Co-payment waiver for HIV medication

Directive number: QH-HSD-056: 2023
Effective date: 9 October 2023
Review date: 9 October 2026
Supersedes: N/A

Purpose

Queensland Health is committed to the virtual elimination of HIV transmission by 2030 and supports the achievement of the UNAIDS HIV 95-95-95 targets which seek to ensure that 95 per cent of HIV-positive people know their HIV status, 95 per cent of people who know their HIV-positive status are on antiretroviral therapy, and 95 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 with HIV (PHIV) who are living in Queensland 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 medication to enable the provision of free HIV medication listed on the Pharmaceutical Benefits Scheme and available through the Queensland Health List of Approved Medicines to all people with HIV (PHIV), 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 PHIV who are living in Queensland beyond a short-term stay, regardless of Medicare status. 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 that prospective patients with English as a second language understand the information provided to them.
• Ensure that 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 PHIV 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 PHIV in i.Pharmacy using the classification “HIV Medicare Ineligible OUTP”. This classification is not enabled for PBS and will not raise a patient invoice.

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, Advanced Public Health Officer on 07 3328 9711 or Susan.Greenbank@health.qld.gov.au

Review

Supersedes:  N/A

Approval and implementation

Directive Custodian

Executive Director, Communicable Diseases Branch, Queensland Public Health and Scientific Services.

Approval by Chief Executive

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

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 PHIV to meaningfully improve their health outcomes and reduce their viral load and risk of ongoing HIV transmission.

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