QLD S100 HIV Co-Payment Program

All the following patient eligibility criteria must be met for the co-payment to be paid by Queensland Health:

• Queensland residents who are patients of:
  • Queensland public hospitals or sexual health clinics, or
  • authorised community prescribers in Queensland for HIV medications, or
  • an interstate specialist/prescriber where the Queensland resident lives in a border area
• Patient prescriptions under section 100 of the National Health Act 1953 for:
  • s100 HSD Community Access for HIV.
• Prescriptions filled through Queensland:
  • public hospital pharmacies, or
  • community pharmacies (must be Medicare eligible).

Pharmacists must review a completed Patient Consent Form alongside a valid s100 HIV prescription before dispensing.

If the Patient Consent Form is not available, the pharmacist will need to supply a form to the patient to complete and sign, prior to dispensing any eligible s100 HIV medicines.

The Queensland s100 HIV Patient Co-Payment Waiver Initiative applies only to s100 Highly Specialised Drugs Program (Community Access) drugs for HIV antiretroviral therapy.

The co-payment waiver is only for HIV antiretroviral medication for the treatment of people with HIV.
It does not extend to HIV medication for HIV-negative people for the purpose of PrEP.

Claiming

To submit s100 co-payment claims and receive re-imbursement from Queensland Health, Section 90 approved QLD community pharmacies must create a user account to access to the online claiming portal.

Claims will either be submitted by uploading the QLD s100 HSD Claim Template (maximum of 100 claims) or by entering the dispensing details directly into the online claiming portal (maximum of 10 claims).

Payments

In addition to the cost of the co-payment for eligible patients, pharmacies are paid a service fee for the work associated with submitting claims on behalf of patients.

The fees are $2.23 (incl GST) for each co-payment claimed and a one-off monthly administration fee of $13.42 (incl GST) for the first claim made each month.