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Medicare ineligibles

Since November 2011, 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.

The AHOD Temporary Residents’ Access Study (ATRAS) started out of necessity to help a vulnerable group of 180 HIV-positive people by providing free antiretrovirals (ARVs) to people who were not yet permanent residents – commonly those on student or bridging visas.

NAPWHA’s Poz Action 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.

NAPWHA’s work involves influencing key federal government agencies towards improving health equity and treatment access for people with HIV ineligible for Medicare.

Background

In 2007, a consultation between the National Association of People with HIV Australia (NAPWHA), the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), 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]

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

Summary

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.

 

Recommendations

NAPWHA are advocating on the position:

  • That the Commonwealth government approves access to PBS ARV treatments for Medicare ineligible PLHIV currently residing in Australia.
  • That the Commonwealth government negotiates with pharmaceutical companies to contribute proportionately towards the provision of ARV to this finite group.
  • That the Commonwealth government coordinates improved, regular and standardised data collection from the State and Territory jurisdictions and pharmaceutical companies to better understand the cohort of Medicare ineligible PLHIV in Australia and their doctors’ prescribing patterns.
  • That the Commonwealth government regulate that all temporary resident visas to Australia require health insurance that covers all HIV treatment and care.
  • That the Commonwealth Government Communicable Diseases Network of Australia (CDNA) endorse the principle that access to ARVs is a public health issue and that all people with HIV in Australia, regardless of Medicare status, should receive equitable and affordable access to all HIV testing services and the most appropriate HIV treatment and care.

 

Related external links

TIMOR-LESTE

Find out about our work with Estrella Plus

IGAT HOPE Inc.

Representing people living with HIV in PNG

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