QLD s100 HIV Patient Co-Payment Program
The Pharmacy Guild of Australia (The Guild) will be administering patient co-payment reimbursement on behalf of the QLD Government for s100 HIV Antiretroviral Therapy dispensed at QLD community pharmacies.
On 26 July 2023, Shannon Fentiman, the Minister for Health, Mental Health and Ambulance Services and Minister for Women announced the removal of co-payments for HIV antiretroviral therapy (ART) provided by Queensland Health and community pharmacies for people with HIV who are resident in Queensland beyond a short-term stay, regardless of their Medicare eligibility.
This means that eligible people living with HIV in Queensland beyond a short-term stay (i.e. greater than three months) will no longer be required to pay the patient co-payment for HIV medication dispensed in Queensland from 3 October 2023.
The initiative applies to Queensland residents, treated by Queensland authorised prescribers, who are prescribed HIV medications under Section 100 of the National Health Act 1953. This includes public non-admitted patients, outpatients or day patients, inpatients on discharge from public hospitals and privately referred, non-admitted patients treated by Queensland public hospitals or by authorised community prescribers. The co-payment waiver applies regardless of whether HIV medication prescriptions are filled through Queensland public hospitals or community pharmacies.
The Queensland Government will cover the cost of the co-payment for HIV medication for eligible patients that choose to get their HIV medication dispensed from community pharmacies as part of this initiative.
S100 Portal
All claims are submitted through the s100 HSD Co-payment Program Claiming Portal
Program resources
New to the Program? Program resources covers the information you need to get started.
Below are the step-by-step instructions and resources on how to participate in the program.
| Step | Instructions | Video |
|---|---|---|
| 1. Create a user account in the portal | View | |
| 2. Register a new pharmacy or associate your account with an existing pharmacy | View | Watch |
| 3. Complete the claim template | View | Watch |
| 4. Submit your claim application online | View | Watch |
| 5. Re-submit your application if returned to 'Draft' status | View | Watch |
| 6. Download remittance advice | View | |
| 7. Update your pharmacy's account | View | Watch |
Claiming and payments
Claiming
From 31 October, claims will either be submitted by entering the dispensing details directly into the online claiming portal or by uploading the QLD s100 HSD Claim Template (maximum of 100 claims).
Pharmacies must receive consent from the patient to claim the co-payment on their behalf at the time of dispensing, using the Patient Consent Form.
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.
Pharmacies are encouraged to submit claims for reimbursement on a monthly basis.
Patient eligibility
All of 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).
Patients eligible for the co-payment waiver can present to any Queensland pharmacy with a script for HIV medication listed on the Pharmaceutical Benefits Scheme.
The patient will be required to consent to the pharmacist for their personal details to be provided to the Pharmacy Guild of Australia (the Guild) for the purposes of reimbursement of the co-payment to the pharmacy.
3 Year Patient Consent Form Qld
The co-payment waiver is only for HIV medication for the treatment of people with HIV. It does not extend to HIV medication for HIV-negative people for the purpose of PrEP.
Medicines eligibility
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 medication for the treatment of people with HIV. It does not extend to HIV medication for HIV-negative people for the purpose of PrEP.
Have a question?
Contact us on:
- Phone: (9am to 5pm AET) Monday to Friday
- Email: guild.solutions@guild.org.au
Page last updated on: 11 October 2024