knows that:

  • HIV medications made available under this initiative are to be used only for the purpose of treating their HIV
  • there are risks associated with HIV treatment and any costs incurred for services involving comorbidities or any health condition arising from taking HIV medications is not covered by this initiative and may incur a fee.

Please ensure that any patients with English as a second language understand the information provided to them.

For more information refer to protocol QH-HSDPTL-055-1.

Dispenser guidance

Public hospital pharmacy guidance

Public hospital pharmacies please refer to Directive QH-HSD-056: 2023, Directive QH-HSD-055:2023 and protocol QH-HSDPTL-055-1.

Community pharmacy guidance

The Pharmacy Guild of Australia is administering reimbursements for the co-payment program on behalf of Queensland Health. Use their S100 Highly Specialised Drugs Co-payment Program Portal to submit your HIV co-payment waiver claims. You will need to create a user account for your pharmacy before you can make a claim.

In addition to reimbursement of the co-payment (general or concessional) for eligible patients, you will be paid a monthly administration fee and a service fee per item dispensed.

The Pharmacy Guild will process claims within 10 business days. We encourage you to submit claims for reimbursement on a monthly basis.

Please be aware:

  • only people enrolled in Medicare can collect their free HIV prescriptions from community pharmacies (anyone not enrolled in Medicare will need go to a public hospital pharmacy)
  • all patients must complete a privacy consent form, which they must show you every time they collect a prescription.

Visit the Pharmacy Guild of Australia for further information on the reimbursement process.

Last updated: 19 December 2023