SPOTLIGHT: Why pharmacists still can’t prescribe ARVs, months after court gave the green light

A Supreme Court of Appeal ruling in October 2025 cleared the way for specially trained and permitted pharmacists to dispense antiretroviral medicines without a doctor’s script. Seven months later, no pharmacists are providing these services yet. Spotlight explores the reasons for the delay.

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After a three-and-a-half year court battle between a group of private doctors and the South African Pharmacy Council (SAPC), the Supreme Court of Appeal (SCA) cleared the way for the council to implement pharmacist-initiated management of antiretroviral treatment (Pimart) in October 2025.

The SAPC welcomed the ruling with a bullish press conference promising rapid implementation of Pimart. “The South African Pharmacy Council, together with stakeholders and the Department of Health, will work with speed to ensure that Pimart-trained pharmacists join other primary healthcare practitioners in providing primary care in relation to HIV and Aids,” said Mogologolo Phasha, president of the SAPC, at the time.

Vincent Tlala, CEO and registrar of the SAPC, also in October 2025, said the SAPC aimed to issue an e-note inviting pharmacists to apply for the Pimart permits in November. However, seven months later, this has still not happened and no pharmacists in the country are yet permitted to provide Pimart services.

Pharmacist-initiated management of antiretroviral treatment is a form of task-shifting that allows pharmacists to provide some limited HIV services that are currently only provided by doctors and nurses. The programme seeks to better use pharmacists in the country’s HIV response and relieve some of the burden on overcrowded and underresourced public clinics. It will also offer a route into treatment for people who are not willing or able to visit clinics.

It is intended that, under the Pimart programme, pharmacists who have completed a dedicated training programme and have received a special permit from the director-general of health will be authorised to provide first-line antiretroviral treatment to people with uncomplicated HIV without a doctor’s script. They will also be allowed to dispense HIV prevention medicines without a doctor’s script – this includes both pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). PrEP is taken prior to sex to prevent potential infection while PEP is taken shortly after a possible HIV exposure to prevent infection.

Pimart was proposed by the SAPC in response to a request from the health department for the SAPC to design an intervention to ena