- Appeal dismissed with costs, confirming SAPC’s implementation of PIMART.
- The court finds procedural fairness was observed and the initiative is rationally connected to public health objectives.
- PIMART is limited to accredited pharmacists and does not encroach on doctors’ professional domain.
The Supreme Court of Appeal has decisively dismissed an appeal from the Independent Practitioners Association Foundation, firmly upholding the South African Pharmacy Council’s decision to allow pharmacists to provide pharmacist-initiated management of antiretroviral therapy services, known as PIMART.
The ruling, delivered on 9 October 2025 by Justice T Makgoka and agreed to by four other justices, cements the legality and importance of the SAPC’s initiative. The appeal was dismissed with costs, including those for two counsel.
“This case concerns primary health care for people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS),” wrote Justice Makgoka. “Despite previous efforts to reduce new HIV infections, including Nurse-Initiated Management of Antiretrovirals (NIMART), the rates of new infections remained high. PIMART is a crucial intervention to improve access to treatment, particularly in rural areas where pharmacists are well-positioned to deliver first-line HIV therapy.”
Procedural fairness upheld
The IPA Foundation challenged the SAPC’s publication of Board Notice 101 of 2021, arguing that pharmacists should not diagnose and treat HIV and that the process was procedurally unfair. The Supreme Court of Appeal rejected these claims, stating that the SAPC had followed the proper legal procedures and had acted within its powers.
Justice Makgoka explained, “The IPA and its members, like all other interested parties, were given sufficient notice of the introduction of PIMART through publication in the Gazette. Procedural fairness requires that a party likely to be disadvantaged by the outcome of a decision be given an opportunity to be properly represented and fairly heard before a potentially prejudicial decision is made.”
The court further found that PIMART is rationally connected to public health objectives. According to the judgment, “PIMART was devised by a group of medical experts and is rationally connected to the objective of increasing access to healthcare for HIV first-line treatment. Its introduction constitutes a rational legislative and practical measure within the competence of the SAPC, enhancing access to healthcare in fulfilment of the State’s obligation under section 27(2) of the Constitution.”
Collaboration, not encroachment
Concerns that the initiative might encroach on doctors’ professional domain were dismissed. The court clarified that PIMART is available only to accredited pharmacists and is limited to preventive care, PrEP and PEP provision, and first-line antiretroviral therapy. “Medical practitioners do not have exclusive rights to care for people living with HIV/AIDS, and PIMART is part of a collaborative public health effort,” the judgment stated.
On the claimed conflict with the Medicines Act, the court noted that the Director-General is authorised under section 22A(15) to issue permits to health practitioners other than medical doctors to dispense medicines. As Justice Makgoka explained, “The Director-General acted within the powers granted by this provision, and the validity of that provision has not been challenged by the IPA.”
In closing, the court found no merit in the IPA’s arguments regarding procedural fairness, infringement on doctors’ scope of practice, or the rationality of the initiative. The SCA confirmed the high court’s decision and dismissed the appeal with costs, including the costs of two counsel.
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