- Pharmacists have a vital role to play in patient care in HIV, viral hepatitis and sexual health. From 1 July 2015 HIV medicines are able to be dispensed in community pharmacy, with Government remuneration. The medicines remain Section 100 Highly Specialised Drugs (S100) but will be accessible by patients from community pharmacies, where previously these medicines have only been dispensed in hospital setting.
- Community pharmacists are an integral part of the HIV care team, when people living with HIV will be able to choose to have their HIV s100 medications dispensed in the community.
- ASHM has had a long association with a small number of mainly hospital-based pharmacists who work in HIV medicine and trained pharmacists who have ventured into other areas such as research.
- ASHM is involved in a number of initiatives to equip community pharmacists to play a greater role in HIV medicine, including face-to-face training, resources and webinars. We are also working with pharmacists' professional publications to raise awareness about s100 dispensing in the community.
- ASHM extended complementary ASHM membership for the 2015-2016 membership year to community pharmacists
Community Pharmacy Dispensing of HIV s100 Medications
From 1 July 2015 pharmacists will be able to dispense HIV s100 medications irrespective of whether the prescription originated in the community or from a public hospital. This will be on a streamlined prescription, with a new number, and must be written after 1 July 2015. Scripts from before 1 July 2015 will still be honoured but the patient will need to attend the pharmacy they currently use.
Details about the scheme are available on the PBS website and through the Pharmacy Guild of Australia, the Pharmaceutical Society of Australia.
Guidelines: HIV and community pharmacy
The Pharmaceutical Society of Australia has produced comprehensive practice support resources that give community pharmacists a valuable overview of the changes, the condition and the medicines used in treatment:
Post Exposure Prophylaxis (PEP) is not on PBS and Should Not Be Dispensed by Community Pharmacists
PEP is the administration of HIV antiretroviral medication soon after exposure to HIV. The aim is to prevent the establishment of infection. PEP is not a licensed use for ART and so is not able to be dispensed on the PBS.
The only way patients can access PEP is from a hospital pharmacist, where supply is subsidised by state and territory health departments. If a patients comes to you requesting PEP please direct them to the local hospital emergency service.
It is important that PEP is administered as soon as possible after exposure and definitely within 72 hours. You should not attempt to order PEP privately for a patient as this will be very costly and time for stock to arrive could render the administration of PEP useless.
Antiretroviral Agents Adult Dosage Card
View or Download the May 2015 Adult Dosage Card
Information for Prescribing Clinicians
- All pharmacies will be able to dispense HIV s100 drugs, irrespective of where the prescription originated.
- You do not need to keep stock on the shelf, much supply will be just-in-time.
- Discuss individual arrangements with clients to suit their needs and your ordering processes
- HIV drugs remain s100 and special arrangements are being put in place.
- HIV medications are much less complex today and many people are on one pill daily regimens.
- Treatment remains life-long.
It is vital that drugs are taken as prescribed without dose interruptions or missed dose.
It is anticipated that many pharmacists will fill HIV s100 scripts on a just-in-time basis. Some pharmacies with a high HIV positive clientele or near a HIV service or community HIV prescriber may stock some common medications and combinations. These pharmacists will play in increasing important role in the ongoing care of their HIV positive clients.
HIV treatment has improved greatly over the past 15 years:
- Many drugs are available in single pill daily regimens.
- The side-effect profile is much improved and fewer toxicities are experienced.
- Treatment remains life long and while newer medications are more forgiving of the occasional missed does, the development of resistance remain a big issue for people living with HIV.
- It is vitally important that people can stay on their first line therapy as long as possible.
- The aim should always be 100% compliance with the prescribed regimen.
One of the most common reasons reported for missed doses is forgetting or having difficulties getting a script filled.
Community dispensing is much more flexible than having to rely on hospital based dispensing where access hours are much more restrictive. But it means that pharmacists may need to initiate individual arrangements with their HIV clients.
ASHM is advising clinicians and their patients to get scripts filled a week before they run out of pills.
Information for consumers is available on the Positive Life website