Specially trained pharmacists will soon be allowed to dispense antiretrovirals without a doctor’s script. (Photo: Shutterstock)News & Features
27th October 2025 | Catherine Tomlinson
A landmark ruling from the Supreme Court of Appeal means specially trained pharmacists will soon be allowed to dispense antiretrovirals without a doctor’s script. Pharmacists with the required training will need special permits from the director general of health. While no pharmacists yet hold these permits, Spotlight reports that they may be able to start applying for them as soon as next month.
The South African Pharmacy Council (SAPC) can go ahead and implement pharmacist-initiated management of antiretroviral treatment, otherwise known as PIMART. The green light from the Supreme Court of Appeal earlier in October comes after a three-and-a-half-year-long legal battle. This ruling means that pharmacists who have completed the requisite supplementary training and are granted the required permits by the Director-General (DG) of the Department of Health can dispense antiretroviral medicines to prevent and treat HIV without a doctor’s script.
“There clearly was a rational connection between PIMART and its purpose, which was to expand access to first-hand HIV therapy, authorised by the Pharmacy Act,” the judgment held: https://t.co/oEBnrUrItG https://t.co/X13J6uAV05
— Spotlight (@SpotlightNSP) October 10, 2025
No pharmacists have yet been granted PIMART permits by the DG, so for now a doctor’s script is still needed to access antiretroviral medicines from pharmacies. However, processes to enable pharmacists to provide antiretroviral medicines without a doctor’s script are underway and pharmacists may be able to begin applying for PIMART permits as soon as next month. It is plausible that by early 2026, members of the public will be able to get antiretrovirals without a script at some pharmacies.
The court case
On 9 October 2025, the Supreme Court of Appeal rejected an appeal by the IPA Foundation, a group of private doctors, seeking to block the implementation of PIMART in South Africa.
The matter stretches back to February 2022, when the IPA Foundation first approached the North Gauteng High Court in Pretoria in an attempt to stop the implementation of PIMART. That court ruled against the IPA Foundation in 2023. The IPA Foundation then appealed that judgment, which left the PIMART programme in legal limbo until the Supreme Court of Appeal handed down its ruling.
While the Supreme Court’s ruling removes the legal impediments to implementing PIMART, there are still several things that need to happen before pharmacists can start providing antiretroviral medicines to treat and prevent HIV without a doctor’s script.
Eventually, pharmacists holding PIMART permits will be able to start people with uncomplicated HIV onto first-line antiretroviral treatment. They will also be allowed to provide antiretroviral medicines for HIV negative people to prevent HIV infection. This includes both pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). PrEP is typically taken as a daily pill that reduces the risk of contracting HIV to close to zero. PEP is taken as a 28-day course of treatment after someone has possibly been exposed to HIV.
From NIMART to PIMART
Currently, the vast majority of people taking antiretrovirals to treat HIV in South Africa were started on treatment by nurses, without a doctor’s script. This is because in 2010, public sector nurses were empowered to initiate HIV treatment under a programme called nurse-initiated management of ART, or NIMART. It is highly unlikely that South Africa’s HIV treatment programme could have grown as fast as it has had it not been for NIMART expanding the pool of healthcare workers who could start people on treatment.
PIMART now further expands the cadre of health workers able to start people on antiretroviral medicines to also include pharmacists. Both NIMART and PIMART are forms of task-shifting, a strategy by which tasks are shifted in the healthcare system to improve efficiency and reduce bottlenecks.
PIMART was initially proposed by the SAPC in response to a request from the Department of Health for pharmacists to play a larger role in supporting the country’s HIV response.
Dr Camilla Wattrus, clinical director of the Southern African HIV Clinicians Society (SAHCS), told Spotlight that when NIMART was proposed, there was similar resistance against nurses starting people on antiretroviral treatment. But she said NIMART has been hugely successful.
“Essentially, now it’s nurses who are spearheading our HIV programme and without them we wouldn’t have the largest HIV programme in the world,” she said.
The case for PIMART
There are around eight million people living with HIV in South Africa, but only 6.2 million (78%) of them are taking treatment for it. Antiretroviral treatment is recommended for everyone living with HIV, both for their own health and to reduce the chances of further transmission of the virus.
Getting treatment coverage from 78% to over 90%, as government aims to do, won’t be easy. One reason for that is that not everyone, particularly men, likes to visit our public sector clinics, which is where most people are currently diagnosed and started on treatment. Some people who refuse to go to the clinic might be willing to visit a private sector pharmacy.
Pharmacies are often the first point of contact for people seeking healthcare advice or services. They provide a broad range of services and attract users of both South Africa’s public and private health sectors, as well as those that fall into the cracks in between.
Mogologolo Phasha, president of the SAPC, said the nation’s plan to ensure that 95% of persons living with HIV are aware of their status, 95% of them are on treatment, and 95% of those on treatment are virally suppressed, “is more in reach with the implementation of PIMART”. He was speaking at a 13 October media briefing on the PIMART ruling.
What are the next steps?
The SAPC already outlined the competency standards, supplementary training requirements, and permits required for pharmacists to initiate antiretroviral medicines without a doctor’s script in Board Notice 101 of 2021. The Board Notice clarifies that before pharmacists can apply to the DG for a permit to provide PIMART services they must complete the required supplementary training. According to Professor Natalie Shellack, chairperson of the SAPC Education Committee, the PIMART supplementary training course was developed jointly by SAHCS and SAPC.
The SAHCS offers the PIMART training course online as an accredited continuous professional development (CPD) course. More than a thousand pharmacists have already completed this training.
The rub, however, is that because of the IPA Foundation’s court challenge, the SAHCS’s course was never accredited as a supplementary training course required for a PIMART permit. Dr Fiona Storie, CEO of SAHCS, told Spotlight that the SAHCS is engaging with the SAPC to get this accreditation.
Mojo Mokoena, COO of the SAPC, said at the SAPC media briefing that several parties have expressed interest in providing supplementary PIMART training to pharmacists and that the SAPC will begin accepting applications and accrediting training courses that meet the required standards.
Lizeth Kruger, Dischem’s Clinical Executive, told Spotlight that their existing staff completed the PIMART course several years ago, but that given the time lapse and updates to material, “those individuals will need to do a refresher course to ensure compliance and up-to-date knowledge”.
She added that Dischem intends for all new employees to complete the course as part of their onboarding.
How the permits work
The specific permit that a pharmacist will require from the DG is a Section 22(A) 15 permit. The DG has not yet started to accept these applications, but Vincent Tlala, CEO and Registrar of the SAPC, told media that the SAPC is engaging the DG on the permitting process. The expectation is that it will be able “to issue an e-note sometime in November inviting pharmacist to apply” for permits from the DG using SAPC’s electronic application system, Tlala said.
Pharmacists that do not hold a Section 22(A)15 permit can typically only initiate Schedule 0, Schedule 1, and Schedule 2 medicines that do not require a doctor’s script. Medicines are scheduled from 0 through 8, based on the risks they pose, with Schedule 0 medicines having the lowest risk profile.
According to the Department of Health, Section 22A(15) of the Medicines and Related Substances Act (Act 101 of 1965) empowers the DG to “issue Section 22A(15) permits to health professionals in order for them to acquire, possess, use or supply any specified Schedule 1 to 5 substance, with conditions as the Director-General may determine”.
The use of Section 22(A)15 permits to enable pharmacists to initiate medicines Schedule 3 and higher without a doctor’s prescription is not limited to HIV.
Board Notices published by SAPC in 2021, 2022, and 2023, outline the competency standards and training required for pharmacists to provide immunisation services, sexual and reproductive health services, and primary care drug therapy and provide for the granting of Section 22(A)15 permits when necessary to enable this.
Pharmacy fees
Before PIMART can be implemented, the SAPC must update the Board Notice specifying the services for which pharmacists can charge a fee to include PIMART consultations.
Tlala told media at the SAPC briefing that this Board Notice would be updated in November. This update will provide clarity on the maximum consultation fee that pharmacists can charge for providing PIMART services.
Are all pharmacies ready for PIMART?
In addition to the requirements pharmacists must meet to provide PIMART services, pharmacies themselves must also meet certain requirements to offer these services. Among others, they must have consultation rooms and patient record keeping systems that meet mandatory standards. Pharmacies must also have processes in place to refer patients onto other providers – such as doctors and laboratory services.
While pharmacists have not yet begun to initiate PrEP on their own, some pharmacies with nurses on staff have already begun to provide these services with digital support from off-site doctors for scripting. Following the Supreme Court of Appeal ruling, trained pharmacists will now be able to initiate first-line ART, PEP, and PrEP for uncomplicated patients without doctor’s prescriptions or pharmacy-based nurses.
The lab test challenge
Possibly the biggest challenge that remains to be worked out is how pharmacies will draw blood for laboratory testing, when this is needed. While rapid finger prick HIV tests performed in pharmacies can be used to initiate first-line antiretroviral treatment, PrEP and PEP, ongoing use of antiretroviral treatment generally requires laboratory testing of blood samples.
Pharmacies that have nurses on staff may be able to draw blood on-site to be couriered to laboratories, but pharmacies without a nurse or trained phlebotomist on staff may need to refer patients to private labs for the required blood tests. Such a referral approach is already broadly used by private doctors in South Africa.
In a March letter to the Southern African Journal of HIV Medicine, Ezintsha researchers recommended that pharmacies providing PIMART services train staff to collect blood samples, develop service level agreements with laboratory providers, and/or consider investing in point-of-care devices.
How much will it cost to get ART from a pharmacist?
While PIMART is expected to provide a more affordable avenue to HIV treatment and prevention than is currently available through the private sector, there will still be costs involved to access HIV treatment and prevention at pharmacies.
The costs of PIMART will include the cost of medicines, pharmacist consultations and dispensing fees, the cost of rapid HIV tests, and the costs of laboratory tests performed at private labs, when needed.
Tlala told media that the SAPC is hopeful that pharmacies will be able to access and dispense state procured stock of antiretroviral medicines to eligible patients, which will significantly improve the affordability of PIMART services.
What do users think about PIMART?
No pharmacists have yet been granted permits to provide PIMART, but the feasibility of providing these services at pharmacies and the acceptability and uptake of these services has been assessed in research projects conducted by the research center Ezintsha and the SAHCS. In these research projects, pharmacy staff and nurses received off-site digital support from doctors for scripting.
Angela Tembo, director of pharmacy health at Ezintsha, told Spotlight that research conducted in South Africa has shown that pharmacies are the preferred point of access for HIV services for many people, including young women.
Pharmacies are perceived as being easier to access than public clinics because of their convenient locations and extended hours of operation, said Tembo.
Ezintsha’s research further showed that people felt they could access HIV prevention and treatment in a more private and confidential way at pharmacies than at public clinics, because pharmacies are also places of shopping. “You could be there for anything and no one will know,” said Tembo.
