Transgender Refugees living in the community in Australia and Access to Primoteston
Recently, in the last few weeks, RISE: Refugee Survivors and Ex-detainees’ transgender members who were coercively assigned female at birth and are living in the community, raised concerns about the removal of Primoteston Depot (a form of testosterone injection) from the Australian Pharmaceutical Benefits Scheme (PBS). Primoteston has been removed from PBS by the manufacturer Bayer Pharmaceuticals for commercial reasons. This forces our members to purchase the medication at the full price of about $40 every 4-6 weeks. Generic brand testosterone is also not available through the system. For this reason, a meeting was organised last weekend by affected RISE transgender members to discuss this issue. Clearly it has had a particularly devastating impact on our community members as they are also struggling with Australia’s precarious and abusive refugee visa process, with limited access to health and welfare services. Furthermore, it became clear in the discussion that even service providers that explicitly claim to support transgender people have failed to address the barriers transgender refugees face when it comes to accessing hormone replacement therapy.
In order for an unemployed RISE member living in the community on a bridging visa with Medicare, to purchase prescribed medication at a concession price they have to be approved for Status Resolution Support Services (SRSS) by the Australian Department of Home Affairs. If their SRSS application is approved, in addition to SRSS payments which is 89% of the standard Centrelink welfare payments they are assigned to a private subcontractor such as AMES or Life Without Barriers for “settlement” support. They do not have access to a healthcare card and have to depend on a letter from the SRSS provider to allow access to specific pharmacies to purchase PBS medication at a concession price. Currently, AMES provides a letter that is usually valid for only 1 or 3 months which has to be renewed each time it expires. For RISE members (all of whom are ex-detainees) on 5 year temporary visas, the government will only allow them to receive Centrelink payments for up to 18 months in total. We also need to keep in mind RISE members who are undocumented or on bridging visas, who don’t have access to Medicare, the right to work or any welfare support payments and have to pay full price for all medication. The recent cuts to SRSS by the Department of Home Affairs places more of our members in this latter category.
When a person changes from Primoteston to a testosterone injection available on PBS such as Reandron (also manufactured by Bayer), they may have to continue to use Primoteston during a temporary overlapping period with Reandron. So even RISE members eligible for PBS medication at a concession rate who decide to change from Primoteston to Reandron, will initially have to pay for Primoteston at the full price, in addition to Reandron at concession price. Moreover, different people may react differently to different brands of testosterone and for these reasons many transgender people who use Primoteston cannot switch to a more affordable brand of testosterone.
RISE calls on health and welfare providers, particularly ones that claim and/or funded to support refugees and transgender people, to take direction from transgender refugees and effectively address the issues described above without further delay.