Medicare Part D “Protected Classes” Receive Reprieve from Proposed Changes that Would Have Created Barriers for People Living with HIV from Accessing Life-Sustaining Medications

Medicare Part D “Protected Classes” Receive Reprieve from Proposed Changes that Would Have Created Barriers for People Living with HIV from Accessing Life-Sustaining Medications

Washington, DC – The American Academy of HIV Medicine (AAHIVM), an independent organization of HIV specialists and other care providers dedicated to promoting excellence in HIV care, celebrated the recent decision by the Centers for Medicare and Medicaid Services (CMS) regarding Medicare Prescription Drug Plan (Part D). CMS retracted its proposal to introduce changes that would have created barriers to accessing critical HIV drug therapies. Nearly 25% of people living with HIV in the US rely on Medicare as their medical insurer.

According to CMS’s announcement, the Department of Health and Human Services (HHS) will continue to require that Medicare Part D plans cover all (or virtually all) HIV antiretroviral drugs without prior authorization (a process of requiring coverage and utilization review prior to prescribing the preferred regimen) and step therapy (a process of starting patients on a less expensive treatment regimen and requiring them to “fail” on these options in order to get access to the prescriber’s recommended regimen). Retraction of these two barriers will apply to all Medicare patients living with HIV, including new, treatment-naïve patients.

At the end of 2018, the Trump administration proposed these restrictive changes in Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out of Pocket Expenses as a way to control drug costs. HIV care providers have numerous important considerations when prescribing medications, such as the person’s adherence, drug resistances, other medical conditions and drug-drug interaction. Given this, limiting these patients to a one-size fits all approach to treatment would have yielded dangerous and possibly more costly results.

AAHIVM has been working diligently on this this issue since it was introduced by the administration. In addition to an aggressive advertising campaign targeting key decision-makers inside the beltway, the Academy mobilized its members and credentialed HIV specialists to express their professional opinions on the matter. Over the course of the last six months, AAHIVM membership has participated in a local op-ed writing campaign, offered public comments, signed onto consensus letters, and lent their voices to the debate by contacting their representatives.

“This victory is made possible in no small part by the outspoken and passionate HIV care providers across the country that were willing to take a stand for their patients,” stated Bruce J. Packett, executive director of AAHIVM. “Many of these healthcare professionals have been in the HIV field from the beginning and understand how far we have come. They were not willing to watch us take a step back.”

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