This is absolutely FALSE imformation. That may be true for some medications but certainly NOT HIV medications. Get your facts correct before commenting on issues you are not entirely familiar with.
Access to HIV+ / AIDs treatment
- Thread starter Tremaine
- Start date
This is absolutely FALSE imformation. That may be true for some medications but certainly NOT HIV medications. Get your facts correct before commenting on issues you are not entirely familiar with.
D_Sparroe Spongecaques
Experimental Member
Read through the thread again and see my job on my profile
I have no reason to lie FFS!
Look, I've had it! This thread can, and should, be an incredibly informative thread. It's an excellent topic. The kind of thread that this site is all about. There is no reason to introduce drama and politics into this thread, there's already too much of that site-wide. If any of you can't discuss this like adults, then put each other on ignore, and move on. If this devolves further, or moves to name-calling, I'll report you myself.
- Joined
- Feb 6, 2006
- Posts
- 209
- Media
- 8
- Likes
- 274
- Points
- 218
- Location
- Liverpool (England)
- Sexuality
- 69% Gay, 31% Straight
- Gender
- Male
Tasha
As I have requested, but has not been forthcoming, please give us or me the facts and I will follow them up. In which part of the country (UK) is this practice happening. If it is true as you asset, from your apparent position at work, please be so kind as to back it up. Otherwise you can not be entirely surprised that others of us are, to say the least, sceptical of the assertion. Especially when our own experience and knowledge says otherwise.
As I have requested, but has not been forthcoming, please give us or me the facts and I will follow them up. In which part of the country (UK) is this practice happening. If it is true as you asset, from your apparent position at work, please be so kind as to back it up. Otherwise you can not be entirely surprised that others of us are, to say the least, sceptical of the assertion. Especially when our own experience and knowledge says otherwise.
- Joined
- Feb 6, 2006
- Posts
- 209
- Media
- 8
- Likes
- 274
- Points
- 218
- Location
- Liverpool (England)
- Sexuality
- 69% Gay, 31% Straight
- Gender
- Male
The NICE National Institute for Clinical Excellence (NICE) in the UK Guidelines for HIV/AIDS treatment is thus:
Antiretroviral treatment is initiated in secondary care or specialist centres. As a guide:
These recommendations are based on guidelines issued by the British HIV Association (BHIVA) Treatment Guidelines Writing Group [British HIV Association, 2008b; Gazzard and BHIVA Treatment Guidelines Writing Group, 2008].
For primary HIV infection
What antiretroviral drugs are available in UK?
Class and mechanism of action
Drug*
Nucleoside reverse transcriptase inhibitors (NRTIs)
Didanosine (ddI, Videx®)
Emtricitabine (FTC, Emtriva®)
Lamivudine (3TC, Epivir®)
Stavudine (d4T, Zerit®)
Zidovudine (AZT)
Combined NRTI products:
Combined NtRTI and NRTI products:
Etravirine (Intelence®)
Nevirapine (Viramune®)
Protease inhibitors (PIs)
Darunavir (Prezista®)
Fosamprenavir (Telzir®)
Indinavir (Crixivan®)
Lopinavir + ritonavir (Kaletra®)
Nelfinavir (Viracept®)†
Ritonavir (Norvir®)
Saquinavir (Invirase®)
Tipranavir (Aptivus®)
Fusion inhibitors
CCR5 inhibitors
Integrase inhibitors
* Drug name (abbreviation and brand name).
† No longer used in the UK.
Antiretroviral treatment is initiated in secondary care or specialist centres. As a guide:
- For primary HIV infection (HIV seroconversion illness), antiretroviral drug treatment should be routinely considered in people with:
- Neurological involvement.
- Any AIDS-defining illness.
- A CD4 count persistently less than 200 cells/mm3 (that is for 3 months or more).
- For established HIV infection, drug treatment should be initiated for:
- People with a CD4 count less than 350 cells/mm3. This should be confirmed on at least one consecutive sample, in the absence of any obvious reason for transient CD4+ T-lymphocyte depletion.
- For information on initiating treatment in people with a CD4 count greater than 350 cells/mm3, see Additional information.
- Pregnant women, to prevent transmission to the child. Treatment may be stopped after delivery.
- Anyone with symptomatic disease, regardless of CD4 count
- People with a CD4 count less than 350 cells/mm3. This should be confirmed on at least one consecutive sample, in the absence of any obvious reason for transient CD4+ T-lymphocyte depletion.
- For people with a CD4 count greater than 350 cells/mm3, the British HIV Association Treatment Guidelines Writing Group recommends that antiretroviral treatment may be started or considered for a small group of people with the following conditions [Gazzard and BHIVA Treatment Guidelines Writing Group, 2008]:
- AIDS diagnosis (for example Kaposi's sarcoma) or any HIV-related comorbidity.
- Hepatitis B infection, where treatment of hepatitis B is indicated.
- Hepatitis C infection in some cases, where treatment for hepatitis is deferred.
- Low CD4 percentage (for example less than 14%, where Pneumocystis jiroveci pneumonia prophylaxis would be indicated).
- Established cardiovascular disease or a very high risk of cardiovascular events (for example Framingham risk of cardiovascular disease greater than 20% over 10 years).
- For people who do not have an AIDS diagnosis or co-infection with hepatitis B or C virus, and whose CD4 counts are greater than 500 cells/mm3, the guideline highlights that the benefits of starting antiretroviral treatment 'remain unclear'. It recommends considering enrolment into a 'when to start' trial where this is an option.
- For people with a CD4 count greater than 350 cells/mm3, the British HIV Association Treatment Guidelines Writing Group recommends that antiretroviral treatment may be started or considered for a small group of people with the following conditions [Gazzard and BHIVA Treatment Guidelines Writing Group, 2008]:
These recommendations are based on guidelines issued by the British HIV Association (BHIVA) Treatment Guidelines Writing Group [British HIV Association, 2008b; Gazzard and BHIVA Treatment Guidelines Writing Group, 2008].
For primary HIV infection
- Given the lack of evidence, the BHIVA criteria for initiating antiretroviral treatment is based on expert opinion, with the aims of:
- Preserving specific anti-HIV immune responses (that would otherwise be lost) which are associated with long-term non-progression in untreated people.
- Reducing morbidity due to high viraemia and CD4+ T-lymphocyte depletion during acute infection.
- Reducing the risk of onward HIV transmission.
- The BHIVA Treatment Guideline Writing Group recommends that every effort should be made to start antiretroviral treatment before the CD4 count falls below 200 cells/mm3 because initiating treatment below this CD4 count is associated with a significantly greater risk of disease progression and death.
- The BHIVA recommendation to start treatment in all people with a CD4 count less than 350 cells/mm3 is based on expert opinion and a consideration of available trial evidence.
- The guideline recommends that antiretroviral treatment should be initiated in all people with CD4 count less than 350 cells/mm3. Although several studies suggested that 'CD4 percentage may have a small additional prognostic value independently of the total CD4 cell count' [Gazzard and BHIVA Treatment Guidelines Writing Group, 2008], the BHIVA Treatment Guideline Writing Group found the data conflicting. Some studies have indicated that CD4 percentages less than 15–17% were indicative of increased risk of disease progression.
What antiretroviral drugs are available in UK?
- Seven classes of antiretroviral drugs are marketed in the UK (see Table 1). For further information on mechanism of action, see HIV replication, genetic variation, antiretrovirals.
- To aid adherence, several combination products are available (see Table 1). These are commonly prescribed by their proprietary names.
- All antiretroviral drugs are available as tablets or capsules, except for enfuvirtide, which is available as an injection.
Class and mechanism of action
Drug*
Nucleoside reverse transcriptase inhibitors (NRTIs)
- Interfere with the transcription of viral RNA into DNA.
- Incorporated into newly synthesized viral DNA, and prevent further transcription.
Didanosine (ddI, Videx®)
Emtricitabine (FTC, Emtriva®)
Lamivudine (3TC, Epivir®)
Stavudine (d4T, Zerit®)
Zidovudine (AZT)
Combined NRTI products:
- Lamivudine + zidovudine (Combivir®)
- Abacavir + lamivudine (Kivexa®)
- Abacavir + lamivudine + zidovudine (Trizivir®)
- Mechanism of action identical to NRTIs.
Combined NtRTI and NRTI products:
- Emtricitabine + tenofovir (Truvada®)
- Efavirenz + emtricitabine + tenofovir (Atripla®)
- Interfere with the transcription of viral RNA into DNA.
- Bind directly to the reverse transcriptase enzyme, and inhibit its function.
Etravirine (Intelence®)
Nevirapine (Viramune®)
Protease inhibitors (PIs)
- Interfere with the cleavage of large proteins into smaller proteins that are necessary for viral replication.
Darunavir (Prezista®)
Fosamprenavir (Telzir®)
Indinavir (Crixivan®)
Lopinavir + ritonavir (Kaletra®)
Nelfinavir (Viracept®)†
Ritonavir (Norvir®)
Saquinavir (Invirase®)
Tipranavir (Aptivus®)
Fusion inhibitors
- Interfere with binding, fusion and entry of HIV-1 to the host cell by blocking one of several targets.
CCR5 inhibitors
- Binds to CCR5 receptors, preventing the HIV virus from binding to these receptors. Consequently, this prevents CCR5-trophic HIV virus from engaging with a CD4 cell.
Integrase inhibitors
- Interfere with the integration of HIV-derived DNA into the host cell's DNA.
* Drug name (abbreviation and brand name).
† No longer used in the UK.
Bbucko
Cherished Member
- Joined
- Oct 28, 2006
- Posts
- 7,232
- Media
- 8
- Likes
- 326
- Points
- 208
- Location
- Sunny SoFla
- Sexuality
- 90% Gay, 10% Straight
- Gender
- Male
In the US, so much of the quality of your care and access to meds depends on where you live.
I have lived with HIV for over 26 years and have been on meds since 1996. Until 2003 I had private insurance and, generally, my care was excellent. I had access to specialists to treat not just the HIV but all the health issues one who has lived long-term with the virus is likely to have (neurological and GI issues, dermatological stuff, etc.).
The side effects of the early versions of the meds, especially in the mid-late 90s, could range from debilitating (chronic, "garden-hose" diarrhea with little or no warning) to really annoying (odd numbness in the extremities, ringing in the ears, etc). I was incredibly lucky to have worked for people who understood that some days would be better for me than others; only briefly (about six months) did I work for a corporation (not an individual entrepreneur) which took issue with the flexibilities my schedule required. In addition to coping with side-effects and associated issues, there was the sheer volume of doctor's appointments and tests which could not all be scheduled around my job.
People who live and work with HIV are square pegs for the round holes offered as employment by private corporations: in addition to all the other things I listed above, there are issues involving mental health (beginning with chronic depression, for starters) that not just effect one's ability to work effectively in certain environments, but, again, are likely to require scheduling flexibility and additional medications. We also drive up the cost of insurance in anything but the biggest pools, so there are strong incentives for people living with HIV to find work with individual entrepreneurs (like what I still do), work for non-profits or work for themselves. Most corporations find us unemployable.
Aside from issues related to work, there are other enormous incentives for guys who can work to go on disability: the primary being access to quality health care through Medicare, which, for the time being, is comparable to the best gold-plated private insurance plan. And because it is a Federally-run program, the care one gets on Medicare in Maine is the same care as one gets in California (presuming the doctors are comparable: the benefits are identical nationwide). I know at least a dozen guys (probably more) who are fit and as able to work as anybody in theory, but who cannot return to work because of the quality of the care they get on Medicare, aside from the fact that they have special needs regarding scheduling, etc.
In order to be eligible for SSDI and Medicare, though, one must be provably poor, with no cash or assets. Those not immediately poor enough are allowed "spend-down" time to rid themselves of as many assets as are required in order to meet eligibility standards. And, of course, one must have the right doctor and the right lawyer to assist you, because the process is expensive, time-consuming and pretty complicated for the layman. I, myself, attempted to file in 2002 when I was going through an especially rough patch medically (at one point I actually flat-lined), but my application was denied: shoulda got myself a lawyer
The alternative to SSDI/Medicare is for the working poor or anyone else who does not have insurance but is not "sick" enough yet. That is the patchwork of programs described by FuzzyKen and which I'll give some more details on. Though most of the funds discussed below are Federal, they are administered by each state, which is where you're apt to find discrepancies.
The first of these programs is Medicaid, which is not Medicare, though they sound really similar. Medicaid was originally set up for kids and their mothers in the 1960s and has grown over the years into a nearly-incomprehensible and insanely complicated network of funding for all kinds of medical services for those without insurance; the actual funds are party Federal and partly State/Local.
Because of eccentricities both in the law and at each local level, some places are better to live than others who require Medicaid. The laws determining eligibility and level of service are all State-level, and within each state, there are asymmetries, with some cities and/or counties offering more comprehensive care than others.
The Ryan White CARE Act was set up in the 80s to help states cope with the extra burden HIV/AIDS imposed on their health care budgets. But because of the way tax-money is disbursed through Congress, it needs to be continuously re-approved (it's an Ear-Mark, not an Entitlement) and is only ever meant to be used as emergency funds. It is entirely Federal money but is administered on a state level based, in part, on what they request from Congress. Go-it-alone states (Utah springs immediately to mind) get very little Ryan White money to begin with and is draconian in how, when and for whom it gets used. Other states, New York and California, especially, have enormous Ryan White budgets and very different criteria by which the money is spent. In some states, like Florida, it is administered on a county level.
When AZT was first available, it was insanely expensive (anti-retrovirals still are), so ADAP (AIDS Drug Assistance Programs) was added into Ryan White specifically to cover the cost of the meds (only), though in practice both Ryan White and ADAP funds are used for things which may or may not be considered either emergency services nor strictly medications, either.
ADAP is administered separately from Ryan White (though they are effectively part of the same program) and the formularies of available medications vary drastically from state to state. Not every anti-retroviral is required by the feds to be available on every formulary, though at least one medication per class of drug is (there are, I believe, currently four classes of meds currently available, with a fifth on the way). Some ADAPs offer meds that help cope with side-effects, psych meds and pain meds, others do not.
It will probably shock most people to know that there are currently over 2300 Americans living on ADAP waiting lists, who need meds but cannot get them until someone else dies or greater funds are approved by Congress. People living with HIV/AIDS have been living on Sarah Palin's otherwise fictitious "death panels" for at least 20 years!
Since each state administers its Medicaid, RW and ADAPs differently, the criteria for eligibility varies enormously from state to state (sometimes county to county), and bear in mind that, unlike Medicare/SSDI recipients, these people are still working. Last time I checked, Federal Poverty Line (FPL) was set at just over $10,000 per year. Some states had elegibility standards as low as 150% of FPL, meaning anyone earning more than that was "too rich" to receive any benefits under RW/ADAP (sometimes even Medicaid, which doesn't pay for the meds either way); New York had the highest standard at 500%, but that's probably been changed by now.
In October 2003, when I lost my private insurance, I became intimately familiar with the public health care system in Florida. Back in Massachusetts and Connecticut (where I lived for four years between 99 and 03), RW funds covered my co-pays (which, like Scott's ran hundreds of dollars a month), they were not in Florida (even when I had insurance). The income restrictions were 300%; when I finally found a career job in Jan of 04, they didn't offer insurance, so I worked a $65,000 per year job for $30,000. When they closed that store, my unemployment was too low to cover both my rent and car payment/insurance/gas, so I lost my car, which further restricted my employment opportunities.
I've worked mostly in a bar for the last four years, after a 25+ year career selling, designing and merchandising high-end/custom furniture. The bar work is highly problematic for the administrators of RW/ADAP/Medicare in the county where I live (Broward) because it's completely unverifiable, and I'm required to provide all bank statements, leases, utility bills, pay stubs, etc every six months to determine if I'm still "poor" enough to qualify. The county clinics are day-long time wasters in hot, dirty, ugly facilities, and the county pharmacies involve three bus transfers each way, which is another day wasted.
It also goes without saying that my neurological, dermatological, GI, Mental Health and chronic pain issues are not addressed by the county at any level whatsoever.
One last thing: Once, while in a battle with my insurance company in Connecticut over whether or not a certain $850 bill had been pre-approved or not, I had my pharmacist print out the full retail cost of all my meds: AVs, GI, pain, psych, etc. The monthly cost of my medication was almost $7000, and that was in 2002.
I have lived with HIV for over 26 years and have been on meds since 1996. Until 2003 I had private insurance and, generally, my care was excellent. I had access to specialists to treat not just the HIV but all the health issues one who has lived long-term with the virus is likely to have (neurological and GI issues, dermatological stuff, etc.).
The side effects of the early versions of the meds, especially in the mid-late 90s, could range from debilitating (chronic, "garden-hose" diarrhea with little or no warning) to really annoying (odd numbness in the extremities, ringing in the ears, etc). I was incredibly lucky to have worked for people who understood that some days would be better for me than others; only briefly (about six months) did I work for a corporation (not an individual entrepreneur) which took issue with the flexibilities my schedule required. In addition to coping with side-effects and associated issues, there was the sheer volume of doctor's appointments and tests which could not all be scheduled around my job.
People who live and work with HIV are square pegs for the round holes offered as employment by private corporations: in addition to all the other things I listed above, there are issues involving mental health (beginning with chronic depression, for starters) that not just effect one's ability to work effectively in certain environments, but, again, are likely to require scheduling flexibility and additional medications. We also drive up the cost of insurance in anything but the biggest pools, so there are strong incentives for people living with HIV to find work with individual entrepreneurs (like what I still do), work for non-profits or work for themselves. Most corporations find us unemployable.
Aside from issues related to work, there are other enormous incentives for guys who can work to go on disability: the primary being access to quality health care through Medicare, which, for the time being, is comparable to the best gold-plated private insurance plan. And because it is a Federally-run program, the care one gets on Medicare in Maine is the same care as one gets in California (presuming the doctors are comparable: the benefits are identical nationwide). I know at least a dozen guys (probably more) who are fit and as able to work as anybody in theory, but who cannot return to work because of the quality of the care they get on Medicare, aside from the fact that they have special needs regarding scheduling, etc.
In order to be eligible for SSDI and Medicare, though, one must be provably poor, with no cash or assets. Those not immediately poor enough are allowed "spend-down" time to rid themselves of as many assets as are required in order to meet eligibility standards. And, of course, one must have the right doctor and the right lawyer to assist you, because the process is expensive, time-consuming and pretty complicated for the layman. I, myself, attempted to file in 2002 when I was going through an especially rough patch medically (at one point I actually flat-lined), but my application was denied: shoulda got myself a lawyer
The alternative to SSDI/Medicare is for the working poor or anyone else who does not have insurance but is not "sick" enough yet. That is the patchwork of programs described by FuzzyKen and which I'll give some more details on. Though most of the funds discussed below are Federal, they are administered by each state, which is where you're apt to find discrepancies.
The first of these programs is Medicaid, which is not Medicare, though they sound really similar. Medicaid was originally set up for kids and their mothers in the 1960s and has grown over the years into a nearly-incomprehensible and insanely complicated network of funding for all kinds of medical services for those without insurance; the actual funds are party Federal and partly State/Local.
Because of eccentricities both in the law and at each local level, some places are better to live than others who require Medicaid. The laws determining eligibility and level of service are all State-level, and within each state, there are asymmetries, with some cities and/or counties offering more comprehensive care than others.
The Ryan White CARE Act was set up in the 80s to help states cope with the extra burden HIV/AIDS imposed on their health care budgets. But because of the way tax-money is disbursed through Congress, it needs to be continuously re-approved (it's an Ear-Mark, not an Entitlement) and is only ever meant to be used as emergency funds. It is entirely Federal money but is administered on a state level based, in part, on what they request from Congress. Go-it-alone states (Utah springs immediately to mind) get very little Ryan White money to begin with and is draconian in how, when and for whom it gets used. Other states, New York and California, especially, have enormous Ryan White budgets and very different criteria by which the money is spent. In some states, like Florida, it is administered on a county level.
When AZT was first available, it was insanely expensive (anti-retrovirals still are), so ADAP (AIDS Drug Assistance Programs) was added into Ryan White specifically to cover the cost of the meds (only), though in practice both Ryan White and ADAP funds are used for things which may or may not be considered either emergency services nor strictly medications, either.
ADAP is administered separately from Ryan White (though they are effectively part of the same program) and the formularies of available medications vary drastically from state to state. Not every anti-retroviral is required by the feds to be available on every formulary, though at least one medication per class of drug is (there are, I believe, currently four classes of meds currently available, with a fifth on the way). Some ADAPs offer meds that help cope with side-effects, psych meds and pain meds, others do not.
It will probably shock most people to know that there are currently over 2300 Americans living on ADAP waiting lists, who need meds but cannot get them until someone else dies or greater funds are approved by Congress. People living with HIV/AIDS have been living on Sarah Palin's otherwise fictitious "death panels" for at least 20 years!
Since each state administers its Medicaid, RW and ADAPs differently, the criteria for eligibility varies enormously from state to state (sometimes county to county), and bear in mind that, unlike Medicare/SSDI recipients, these people are still working. Last time I checked, Federal Poverty Line (FPL) was set at just over $10,000 per year. Some states had elegibility standards as low as 150% of FPL, meaning anyone earning more than that was "too rich" to receive any benefits under RW/ADAP (sometimes even Medicaid, which doesn't pay for the meds either way); New York had the highest standard at 500%, but that's probably been changed by now.
In October 2003, when I lost my private insurance, I became intimately familiar with the public health care system in Florida. Back in Massachusetts and Connecticut (where I lived for four years between 99 and 03), RW funds covered my co-pays (which, like Scott's ran hundreds of dollars a month), they were not in Florida (even when I had insurance). The income restrictions were 300%; when I finally found a career job in Jan of 04, they didn't offer insurance, so I worked a $65,000 per year job for $30,000. When they closed that store, my unemployment was too low to cover both my rent and car payment/insurance/gas, so I lost my car, which further restricted my employment opportunities.
I've worked mostly in a bar for the last four years, after a 25+ year career selling, designing and merchandising high-end/custom furniture. The bar work is highly problematic for the administrators of RW/ADAP/Medicare in the county where I live (Broward) because it's completely unverifiable, and I'm required to provide all bank statements, leases, utility bills, pay stubs, etc every six months to determine if I'm still "poor" enough to qualify. The county clinics are day-long time wasters in hot, dirty, ugly facilities, and the county pharmacies involve three bus transfers each way, which is another day wasted.
It also goes without saying that my neurological, dermatological, GI, Mental Health and chronic pain issues are not addressed by the county at any level whatsoever.
One last thing: Once, while in a battle with my insurance company in Connecticut over whether or not a certain $850 bill had been pre-approved or not, I had my pharmacist print out the full retail cost of all my meds: AVs, GI, pain, psych, etc. The monthly cost of my medication was almost $7000, and that was in 2002.
Bbucko
Cherished Member
- Joined
- Oct 28, 2006
- Posts
- 7,232
- Media
- 8
- Likes
- 326
- Points
- 208
- Location
- Sunny SoFla
- Sexuality
- 90% Gay, 10% Straight
- Gender
- Male
Two other things I really should have posted above, but which probably have gotten lost in the wall of text anyway:
1) My sincerest and warmest thanks to Scott and TomCat for "coming out poz" in this thread. Aside from NakedWally (who doesn't even post here anymore, I don't believe), we are the only three HIV+ members who are open about it whom I'm aware of. You will undoubtedly be made a target for a troll or two, but your courage and frankness are extremely appreciated.
2) The best places to get current, up-to-the-minute info on HIV/AIDS treatment and the politics of its delivery are:
*The Henry J Kaiser Family Foundation: the best spot on the web for all matters related to health care in the US, bar none;
*AIDSmeds.com: I was once much more heavily involved with these folks than I am currently, though I'm still an active member I rarely post any more (political issues once they were purchased by POZ magazine and subsequent changes in the direction of the moderation, including the banning of some high-info posters). But their info pages are the best, latest and most comprehensive on transmission, testing, risk assessment, etc, and their overview of available medications is simply the best available online;
*ADAP Advocacy Association (aaa+): a non-profit group that operates yearly conferences specifically regarding ADAP issues (the only ones in the country that do so in that specialty), the CEO is a personal friend of mine and former employer who is HIV+. Anyone with an interest in ADAP needs to visit them often (and a donation, though not required for membership, would be appreciated).
I would avoid US Federal Agency websites for the time being; they were disastrous during the Bush administrations and full of contradictory (and occasionally flat-out incorrect) info, especially in risk assessment. Remember, the chief AIDS prevention strategy of those years was "abstinence only". I do not know to what degree they've been cleaned up and corrected. But last I checked (shortly after the election in 08), the CDC and NIH websites were deeply flawed.
The Body is another website I'd avoid: they do not always give the best advice and do not have all their facts straight on many occasions. Regardless of your own personal experiences with them which may have been overall positive, as someone who has been on the "inside" of internet access to reliable, agenda-free info on HIV/AIDS for over five years, I gotta say that you should give them a pass.
1) My sincerest and warmest thanks to Scott and TomCat for "coming out poz" in this thread. Aside from NakedWally (who doesn't even post here anymore, I don't believe), we are the only three HIV+ members who are open about it whom I'm aware of. You will undoubtedly be made a target for a troll or two, but your courage and frankness are extremely appreciated.
2) The best places to get current, up-to-the-minute info on HIV/AIDS treatment and the politics of its delivery are:
*The Henry J Kaiser Family Foundation: the best spot on the web for all matters related to health care in the US, bar none;
*AIDSmeds.com: I was once much more heavily involved with these folks than I am currently, though I'm still an active member I rarely post any more (political issues once they were purchased by POZ magazine and subsequent changes in the direction of the moderation, including the banning of some high-info posters). But their info pages are the best, latest and most comprehensive on transmission, testing, risk assessment, etc, and their overview of available medications is simply the best available online;
*ADAP Advocacy Association (aaa+): a non-profit group that operates yearly conferences specifically regarding ADAP issues (the only ones in the country that do so in that specialty), the CEO is a personal friend of mine and former employer who is HIV+. Anyone with an interest in ADAP needs to visit them often (and a donation, though not required for membership, would be appreciated).
I would avoid US Federal Agency websites for the time being; they were disastrous during the Bush administrations and full of contradictory (and occasionally flat-out incorrect) info, especially in risk assessment. Remember, the chief AIDS prevention strategy of those years was "abstinence only". I do not know to what degree they've been cleaned up and corrected. But last I checked (shortly after the election in 08), the CDC and NIH websites were deeply flawed.
The Body is another website I'd avoid: they do not always give the best advice and do not have all their facts straight on many occasions. Regardless of your own personal experiences with them which may have been overall positive, as someone who has been on the "inside" of internet access to reliable, agenda-free info on HIV/AIDS for over five years, I gotta say that you should give them a pass.
Bbucko, I just wanted to thank you again, publicly, for your post. This is the kind of issue and discussion that this site can take pride in presenting, one that actually informs people, and tells them what's available to them.
Thank you!
When I lived in Sydney, Australia, I knew a few dudes I suspected as having HIV. They all seemed to live so wildly. I couldn't figure it out. They were killing themselves and it made me very sad.
Bbucko
Cherished Member
- Joined
- Oct 28, 2006
- Posts
- 7,232
- Media
- 8
- Likes
- 326
- Points
- 208
- Location
- Sunny SoFla
- Sexuality
- 90% Gay, 10% Straight
- Gender
- Male
Not everyone who is HIV+ is a self-destructive sociopath, but it's been estimated that upwards of 80% of everyone living with HIV has some sort of Mental Health issue, even excluding chronic depression.
We tend to be much less risk-averse than the average person, and a high proportion of recently-infected people have issues with substance dependency issues. Bear in mind that the riskiest activity for transmission is sharing IV drug works; second is unprotected anal sex with an HIV infected person. Why needle-exchange programs are still so controversial is completely beyond me: it's not about condoning illegal drug activity, it's about saving lives and the enormous monetary cost in doing so (on a strictly pragmatic level).
People also go through different periods in their lives that are more inherently stable than others. Despite the numerous (and frequently toxic) problems I had in my last relationship, it offered me a ground-base with which I could maintain as healthy, centered and balanced a lifestyle as possible. I even gave up alcohol completely for four years, though have since re-introduced it back into my life.
NB: I am not an alcoholic, nor was my decision to abstain from alcohol suggested to me by my doctor(s): it was strictly a personal choice.
My life now is much less certain and constrained as a single man than it was when I was partnered. Though I don't always make the best of choices (who really does, consistently?) I live a life that suits me right now. Though this does not include use of illicit drugs, I doubt fewer than 15% of my friends and associates choose to abstain from them entirely, whether poz or neg.
In the end, we all live with the consequences of our actions. Those amongst us who live with HIV are reminded of that every single day, and that reminder is often highly stressful. While I don't necessarily condone the bad choices some people make in their lives, I don't find it my place to criticize them for it any more than I choose to emulate it.
- Joined
- Feb 6, 2006
- Posts
- 209
- Media
- 8
- Likes
- 274
- Points
- 218
- Location
- Liverpool (England)
- Sexuality
- 69% Gay, 31% Straight
- Gender
- Male
Of course many folks with HIV have mental issues. How can they not? Non-ill folks easily have mental issues. (I have mine for sure.)
No, not every person who is HIV+ is a self-destructive sociopath. That really wasn't my point. But many are self-destructive (I would take out the word "sociopath"). That said, I know the stereotypes of gay men with HIV are ugly, but the more enlightened folk in the world make efforts to look beyond them and ponder the mental and physical anguish of those who are ill.
Both of maternal grandparents always refused to quit smoking - a very self-destructive behavior. Ultimately, it was their decision, but a most poor one, and one that cost them their lives.
When we care about people, we don't like them engaging in self-destructive behaviors. It's really that simple. But, again, we can't tell an adult what he can and cannot do, as long as he's not hurting others.
As compassion is one of the most incredible virtues, I extend great love and healing to all of those who suffer on this thread.
Peace:smile:
Last edited:
- Joined
- Feb 6, 2006
- Posts
- 209
- Media
- 8
- Likes
- 274
- Points
- 218
- Location
- Liverpool (England)
- Sexuality
- 69% Gay, 31% Straight
- Gender
- Male
I have now gotten back from a very long and exhausting day.
I should like to thank Bbucko for a very full detailed and personal account of the ordeal that is involved of jumping through the administrative hoops to get the treatment and support that is so essential for anyone who is sick through what is at the end of the day no fault of their own.
Iseems to me just crimial that the system seems to ensure that people who could otherwise be economically active or be able to contribute in so what are forced to essentially put them selves on the scrape heap - is it any surprise that some feel destructive.
Thank you again.
I should like to thank Bbucko for a very full detailed and personal account of the ordeal that is involved of jumping through the administrative hoops to get the treatment and support that is so essential for anyone who is sick through what is at the end of the day no fault of their own.
Iseems to me just crimial that the system seems to ensure that people who could otherwise be economically active or be able to contribute in so what are forced to essentially put them selves on the scrape heap - is it any surprise that some feel destructive.
Thank you again.
- Joined
- Feb 6, 2006
- Posts
- 209
- Media
- 8
- Likes
- 274
- Points
- 218
- Location
- Liverpool (England)
- Sexuality
- 69% Gay, 31% Straight
- Gender
- Male
I have been passed this information from Victoria - Australia
HIV/AIDS Victorian HIV/AIDS Strategy 2002-2004 and Addendum 2005-2009
The first Victorian HIV/AIDS Strategy (2002–2004) was formulated within the framework of the fourth National HIV/AIDS Strategy (1999–2000 to 2003–2004) and was endorsed as a whole of Victorian government document.
It guided the public health and acute care responses and was the basis of the community and service providers' partnership in relation to HIV/AIDS during 2002–2004. The key outcomes of that strategy are discussed in “An overview of the Victorian HIV/AIDS Strategy (2002–2004)”, in the document below.
With the end of the term of the strategy on 31 December 2004, the Ministerial Advisory Committee on Blood-borne and Sexually Transmissible Infections advised that the priority activities identified in the strategy remained current and that the document did not need to be rewritten. However, the committee identified a number of new and emerging issues to be addressed by government and the funded sector.
As such, the Victorian HIV/AIDS Strategy 2002–2004 and Addendum 2005–2009 is comprised of the text of the Victorian HIV/AIDS Strategy (2002–2004) and the following additional priority issues:
and the following link which has an addendum for 2009
http://www.health.vic.gov.au/__data/assets/pdf_file/0011/19937/hiv_strategy_05-09.pdf
HIV/AIDS Victorian HIV/AIDS Strategy 2002-2004 and Addendum 2005-2009
The first Victorian HIV/AIDS Strategy (2002–2004) was formulated within the framework of the fourth National HIV/AIDS Strategy (1999–2000 to 2003–2004) and was endorsed as a whole of Victorian government document.
It guided the public health and acute care responses and was the basis of the community and service providers' partnership in relation to HIV/AIDS during 2002–2004. The key outcomes of that strategy are discussed in “An overview of the Victorian HIV/AIDS Strategy (2002–2004)”, in the document below.
With the end of the term of the strategy on 31 December 2004, the Ministerial Advisory Committee on Blood-borne and Sexually Transmissible Infections advised that the priority activities identified in the strategy remained current and that the document did not need to be rewritten. However, the committee identified a number of new and emerging issues to be addressed by government and the funded sector.
As such, the Victorian HIV/AIDS Strategy 2002–2004 and Addendum 2005–2009 is comprised of the text of the Victorian HIV/AIDS Strategy (2002–2004) and the following additional priority issues:
- Improve the recording of Indigenous status in blood-borne virus (BBV) and sexually transmissible infection (STI) notifications;
- Refocus HIV/AIDS health promotion efforts to encourage testing and treatment for HIV and STIs;
- Ensure the direct involvement of HIV positive people in HIV prevention and education strategies;
- Focus on the needs of and issues faced by an ageing population of people living with HIV/AIDS;
- Focus on the BBV/STI needs of Indigenous people in custodial settings;
- Increase the capacity of culturally and linguistically diverse communities most affected by HIV/AIDS to contribute to policy and program development and implementation;
- Improve HIV/AIDS monitoring, treatment, education and support for people in custodial settings;
- Provide education and access to appropriate health services for Indigenous and culturally and linguistically diverse youth; and
- Develop comprehensive service delivery pathways spanning urban, regional and rural areas.
and the following link which has an addendum for 2009
http://www.health.vic.gov.au/__data/assets/pdf_file/0011/19937/hiv_strategy_05-09.pdf
- Joined
- Feb 6, 2006
- Posts
- 209
- Media
- 8
- Likes
- 274
- Points
- 218
- Location
- Liverpool (England)
- Sexuality
- 69% Gay, 31% Straight
- Gender
- Male
Also I am informed that in Auz they have what is called the
Pharmaceutical Benefit Scheme (PBS)
What is the PBS?
The PBS Schedule lists all of the medicines available to be dispensed to patients at a Government-subsidised price. The Schedule is part of the wider Pharmaceutical Benefits Scheme managed by the Department of Health and Ageing and administered by Medicare Australia.
This schedule is now on-line and updated on a monthly basis. This on-line searchable version contains:
Who is eligible for the PBS?
The Scheme is available to all Australian residents who hold a current Medicare Medicare
card.
Overseas visitors from countries with which Australia has a Reciprocal Health Care Agreement (RHCA) are also eligible to access the Scheme. Australia currently has RHCAs with: Italy, New Zealand, the Republic of Ireland, Finland, Malta, the Netherlands, Sweden, Norway, the United Kingdom and Belgium.
Residents of these countries must show their passports when lodging a prescription to prove their eligibility or they can contact Medicare and get a Reciprocal Health Care Agreement Card to prove their eligibility. Some overseas visitors may not be eligible for this card.
Only those eligible for the PBS will receive subsidised medication and every time you present your script to the pharmacist, you will need to provide your Medicare card.
Eligible veterans may need to present their DVA card in addition to their Medicare card.
With your consent, the pharmacist may (at their discretion) keep a record of your Medicare number so that you do not have to show the actual card every time you lodge a script.
What is the RPBS?
The Repatriation Pharmaceutical Benefits Scheme (RPBS) is subsidised by the Department of Veterans’ Affairs, and can be used by veterans who have DVA White, Gold or Orange Card.
If you hold one of these cards then you are eligible for all PBS medicines, and other medicines listed on the RPBS, depending on your DVA entitlement. All medicines supplied under the RPBS are dispensed at the concessional rate (or free if the patient has reached their Safety Net threshold).
DVA white card entitles you to RPBS and PBS medicines at the concessional rate for a specific medical condition (which is at your doctor’s discretion). You can receive all other PBS medicines at the general rate.
DVA gold and orange cards entitle you to all RPBS and PBS medicines at the concessional rate.
What is the Dental Schedule?
Dentists are not able to prescribe general PBS items, but have a separate Dental Schedule from which they can prescribe dental care medicines for their patients.
What is the Optometrical Schedule?
Optometrists are not able to prescribe general PBS items, but have a separate Optometrical Schedule from which they can prescribe eye care medicines for their patients.
Who is eligible for a concession?
To be eligible for a concessional benefit, you will have one of the following concession cards:
Centrelink is responsible for the issue and administration of the Pensioner Concession Card, the Commonwealth Seniors Health Card and Health Care Cards.
DVA DVA
are responsible for White, Gold and Orange Cards.
There is also a DVA Pension Card which entitles holders to PBS medicines at the concessional rate (but not RPBS medicines).
General benefits apply if you do not have any of the above cards.
What are the current patient fees and charges?
Patient co-payments
The co-payment is the amount you pay towards the cost of your PBS medicine. Many PBS medicines cost a lot more than you actually pay as a co-payment.
From 1 January 2010, you pay up to $33.30 for most PBS medicines or $5.40 if you have a concession card. The Australian Government pays the remaining cost.
The amount of co-payment is adjusted on 1 January each year in line with the Consumer Price Index (CPI).
Safety Net
On 1 January 2010, the Safety Net thresholds changed from $318.00 to $324.00 (for concession card holders) and from $1,264.90 to $1,281.30 (for all other patients). These increases include the usual annual CPI indexation. A similar increase has occurred each year for four years (commencing in 2006). The 2009 thresholds include eight additional copayments compared with the 2005 thresholds.
The same general or concessional Safety Net threshold is applied to a family unit regardless of whether the unit consists of an individual, a couple or a family with dependent children. To be included in the same Safety Net family, the partners of a couple may be married or de facto, and of the same or opposite sex. A couple must be living together on a permanent basis, unless living separately due to illness.
After reaching the Safety Net threshold, general patients pay for further PBS prescriptions at the concessional co-payment rate and concession card holders are dispensed PBS prescriptions at no further charge for the remainder of that calendar year. In order to access the Safety Net arrangements, you need to maintain records of your PBS expenditure on a Prescription Record Form. These are available from all pharmacies.
A Safety Net Entitlement card or Safety Net Concession Card can be issued by the pharmacist once the threshold is reached.
For further information about drugs listed on the PBS and Safety Net arrangements, ask your pharmacist, contact the PBS Information Line on 1800 020 613 (free call) or collect a brochure at your nearest Medicare office.
Public Hospitals and the Safety Net
The Safety Net threshold may be reached using scripts filled at both community pharmacies and out-patient pharmacies at public hospitals – this is called the joint Safety Net. From 1 January 2010, the contribution rate for general patients as outpatients at public hospitals in most states and territories in Australia is $26.60. In Queensland and in hospitals in states participating in the pharmaceutical reforms, patients pay the Safety Net value of an item when it is listed in the Pharmaceutical Benefits Scheme, and a maximum of $33.30 for items not listed in the schedule.
In public hospitals from 1 January 2010, concessional patients pay a maximum of $5.40 – except in South Australia where Department of Veterans’ Affairs (DVA) card holders are treated as general patients, and in New South Wales, where DVA White Card holders are treated as general patients.
These amounts are adjusted on 1 January each year.
Items that are priced below the general patient co-payment
For general patients, an allowable additional patient charge can apply. The allowable additional patient charge is a discretionary charge to general patients if a pharmaceutical item has a dispensed price for maximum quantity less than the general patient co-payment. The pharmacist may charge general patients the allowable additional fee but the fee cannot take the cost of the prescription above the general patient co-payment for the medicine.
The maximum fee is currently $3.83 and is adjusted on 1 January each year. This fee does not count towards your Safety Net threshold.
Additional fee for ready prepared items
In addition, if a medicine has a ‘dispensed price for maximum quantity’ less than the general co-payment a safety net recording fee may be charged by your pharmacist. This fee may not take the cost of your script above the co-payment.
Concessional patients do not pay this fee.
This fee is currently $1.05 and is adjusted on 1 August each year. The amount of this fee does count towards your Safety Net threshold.
What is a Price premium?
A price premium or brand premium, may apply to some medicines.
Where there are two or more brands of the same drug on the Schedule, the Government subsidises each brand to the same amount - up to the cost of the lowest priced brand.
If you are taking a more expensive brand the price difference is paid by you as a brand premium. This cost is in addition to your co-payment.
At your request, the pharmacist may be able to substitute a less expensive brand where your doctor has allowed this. If you have any concerns, you should talk to your doctor or pharmacist.
Pharmacists are legally required to charge brand premiums. The brand premium does not count towards the safety net threshold.
Pharmaceutical Benefit Scheme (PBS)
- What is the PBS?
- Who is eligible for the PBS?
- What is the RPBS?
- What is the Dental Schedule?
- What is the Optometrical Schedule?
- Who is eligible for a concession?
- What are the current patient fees and charges?
- Where can I find more information?
What is the PBS?
The PBS Schedule lists all of the medicines available to be dispensed to patients at a Government-subsidised price. The Schedule is part of the wider Pharmaceutical Benefits Scheme managed by the Department of Health and Ageing and administered by Medicare Australia.
This schedule is now on-line and updated on a monthly basis. This on-line searchable version contains:
- All of the drugs listed on the PBS
- Information on the conditions of use for the prescribing of PBS medicines
- Detailed consumer information for medicines that have been prescribed by your doctor or dentist;
- What you can expect to pay for medicines.
Who is eligible for the PBS?
The Scheme is available to all Australian residents who hold a current Medicare Medicare
card.
Overseas visitors from countries with which Australia has a Reciprocal Health Care Agreement (RHCA) are also eligible to access the Scheme. Australia currently has RHCAs with: Italy, New Zealand, the Republic of Ireland, Finland, Malta, the Netherlands, Sweden, Norway, the United Kingdom and Belgium.
Residents of these countries must show their passports when lodging a prescription to prove their eligibility or they can contact Medicare and get a Reciprocal Health Care Agreement Card to prove their eligibility. Some overseas visitors may not be eligible for this card.
Only those eligible for the PBS will receive subsidised medication and every time you present your script to the pharmacist, you will need to provide your Medicare card.
Eligible veterans may need to present their DVA card in addition to their Medicare card.
With your consent, the pharmacist may (at their discretion) keep a record of your Medicare number so that you do not have to show the actual card every time you lodge a script.
What is the RPBS?
The Repatriation Pharmaceutical Benefits Scheme (RPBS) is subsidised by the Department of Veterans’ Affairs, and can be used by veterans who have DVA White, Gold or Orange Card.
If you hold one of these cards then you are eligible for all PBS medicines, and other medicines listed on the RPBS, depending on your DVA entitlement. All medicines supplied under the RPBS are dispensed at the concessional rate (or free if the patient has reached their Safety Net threshold).
DVA white card entitles you to RPBS and PBS medicines at the concessional rate for a specific medical condition (which is at your doctor’s discretion). You can receive all other PBS medicines at the general rate.
DVA gold and orange cards entitle you to all RPBS and PBS medicines at the concessional rate.
What is the Dental Schedule?
Dentists are not able to prescribe general PBS items, but have a separate Dental Schedule from which they can prescribe dental care medicines for their patients.
What is the Optometrical Schedule?
Optometrists are not able to prescribe general PBS items, but have a separate Optometrical Schedule from which they can prescribe eye care medicines for their patients.
Who is eligible for a concession?
To be eligible for a concessional benefit, you will have one of the following concession cards:
- Pensioner Concession Card;
- Commonwealth Seniors Health Card;
- Health Care Card; or
- DVA White, Gold, or Orange Card.
Centrelink is responsible for the issue and administration of the Pensioner Concession Card, the Commonwealth Seniors Health Card and Health Care Cards.
DVA DVA
are responsible for White, Gold and Orange Cards.
There is also a DVA Pension Card which entitles holders to PBS medicines at the concessional rate (but not RPBS medicines).
General benefits apply if you do not have any of the above cards.
What are the current patient fees and charges?
Patient co-payments
The co-payment is the amount you pay towards the cost of your PBS medicine. Many PBS medicines cost a lot more than you actually pay as a co-payment.
From 1 January 2010, you pay up to $33.30 for most PBS medicines or $5.40 if you have a concession card. The Australian Government pays the remaining cost.
The amount of co-payment is adjusted on 1 January each year in line with the Consumer Price Index (CPI).
Safety Net
On 1 January 2010, the Safety Net thresholds changed from $318.00 to $324.00 (for concession card holders) and from $1,264.90 to $1,281.30 (for all other patients). These increases include the usual annual CPI indexation. A similar increase has occurred each year for four years (commencing in 2006). The 2009 thresholds include eight additional copayments compared with the 2005 thresholds.
The same general or concessional Safety Net threshold is applied to a family unit regardless of whether the unit consists of an individual, a couple or a family with dependent children. To be included in the same Safety Net family, the partners of a couple may be married or de facto, and of the same or opposite sex. A couple must be living together on a permanent basis, unless living separately due to illness.
After reaching the Safety Net threshold, general patients pay for further PBS prescriptions at the concessional co-payment rate and concession card holders are dispensed PBS prescriptions at no further charge for the remainder of that calendar year. In order to access the Safety Net arrangements, you need to maintain records of your PBS expenditure on a Prescription Record Form. These are available from all pharmacies.
A Safety Net Entitlement card or Safety Net Concession Card can be issued by the pharmacist once the threshold is reached.
For further information about drugs listed on the PBS and Safety Net arrangements, ask your pharmacist, contact the PBS Information Line on 1800 020 613 (free call) or collect a brochure at your nearest Medicare office.
Public Hospitals and the Safety Net
The Safety Net threshold may be reached using scripts filled at both community pharmacies and out-patient pharmacies at public hospitals – this is called the joint Safety Net. From 1 January 2010, the contribution rate for general patients as outpatients at public hospitals in most states and territories in Australia is $26.60. In Queensland and in hospitals in states participating in the pharmaceutical reforms, patients pay the Safety Net value of an item when it is listed in the Pharmaceutical Benefits Scheme, and a maximum of $33.30 for items not listed in the schedule.
In public hospitals from 1 January 2010, concessional patients pay a maximum of $5.40 – except in South Australia where Department of Veterans’ Affairs (DVA) card holders are treated as general patients, and in New South Wales, where DVA White Card holders are treated as general patients.
These amounts are adjusted on 1 January each year.
Items that are priced below the general patient co-payment
For general patients, an allowable additional patient charge can apply. The allowable additional patient charge is a discretionary charge to general patients if a pharmaceutical item has a dispensed price for maximum quantity less than the general patient co-payment. The pharmacist may charge general patients the allowable additional fee but the fee cannot take the cost of the prescription above the general patient co-payment for the medicine.
The maximum fee is currently $3.83 and is adjusted on 1 January each year. This fee does not count towards your Safety Net threshold.
Additional fee for ready prepared items
In addition, if a medicine has a ‘dispensed price for maximum quantity’ less than the general co-payment a safety net recording fee may be charged by your pharmacist. This fee may not take the cost of your script above the co-payment.
Concessional patients do not pay this fee.
This fee is currently $1.05 and is adjusted on 1 August each year. The amount of this fee does count towards your Safety Net threshold.
What is a Price premium?
A price premium or brand premium, may apply to some medicines.
Where there are two or more brands of the same drug on the Schedule, the Government subsidises each brand to the same amount - up to the cost of the lowest priced brand.
If you are taking a more expensive brand the price difference is paid by you as a brand premium. This cost is in addition to your co-payment.
At your request, the pharmacist may be able to substitute a less expensive brand where your doctor has allowed this. If you have any concerns, you should talk to your doctor or pharmacist.
Pharmacists are legally required to charge brand premiums. The brand premium does not count towards the safety net threshold.
Last edited:
- Joined
- Feb 6, 2006
- Posts
- 209
- Media
- 8
- Likes
- 274
- Points
- 218
- Location
- Liverpool (England)
- Sexuality
- 69% Gay, 31% Straight
- Gender
- Male
Also I am informed that in Auz they have what is called the
Pharmaceutical Benefit Scheme (PBS)
The PBS Schedule lists all of the medicines available to be dispensed to patients at a Government-subsidised price. The Schedule is part of the wider Pharmaceutical Benefits Scheme managed by the Department of Health and Ageing and administered by Medicare Australia.
This schedule is now on-line and updated on a monthly basis. This on-line searchable version contains:
Who is eligible for the PBS?
The Scheme is available to all Australian residents who hold a current Medicare Medicare
card.
Overseas visitors from countries with which Australia has a Reciprocal Health Care Agreement (RHCA) are also eligible to access the Scheme. Australia currently has RHCAs with: Italy, New Zealand, the Republic of Ireland, Finland, Malta, the Netherlands, Sweden, Norway, the United Kingdom and Belgium.
Residents of these countries must show their passports when lodging a prescription to prove their eligibility or they can contact Medicare and get a Reciprocal Health Care Agreement Card to prove their eligibility. Some overseas visitors may not be eligible for this card.
Only those eligible for the PBS will receive subsidised medication and every time you present your script to the pharmacist, you will need to provide your Medicare card.
Eligible veterans may need to present their DVA card in addition to their Medicare card.
With your consent, the pharmacist may (at their discretion) keep a record of your Medicare number so that you do not have to show the actual card every time you lodge a script.
What is the RPBS?
The Repatriation Pharmaceutical Benefits Scheme (RPBS) is subsidised by the Department of Veterans Affairs, and can be used by veterans who have DVA White, Gold or Orange Card.
If you hold one of these cards then you are eligible for all PBS medicines, and other medicines listed on the RPBS, depending on your DVA entitlement. All medicines supplied under the RPBS are dispensed at the concessional rate (or free if the patient has reached their Safety Net threshold).
DVA white card entitles you to RPBS and PBS medicines at the concessional rate for a specific medical condition (which is at your doctors discretion). You can receive all other PBS medicines at the general rate.
DVA gold and orange cards entitle you to all RPBS and PBS medicines at the concessional rate.
What is the Dental Schedule?
Dentists are not able to prescribe general PBS items, but have a separate Dental Schedule from which they can prescribe dental care medicines for their patients.
What is the Optometrical Schedule?
Optometrists are not able to prescribe general PBS items, but have a separate Optometrical Schedule from which they can prescribe eye care medicines for their patients.
Who is eligible for a concession?
To be eligible for a concessional benefit, you will have one of the following concession cards:
Centrelink is responsible for the issue and administration of the Pensioner Concession Card, the Commonwealth Seniors Health Card and Health Care Cards.
DVA
DVA
are responsible for White, Gold and Orange Cards.
There is also a DVA Pension Card which entitles holders to PBS medicines at the concessional rate (but not RPBS medicines).
General benefits apply if you do not have any of the above cards.
What are the current patient fees and charges?
Patient co-payments
The co-payment is the amount you pay towards the cost of your PBS medicine. Many PBS medicines cost a lot more than you actually pay as a co-payment.
From 1 January 2010, you pay up to $33.30 for most PBS medicines or $5.40 if you have a concession card. The Australian Government pays the remaining cost.
The amount of co-payment is adjusted on 1 January each year in line with the Consumer Price Index (CPI).
Safety Net
On 1 January 2010, the Safety Net thresholds changed from $318.00 to $324.00 (for concession card holders) and from $1,264.90 to $1,281.30 (for all other patients). These increases include the usual annual CPI indexation. A similar increase has occurred each year for four years (commencing in 2006). The 2009 thresholds include eight additional copayments compared with the 2005 thresholds.
The same general or concessional Safety Net threshold is applied to a family unit regardless of whether the unit consists of an individual, a couple or a family with dependent children. To be included in the same Safety Net family, the partners of a couple may be married or de facto, and of the same or opposite sex. A couple must be living together on a permanent basis, unless living separately due to illness.
After reaching the Safety Net threshold, general patients pay for further PBS prescriptions at the concessional co-payment rate and concession card holders are dispensed PBS prescriptions at no further charge for the remainder of that calendar year. In order to access the Safety Net arrangements, you need to maintain records of your PBS expenditure on a Prescription Record Form. These are available from all pharmacies.
A Safety Net Entitlement card or Safety Net Concession Card can be issued by the pharmacist once the threshold is reached.
For further information about drugs listed on the PBS and Safety Net arrangements, ask your pharmacist, contact the PBS Information Line on 1800 020 613 (free call) or collect a brochure at your nearest Medicare office.
Public Hospitals and the Safety Net
The Safety Net threshold may be reached using scripts filled at both community pharmacies and out-patient pharmacies at public hospitals this is called the joint Safety Net. From 1 January 2010, the contribution rate for general patients as outpatients at public hospitals in most states and territories in Australia is $26.60. In Queensland and in hospitals in states participating in the pharmaceutical reforms, patients pay the Safety Net value of an item when it is listed in the Pharmaceutical Benefits Scheme, and a maximum of $33.30 for items not listed in the schedule.
In public hospitals from 1 January 2010, concessional patients pay a maximum of $5.40 except in South Australia where Department of Veterans Affairs (DVA) card holders are treated as general patients, and in New South Wales, where DVA White Card holders are treated as general patients.
These amounts are adjusted on 1 January each year.
Items that are priced below the general patient co-payment
For general patients, an allowable additional patient charge can apply. The allowable additional patient charge is a discretionary charge to general patients if a pharmaceutical item has a dispensed price for maximum quantity less than the general patient co-payment. The pharmacist may charge general patients the allowable additional fee but the fee cannot take the cost of the prescription above the general patient co-payment for the medicine.
The maximum fee is currently $3.83 and is adjusted on 1 January each year. This fee does not count towards your Safety Net threshold.
Additional fee for ready prepared items
In addition, if a medicine has a dispensed price for maximum quantity less than the general co-payment a safety net recording fee may be charged by your pharmacist. This fee may not take the cost of your script above the co-payment.
Concessional patients do not pay this fee.
This fee is currently $1.05 and is adjusted on 1 August each year. The amount of this fee does count towards your Safety Net threshold.
What is a Price premium?
A price premium or brand premium, may apply to some medicines.
Where there are two or more brands of the same drug on the Schedule, the Government subsidises each brand to the same amount - up to the cost of the lowest priced brand.
If you are taking a more expensive brand the price difference is paid by you as a brand premium. This cost is in addition to your co-payment.
At your request, the pharmacist may be able to substitute a less expensive brand where your doctor has allowed this. If you have any concerns, you should talk to your doctor or pharmacist.
Pharmacists are legally required to charge brand premiums. The brand premium does not count towards the safety net threshold.
Pharmaceutical Benefit Scheme (PBS)
- What is the PBS?
- Who is eligible for the PBS?
- What is the RPBS?
- What is the Dental Schedule?
- What is the Optometrical Schedule?
- Who is eligible for a concession?
- What are the current patient fees and charges?
- Where can I find more information?
The PBS Schedule lists all of the medicines available to be dispensed to patients at a Government-subsidised price. The Schedule is part of the wider Pharmaceutical Benefits Scheme managed by the Department of Health and Ageing and administered by Medicare Australia.
This schedule is now on-line and updated on a monthly basis. This on-line searchable version contains:
- All of the drugs listed on the PBS
- Information on the conditions of use for the prescribing of PBS medicines
- Detailed consumer information for medicines that have been prescribed by your doctor or dentist;
- What you can expect to pay for medicines.
Who is eligible for the PBS?
The Scheme is available to all Australian residents who hold a current Medicare Medicare
card.
Overseas visitors from countries with which Australia has a Reciprocal Health Care Agreement (RHCA) are also eligible to access the Scheme. Australia currently has RHCAs with: Italy, New Zealand, the Republic of Ireland, Finland, Malta, the Netherlands, Sweden, Norway, the United Kingdom and Belgium.
Residents of these countries must show their passports when lodging a prescription to prove their eligibility or they can contact Medicare and get a Reciprocal Health Care Agreement Card to prove their eligibility. Some overseas visitors may not be eligible for this card.
Only those eligible for the PBS will receive subsidised medication and every time you present your script to the pharmacist, you will need to provide your Medicare card.
Eligible veterans may need to present their DVA card in addition to their Medicare card.
With your consent, the pharmacist may (at their discretion) keep a record of your Medicare number so that you do not have to show the actual card every time you lodge a script.
What is the RPBS?
The Repatriation Pharmaceutical Benefits Scheme (RPBS) is subsidised by the Department of Veterans Affairs, and can be used by veterans who have DVA White, Gold or Orange Card.
If you hold one of these cards then you are eligible for all PBS medicines, and other medicines listed on the RPBS, depending on your DVA entitlement. All medicines supplied under the RPBS are dispensed at the concessional rate (or free if the patient has reached their Safety Net threshold).
DVA white card entitles you to RPBS and PBS medicines at the concessional rate for a specific medical condition (which is at your doctors discretion). You can receive all other PBS medicines at the general rate.
DVA gold and orange cards entitle you to all RPBS and PBS medicines at the concessional rate.
What is the Dental Schedule?
Dentists are not able to prescribe general PBS items, but have a separate Dental Schedule from which they can prescribe dental care medicines for their patients.
What is the Optometrical Schedule?
Optometrists are not able to prescribe general PBS items, but have a separate Optometrical Schedule from which they can prescribe eye care medicines for their patients.
Who is eligible for a concession?
To be eligible for a concessional benefit, you will have one of the following concession cards:
- Pensioner Concession Card;
- Commonwealth Seniors Health Card;
- Health Care Card; or
- DVA White, Gold, or Orange Card.
Centrelink is responsible for the issue and administration of the Pensioner Concession Card, the Commonwealth Seniors Health Card and Health Care Cards.
DVA
DVA
are responsible for White, Gold and Orange Cards.
There is also a DVA Pension Card which entitles holders to PBS medicines at the concessional rate (but not RPBS medicines).
General benefits apply if you do not have any of the above cards.
What are the current patient fees and charges?
Patient co-payments
The co-payment is the amount you pay towards the cost of your PBS medicine. Many PBS medicines cost a lot more than you actually pay as a co-payment.
From 1 January 2010, you pay up to $33.30 for most PBS medicines or $5.40 if you have a concession card. The Australian Government pays the remaining cost.
The amount of co-payment is adjusted on 1 January each year in line with the Consumer Price Index (CPI).
Safety Net
On 1 January 2010, the Safety Net thresholds changed from $318.00 to $324.00 (for concession card holders) and from $1,264.90 to $1,281.30 (for all other patients). These increases include the usual annual CPI indexation. A similar increase has occurred each year for four years (commencing in 2006). The 2009 thresholds include eight additional copayments compared with the 2005 thresholds.
The same general or concessional Safety Net threshold is applied to a family unit regardless of whether the unit consists of an individual, a couple or a family with dependent children. To be included in the same Safety Net family, the partners of a couple may be married or de facto, and of the same or opposite sex. A couple must be living together on a permanent basis, unless living separately due to illness.
After reaching the Safety Net threshold, general patients pay for further PBS prescriptions at the concessional co-payment rate and concession card holders are dispensed PBS prescriptions at no further charge for the remainder of that calendar year. In order to access the Safety Net arrangements, you need to maintain records of your PBS expenditure on a Prescription Record Form. These are available from all pharmacies.
A Safety Net Entitlement card or Safety Net Concession Card can be issued by the pharmacist once the threshold is reached.
For further information about drugs listed on the PBS and Safety Net arrangements, ask your pharmacist, contact the PBS Information Line on 1800 020 613 (free call) or collect a brochure at your nearest Medicare office.
Public Hospitals and the Safety Net
The Safety Net threshold may be reached using scripts filled at both community pharmacies and out-patient pharmacies at public hospitals this is called the joint Safety Net. From 1 January 2010, the contribution rate for general patients as outpatients at public hospitals in most states and territories in Australia is $26.60. In Queensland and in hospitals in states participating in the pharmaceutical reforms, patients pay the Safety Net value of an item when it is listed in the Pharmaceutical Benefits Scheme, and a maximum of $33.30 for items not listed in the schedule.
In public hospitals from 1 January 2010, concessional patients pay a maximum of $5.40 except in South Australia where Department of Veterans Affairs (DVA) card holders are treated as general patients, and in New South Wales, where DVA White Card holders are treated as general patients.
These amounts are adjusted on 1 January each year.
Items that are priced below the general patient co-payment
For general patients, an allowable additional patient charge can apply. The allowable additional patient charge is a discretionary charge to general patients if a pharmaceutical item has a dispensed price for maximum quantity less than the general patient co-payment. The pharmacist may charge general patients the allowable additional fee but the fee cannot take the cost of the prescription above the general patient co-payment for the medicine.
The maximum fee is currently $3.83 and is adjusted on 1 January each year. This fee does not count towards your Safety Net threshold.
Additional fee for ready prepared items
In addition, if a medicine has a dispensed price for maximum quantity less than the general co-payment a safety net recording fee may be charged by your pharmacist. This fee may not take the cost of your script above the co-payment.
Concessional patients do not pay this fee.
This fee is currently $1.05 and is adjusted on 1 August each year. The amount of this fee does count towards your Safety Net threshold.
What is a Price premium?
A price premium or brand premium, may apply to some medicines.
Where there are two or more brands of the same drug on the Schedule, the Government subsidises each brand to the same amount - up to the cost of the lowest priced brand.
If you are taking a more expensive brand the price difference is paid by you as a brand premium. This cost is in addition to your co-payment.
At your request, the pharmacist may be able to substitute a less expensive brand where your doctor has allowed this. If you have any concerns, you should talk to your doctor or pharmacist.
Pharmacists are legally required to charge brand premiums. The brand premium does not count towards the safety net threshold.
- Joined
- Feb 6, 2006
- Posts
- 209
- Media
- 8
- Likes
- 274
- Points
- 218
- Location
- Liverpool (England)
- Sexuality
- 69% Gay, 31% Straight
- Gender
- Male
Further I have determined that in Auz the HIV drugs come under the
HIGHLY SPECIALISED DRUGS PROGRAM
The Australian Government provides funding for certain specialised medications under the Highly Specialised Drugs Program. Highly Specialised Drugs are medicines for the treatment of chronic conditions which, because of their clinical use or other special features, are restricted to supply through public and private hospitals having access to appropriate specialist facilities. To prescribe these drugs as pharmaceutical benefit items, medical practitioners are required to be affiliated with these specialist hospital units. A general practitioner or non-specialist hospital doctor may only prescribe Highly Specialised Drugs to provide maintenance therapy under the guidance of the treating specialist.
Benefits are available for the listed clinical indications only. There is no facility for individual patient approval for indications outside those listed.
To gain access to a Commonwealth funded drug under this program, a patient must attend a participating hospital and be a day admitted patient, a non-admitted patient or a patient on discharge, be under appropriate specialist medical care, meet the specific medical criteria and be an Australian resident in Australia (or other eligible person).
A patient will be required to pay a contribution for each supply of a highly specialised drug at a similar rate to the Pharmaceutical Benefits Scheme. Commonwealth subsidy is not available for hospital in-patients.
Reciprocal Health Care Agreement – Where a patient is entitled to be treated as an eligible person as a visitor from a country with which Australia has entered into a Reciprocal Health Care Agreement, the supply will be limited to the original prescription only. Repeat prescriptions for these patients are not permitted.
If you would like further information about the Highly Specialised Drugs Program, please contact your pharmacy, Medicare Australia (Ph: 132 290) or the Australian Government adviser, the Highly Specialised Drugs Working Party Secretariat (Ph: (02) 6289 2331).
For information on Pharmaceutical Benefits Pricing Authority therapeutic relativity sheets please visit www.health.gov.au and search for ‘relativity sheets’.
HIGHLY SPECIALISED DRUGS PROGRAM
The Australian Government provides funding for certain specialised medications under the Highly Specialised Drugs Program. Highly Specialised Drugs are medicines for the treatment of chronic conditions which, because of their clinical use or other special features, are restricted to supply through public and private hospitals having access to appropriate specialist facilities. To prescribe these drugs as pharmaceutical benefit items, medical practitioners are required to be affiliated with these specialist hospital units. A general practitioner or non-specialist hospital doctor may only prescribe Highly Specialised Drugs to provide maintenance therapy under the guidance of the treating specialist.
Benefits are available for the listed clinical indications only. There is no facility for individual patient approval for indications outside those listed.
To gain access to a Commonwealth funded drug under this program, a patient must attend a participating hospital and be a day admitted patient, a non-admitted patient or a patient on discharge, be under appropriate specialist medical care, meet the specific medical criteria and be an Australian resident in Australia (or other eligible person).
A patient will be required to pay a contribution for each supply of a highly specialised drug at a similar rate to the Pharmaceutical Benefits Scheme. Commonwealth subsidy is not available for hospital in-patients.
Reciprocal Health Care Agreement – Where a patient is entitled to be treated as an eligible person as a visitor from a country with which Australia has entered into a Reciprocal Health Care Agreement, the supply will be limited to the original prescription only. Repeat prescriptions for these patients are not permitted.
If you would like further information about the Highly Specialised Drugs Program, please contact your pharmacy, Medicare Australia (Ph: 132 290) or the Australian Government adviser, the Highly Specialised Drugs Working Party Secretariat (Ph: (02) 6289 2331).
For information on Pharmaceutical Benefits Pricing Authority therapeutic relativity sheets please visit www.health.gov.au and search for ‘relativity sheets’.
- Joined
- Aug 26, 2007
- Posts
- 5,678
- Media
- 22
- Likes
- 7,406
- Points
- 368
- Location
- Eastcoast USA (NYC-Manhattan)
- Verification
- View
- Sexuality
- 50% Straight, 50% Gay
- Gender
- Male
A very imformative thread. I am so glad it was started so that I might be more informed.
I can't believe how unaware and uninformed I have been of these problems.
I was aware that obtaining medical help was a problem for those who were HIV+ or had
AIDS, and was expensive...but I was not aware that there were so many problems and
obsticles, as well as hoops to jump through, in order for them to get the help and aid they
need. I hope this will change soon for it is just plain inhuman for sick people to have to
go through that hasstle while they are coping with their sickness and pain.
I can't believe I have been so naive about these problems for so long, even though over
the years, I have lost many of my friends and a number of business contacts to AIDS.
I've even volunteered for years at God's Love We Deliver, so I can't believe what
"dream world" I have been living in all this time.
Thanks again...
- Joined
- Feb 6, 2006
- Posts
- 209
- Media
- 8
- Likes
- 274
- Points
- 218
- Location
- Liverpool (England)
- Sexuality
- 69% Gay, 31% Straight
- Gender
- Male
Unless anyone can tell us otherwise, it is looking as though, at least thus far, if you have sex of any form that involves another person, that you had better hope that you do not contract HIV, if you are resident anywhere other than the UK. Otherwise you may not be able to readily get the meds that you so desperately need in order to keep living and making a contribution.
Thankfully, in the UK, despite what has been said by one but completely un-substantiated, anyone who aquires HIV / AIDs has free immediate access to the appropriate drug therapy. And, what is more if you are able, you can continue to work and you will not be required to pay, other than the normal contribution that every person in work pays in National Insurance Contributions.
Horray for the NHS - even with all its faults, problems and limitations.
Of course it may be the case that other countries - say in mainland Europe - have a scheme that covers such cases.
Let's add to this thread to make up a major resourse for all.
Thankfully, in the UK, despite what has been said by one but completely un-substantiated, anyone who aquires HIV / AIDs has free immediate access to the appropriate drug therapy. And, what is more if you are able, you can continue to work and you will not be required to pay, other than the normal contribution that every person in work pays in National Insurance Contributions.
Horray for the NHS - even with all its faults, problems and limitations.
Of course it may be the case that other countries - say in mainland Europe - have a scheme that covers such cases.
Let's add to this thread to make up a major resourse for all.
Similar threads
