• Drug Pricing Reform: This proposal is largely based on H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act, which allows the Secretary of Health and Human Services (HHS) to negotiate prices for certain medications. Specifically, this bill would require HHS to negotiate the maximum price for the top 125 drugs that comprise the greatest national spending or the greatest Medicare spending. The original bill largely pertains to Medicare, but the version included in the Build Back Better Act may also include some commercial markets, including those in the Affordable Care Act (ACA) marketplace. As of the drafting of this article, final language is not yet known. On the surface, this proposal seems like a welcome reform to a healthcare system in which households, particularly many that rely on Medicare, can spend huge amounts on prescription drug costs. However, an inadvertent consequence would be that the price of HIV drugs are capped and 340B savings evaporate, sending HIV providers scrambling. The Academy is working diligently to ensure that HIV medications are available to all who need them, while taking into consideration many providers’ reliance on 340B savings.

• Medicaid Expansion: In a previous issue of the VOICE, we wrote about a proposal to extend Medicaid eligibility to those living in the 12 states that have not expanded Medicaid, as offered under the ACA. This ‘Medicaid-like’ program that is expected to be included in this larger legislative package, would provide care for an estimated two million low-income individuals who currently are not eligible for Medicaid or subsidies to purchase private insurance on the ACA marketplace. Academy members who provide care in these 12 states know firsthand how impactful it would be for folks with and at risk for HIV to be eligible for affordable, quality healthcare. As such, the Academy has joined the HIV community in sending a letter to Congress urging them to close this Medicaid “coverage gap.” Doing so would ensure health insurance coverage to the 20 percent of all people living with HIV who are uninsured in non-expansion states, thereby reducing transmissions. Additionally, this proposal offers a way to address racial disparities in healthcare that are exacerbated in non-expansion states, particularly among persons of color who in 2019 alone, accounted for 75 percent of people newly diagnosed with HIV. Closing this gap is imperative to fixing enduring injustices and ending the HIV epidemic.

• Additional Funds for the Ryan White Program: The House Energy and Commerce Committee’s markup of this legislation includes an additional $150 million for the Ryan White HIV/AIDS Program in fiscal year 2022. The Academy signed a letter to Committee leadership applauding the addition of these funds. As readers know, the Ryan White program is an important safety net program that serves as the payer of last resort for more than half of the people living with HIV in the United States. This program provides medical care and prescription drugs along with other services critical to managing HIV, including: case management; mental health and substance use services; adult dental services; and transportation, legal, and nutritional support services. Because of the comprehensive care provided by the Ryan White program, the most recent data shows that over 88 percent of Ryan White clients have achieved viral suppression, which is significantly higher than the viral suppression rate of 69.4 percent of all people with HIV in the United States. While these funds are very much welcome, it’s not yet clear how they will be distributed amongst providers, clinics and services.

Readers can view the full report HERE.