HIV is an area of health that requires specialist medical care and treatment. In Australia, subsidised healthcare and treatment are funded by Medicare, Australia’s public healthcare system. People living with HIV (PLHIV)in Australia who are entitled to Medicare enjoy a very high standard of care and treatment in keeping with international standards.
However, even if someone does not have Medicare there are a number of ways that PLHIV can access healthcare and treatment in Australia.
Medicare is Government-funded and operated and the main provider of healthcare for Australian citizens and permanent residents.
Medicare Card holders are entitled to subsidised treatment from medical practitioners (doctors), nurse practitioners and allied health professionals (physiotherapists, dietitians, podiatrists etc) who have been issued a Medicare provider number. Medicare Card holders are also entitled to free treatment in public hospitals and sexual health clinics.
Who can get a Medicare Card?
Everyone who lives in Australia (excluding Norfolk Island residents) is eligible for a Medicare card if they:
- hold Australian citizenship
- hold New Zealand citizenship (documentation required). For more information please go to the Medicare enrolment for New Zealand citizens page
- have been issued with a permanent visa
- have applied for a permanent visa (excludes an application for a parent visa), have permission to work in Australia or can prove relationship to an Australian Citizen (other requirements may also apply).
For further information call Medicare on 13 20 11 or ask in person at your nearest Medicare Office.
To apply for Medicare fill out the Medicare enrolment application form.
Visitors to Australia
Visitors to Australia from a country that has a Reciprocal Health Care Agreement (RHCA) with Australia are also eligible for medically necessary treatment. Australia currently has RHCAs with Belgium, Finland, Italy, Malta, the Netherlands, New Zealand, Norway, the United Kingdom, and Sweden.
RHCAs provide certain health care services including treatments. Depending on your country of origin and the type of visa you have will determine the amount of access you have to subsidised treatment in Australia.
Asylum seekers (Refugees and humanitarian entrants)
Asylum seekers who have applied for permanent residence and have permission to work are usually eligible for Medicare, depending on individual circumstances. Also, if you are a refugee or humanitarian entrant you may be entitled to payments and services that will help you settle into life in Australia.
Some state health departments waive fees for hospital treatment and other medical services for asylum seekers who are Medicare ineligible, however this may not extend to providing antiretroviral medication.
Further information please go to Medicare’s ‘Support for refugees and humanitarian entrants’ page.
The Pharmaceutical Benefits Scheme (PBS)
In Australia medications are subsidised by the government under a branch of Medicare called the Pharmaceutical Benefits Scheme (PBS )A medicine may cost hundreds of dollars or more but people only need to pay a copayment for medication subsidised by the PBS At the time of the cost of a copayment for HIV treatment is $36.90 for two months’ supply of HIV treatment or $5.60 for people holding concessional cards or equivalent.
HIV antiretroviral drugs are included in the scheme under Section 100 (s100) of the Highly Specialised Drugs Program. Unlike other PBS drugs, these ‘specialised’ drugs can only be dispensed through hospital-based pharmacies and may only be prescribed by appropriately qualified dcctors.
People not eligible for Medicare ('Medicare Ineligible')
Unfortunately, there are many people with HIV living in Australia who do not qualify for Medicare or access to the PBS . Many overseas students fall into this category; as do many people who are here on working visas and the partners of Australian residents who are waiting for a decision to be made about their own permanent residency.
If you do not qualify for Medicare and the PBS but need access to HIV antiretroviral drugs, there are a number of options open to you. NAPWHA does not consider these options ideal and is continuing to lobby for the rights of all people with HIV in Australia to have subsidised access to HIV treatment. NAPWHA believes all people should be able to access HIV treatment, regardless of their citizenship or residency status.
People with HIV who do not have Medicare can access treatment and care through a number of options.
Accessing medical care
In order to obtain treatments you will need a prescription from an appropriately qualified HIV specialist doctor. Your doctor will also need to monitor your blood test results, talk with you about treatments and take care of any other health issues.
HIV antiretroviral drugs can only be prescribed in Australia by:
- doctors who work in large public hospitals;
- doctors who work in public sexual health clinics; and
- community-based general practitioners (GPs) qualified in HIV, also known as ‘HIV s100 prescribers’.
Usually people without Medicare can see an HIV specialist doctor at a public hospital or public sexual health clinic as an outpatient ('patient' not requiring admission). People without Medicare can also choose to see an HIV specialist doctor at a private clinic if they pay full price for their appointments. Sometimes people have Health Insurance that can help cover the cost of these appointments and blood tests.
Doctors who work in large public sexual health clinics are often used to seeing people from overseas and understand the issues experienced by people who are not eligible for Medicare. Some HIV s100 prescribers speak languages other than English and/or specialise in helping people from particular culturally and linguistically diverse backgrounds.
Some clinics are free and some are not. Make sure you ask about any costs involved when you make your first appointment. If you need help finding affordable and appropriate medical care you can ask your local PLHIV organisation or AIDS Council for information about services in your area.
The Australasian Society for HIV Medicine hosts a directory of HIV specialist doctors working in Australia listed by state and suburb, as well as New Zealand. The link will take you to a page on the ASHM website that hosts a number of directory options depending on where in Australia you are looking for care.
There are a number of ways PLHIV who do not have Medicare can access HIV treatment. All of these options require PLHIV to be under the care of an HIV specialist doctor and also a written prescription.
1. Pay full price
For those who can afford it there is always the option of paying full price for HIV treatment through an HIV specialist pharmacy. Most people do not pay full price for HIV treatments as they are expensive.
2. Import generic medications
Some people purchase treatment from a reputable overseas company that makes generic forms of HIV treatment. Although generic formulations have different names and are not manufactured by HIV pharmaceutical companies they contain the same active ingredients that are just as effective against HIV.
Whilst imported generic drugs are less expensive they can still cost several hundreds of dollars for three months’ supply. They also need to be ordered and paid for well in advance as they take time to be delivered and sometimes delivery can be delayed for a number of reasons.
This is a reputable online company based in Cananda.
3. Participate in a clinical trial that supplies HIV treatment
Clinical studies investigate the safety and effectiveness of new HIV treatments as well as looking at different ways to use existing treatments. Clinical studies can often cover the cost of medical care, blood tests as well as treatment.
Clinical studies have always helped us to better understand new and better ways of treating HIV and can be a great choice for some people, regardless of whether or not they have Medicare.
Clinical studies may not be suitable for everyone as there are often exclusion criteria including people with health issues such as hepatitis and women who may become pregnant or who are breastfeeding.
4. Compassionate access schemes
Some pharmaceutical companies that make HIV treatment provide treatment on compassionate grounds to PLHIV who do not have Medicare. Companies consider applications on a case by case basis and your doctor will usually need to say that there are special circumstances preventing you from accessing treatment in another way. Most companies will provide a short term supply until other arrangements can be made. For more information talk to your doctor.