Co-payment waiver for HIV medication

Directive number: QH-HSD-056
Effective date: 14 August 2025
Review date: 14 August 2028
Supersedes: Version 1

Purpose

As outlined in the Queensland HIV Plan 2030, Queensland Health is committed to the virtual elimination of HIV transmission by achieving the 98-98-98 targets by 2030. These targets seek to ensure 98 per cent of all Queenslanders with HIV know their HIV status, 98 per cent of Queenslanders with diagnosed HIV infection are on sustained antiretroviral therapy, and 98 per cent of people on antiretroviral therapy maintain an undetectable viral load to reduce onward transmission.

A co-payment waiver for HIV antiretroviral therapy (ART) dispensed in Queensland pharmacies for all people living with HIV (PLHIV) who are Queensland residents will remove barriers to accessing HIV treatment and increase treatment adherence, the achievement and maintenance of an undetectable viral load and ultimately reduce HIV transmission risk within the community.

This directive fulfills criteria four and five in section 47 (1) of the Hospital and Health Boards Act 2011, ensuring consistent approaches to the delivery of health services and supporting the application of public sector policies.

Scope

This directive applies to all Hospital and Health Services.

Principles

This Health Service Directive supports Queensland Health in meeting national and international goals for the virtual elimination of HIV transmission in Australia.

Outcomes

All Hospital and Health Services shall achieve the following outcome:

• Removal of the co-payment for HIV ART to enable the provision of free HIV medication listed on the Pharmaceutical Benefits Scheme (PBS) and available through the Queensland Health List of Approved Medicines to all PLHIV, regardless of Medicare status, via public hospital pharmacies in Queensland

Mandatory requirements

All Health and Hospital Services shall:

• Apply a co-payment waiver for HIV ART dispensed in Queensland Health pharmacies for all PLHIV who are living in Queensland beyond a short-term stay, regardless of Medicare status. A short-term stay is defined as three months or less. This initiative is not intended for interstate or overseas visitors or tourists to Queensland.
• Advise prospective patients that HIV medications made available under this initiative are to be used only for the purpose of HIV treatment of the specified individual.
• Advise prospective patients of the risks associated with HIV treatment and that any costs incurred for services involving comorbidities or any health condition arising from taking HIV medications may incur a fee.
• Ensure prospective patients with English as a second language understand the information provided to them.
• Ensure HIV ART is only prescribed up to the PBS authorised maximum quantity and number of repeats to reflect the recommended review cycle for people with HIV (i.e., two months of medication with five repeats to enable follow-up medical review and pathology at least every twelve months). If a patient is leaving Queensland to travel/live elsewhere in Australia or overseas, the clinician can provide a bridging supply of two months medication to ensure the patient has sufficient time to engage with local healthcare services.
• Forgo any HIV medication co-payment revenue.
• Record the HIV co-payment waiver in i.Pharmacy using the relevant classification to allow reporting to the Department of Health
• Record dispensing for HIV ART for Medicare eligible PLHIV in i.Pharmacy using the relevant classification “HIV Copayment Waiver (OUTP)” or “HIV Copayment Waiver (DISC)”. These classifications are enabled for PBS and will not raise a patient invoice.
• Record dispensing for HIV ART for Medicare ineligible PLHIV in i.Pharmacy using the classification “HIV Medicare Ineligible OUTP”. This classification is not enabled for PBS and will not raise a patient invoice.

Compliance

Compliance with this directive will be determined via: not applicable.

Human Rights

This initiative is a public health program intended to support the national and international objective of the virtual elimination of HIV in Australia. It will enable PLHIV to meaningfully improve their health outcomes and reduce their viral load and risk of ongoing HIV transmission.

Aboriginal and Torres Strait Islander considerations

This Health Service Directive will not negatively impact Aboriginal and Torres Strait Islander stakeholders.

Related or governing legislation, policy and agreements

• Hospital and Health Boards Act 2011 (Qld)
• Health Service Directive: HIV treatment and care for people who are not eligible for Medicare QH-HSD-055
• Health Service Directive Protocol: HIV treatment and care for people who are not eligible for Medicare QH-HSDPTL-055-1

Supporting documents

Nil

Business area contact

Susan Greenbank, Assistant Director, Blood Borne Viruses and Sexually Transmissible Infections Unit on 07 2100 9259 or Susan.Greenbank@health.qld.gov.au

Approval and implementation

Directive Custodian

Executive Director, Communicable Diseases Branch, Population Health Division.

Approval by Chief Executive

Director General, Queensland Health

Approval date:

14 August 2025

Issued under section 47 of the Hospital and Health Boards Act 2011

Review

This Health Service Directive will be reviewed at least every three years.

Next review due by: 14/08/2028

Definitions of terms used in this directive

Version control

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CLASSIFICATION – OFFICIAL – PUBLIC