From 1 July 2023, the Victorian HIV Treatment Program (the Program) will provide access for people living with HIV without Medicare to antiretroviral therapy (ART).
The Program is exclusive to ART medicines used for the purpose of HIV treatment of the specified individual for the duration of their stay in Australia and while they are ineligible for Medicare. It replaces compassionate access schemes previously operated by pharmaceutical companies.
People eligible for the Program will continue to obtain scripts through s100 prescribers. To be eligible under the Program, a person must meet the following criteria:
- be ineligible for Medicare; and
- report that they are currently residing in Australia beyond a short-term stay; and
- report that they do not have private health that covers HIV ART or prefer not to use it; and
- be receiving appropriate specialist medical care as:
- a patient of an s100 community prescriber, or
- an outpatient in a public health service, or
- a day patient, a patient on discharge, or
- non-admitted patient of a public hospital.
No forms are required to be completed by people eligible for the program.
Prescribers will annotate the script with ‘VICHIVTP’ to endorse the patient’s eligibility as outlined in the Program. ART will then be dispensed through public hospital pharmacies. A list of public hospitals is available at: https://www.health.vic.gov.au/hospitals-and-health-services/public-hospitals-in-victoria.
The Program covers the cost of the ART only. Consultation, pathology or other treatment related to HIV is out of scope of the Program. Co-payments may be waived for patients at the discretion of the hospital and collection of co-payments is the responsibility of each individual hospital.
The Department of Health will reimburse public hospital pharmacies for the commercial cost of Pharmaceutical Benefits Scheme listed ART medications dispensed under the Program. Pharmacies will be required to submit a reimbursement form on a quarterly basis and meet reporting requirements outlined on the reimbursement form.
The Program document, outlining the process summarised above, and the pharmacy reimbursement form will be published on health.vic.gov.au next week. You will receive follow-up communication once published.
Disclaimer: This article was provided by Victorian Department of Health. While every effort has been made to ensure the information is accurate, North Western Melbourne Primary Health Network does not warrant or represent the accuracy, currency and completeness of any information or material included within.