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UPDATE: Changes to HIV treatment access for people ineligible for Medicare

10 May 2022:  AFAO and the National Association of People with HIV Australia (NAPWHA) have developed this briefing paper to update the HIV community workforce on a Commonwealth initiative to provide equitable access to HIV treatment for people ineligible for Medicare.

UPDATE 1 September 2022: The new Australian Government HIV treatment access scheme has not started. People without Medicare cards should continue to access their HIV treatments through their doctors as usual.

CEASE logoHIV treatment must be available for all who need it, regardless of Medicare eligibility. AFAO and NAPWHA believe greater access to HIV treatment will keep people well and prevent onward transmission through effective and affordable treatment as prevention (TasP), ensuring Australia is on track to meet domestic and global elimination targets.

In 2020, 45% of new HIV notifications among gay and bisexual men were reported in overseas-born men. Providing equitable access to HIV treatment and clinical care, regardless of visa status, is a key priority in the AFAO-led Agenda 2025 consensus statement on ending HIV transmission in Australia. The Commonwealth initiative to provide HIV treatment for all is a vital step forward in the Australian HIV response with borders now open again and increasing numbers of temporary residents arriving in Australia.

Changes from 1 July 2022

From 1 July 2022, people with HIV who are ineligible for Medicare will be able to access their treatment free of charge through government-funded hospital pharmacies

* NAPWHA and ASHM (Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine) will ensure that developments around this initiative will be communicated to the clinical workforce, to people with HIV and other stakeholders.

From 1st July, people with HIV who are ineligible for Medicare, and who previously received HIV medication through compassionate access schemes, will be required to transition to alternative access arrangements in order to receive government-funded treatment **.

Option 1:  Individuals will need to engage in care with a public hospital-based physician and have their medication dispensed from a hospital pharmacy. The cost of consultations and any required pathology will be covered by the hospital.

Option 2:  Individuals can continue to see their regular s100 prescriber but will need to have their medication dispensed from a hospital pharmacy. The cost of the consult, and any required pathology will need to be covered by the patient or practice.

Option 3:  Individuals will need to engage in care with a publicly funded sexual health clinic and have their medication dispensed from a hospital pharmacy. The cost of consultations, and any required pathology will be covered by the sexual health clinic.

Option 4:  Individuals can still need to access their medication through the self-importation scheme at their own cost.

** Any additional care or medication costs associated with side effects from treatment will not be covered by this government-funded scheme.

Background

Since November 2011, National Association of People with HIV Australia (NAPWHA) and the Kirby Institute, with the assistance of all Australian HIV pharmaceutical companies, set up a free access trial for people with HIV deemed by the federal government to be ineligible for Medicare. NAPWHA’s work advocates for people with HIV ineligible for Medicare, who often delay starting treatment, and who are forced to purchase ARVs online and may not access their ideal regimen. Our work involves influencing key federal government agencies towards improving health equity and treatment access for people with HIV ineligible for Medicare. A consultation between NAPWHA and the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) In 2007, HIV S100 prescribers nationwide and members of the Australian Health Protection Committee’s Blood Borne Viruses and Sexually Transmissible Infection Standing Committee (BBVSS) estimated the number of Medicare ineligible people living with HIV (PLHIV) in Australia at between 250 and 300[1].

The Australian HIV Observational Database Study (ATRAS) commenced In November 2011 and ran until 2015.  Via a compassionate access scheme, ATRAS provided antiretroviral (ARV) treatment for up to four years to 180 HIV-positive patients who were temporary residents in Australia and ineligible for Medicare[2]

The AHOD Temporary Residents’ Access Study (ATRAS) started out of necessity to help a vulnerable group of 180 HIV-positive people by providing free antiretroviral (ARV) treatment to people who were not yet permanent residents – commonly those on student or bridging visas. ATRAS was the first study in Australia to systematically collect visa and HIV-related information on the sub-group of HIV-positive people who are Medicare ineligible[3]. 

[1]           ATRAS rept 1p.5-6 Background
[2]           ATRAS rept 1 p.2
[3]                Ibid. p2

 

Medicare ineligible PLHIV in Australia Report (2019)

Medicare ineligible PLHIV in Australia Report

In 2019, NAPWHA and the Kirby Institute UNSW, Sydney published an analysis of new data with recommendations for systemic improvements to treatment access  for people living with HIV in Australia who are ineligible for Medicare. The 2019 report concludes that the current system does not work for patients, clinicians, industry partners or State/Territory Governments and it needs a complete overhaul. Medicare ineligible people with HIV need to access treatment and care the same way as other people with HIV in Australia, without additional barriers.

A solution is therefore required that allows clinicians to prescribe from the entire suite of ARV available on the PBS without the  additional burden of direct negotiation with pharmaceutical companies. This solution would facilitate community-based organisations to promote the availability of HIV treatment and care to Medicare ineligible PLHIV.

An unmonitored cohort of HIV positive individuals who are experiencing significant barriers to appropriate care and treatment presents considerable public health implications. Improved, regular and standardised data collection from the State and Territory jurisdictions and pharmaceutical companies is urgently required to better understand this group and their doctors’ prescribing patterns.

 

Related external links

PATSIN

Find out more about the Positive Aboriginal Torres Strait Islander Network (PATSIN)

POSITIVE LIVING

For people living with and affected by HIV

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