HIV Advocates Celebrate Medicare Victory 

A rally to advocate for Medicare. Photo credit: Molly Adams, via flickr.

A change to the rules for Medicare Part D that could have put thousands of people living with HIV at risk has been rolled back and will not go into effect. The rule change would have given insurance companies the power to force people living with HIV off of the medications they currently use.

AIDS United, which lobbied against the change, celebrated the decision.  

“AIDS United is grateful that the final Medicare Part D rule released by the Trump Administration […] will continue guaranteeing access to the treatments that enrollees living with HIV depend on for their health and their lives. AIDS United thanks the Trump Administration for listening to the concerns of all those that would have been affected by this change, as well as the thousands of advocates who responded to the proposed rule change with letters and phone calls to Department of Health and Human Services and Congress,” wrote President and CEO Jesse Milan Jr. in a prepared statement. “We look forward to working with the Administration and Congress to build on the momentum and support behind our collective efforts to end the HIV epidemic by 2030.”

The proposed changes alarmed HIV advocacy organizations as well as other health related groups. Currently Medicare Part D has six protected classes, which includes antiretroviral drugs used to manage HIV. 

“So this is a very pressing issue for HIV population,” Milan previously told SFGN. “Because as we age, our need for Medicare will continue to increase.”  

According to AIDS United these protected classes ensure people living with serious, chronic, and infectious health conditions can access the specific treatments their medical providers prescribe to them without interference from insurance companies. The reason these classes are protected is because for these specific conditions any interruption in drug access would result in significant and rapid health decline. 

The proposed rules change would have given an insurance company the right to require a prior authorization before a particular prescription could be filled. It would also have allowed for policies like “step therapy,” where people are forced to start their treatment out with a lower priced drive and prove that it’s ineffective before being allowed to have the original drug a doctor prescribed to them. 

“And so that's really dangerous for people living with HIV, because it means your doctor has already decided based on all of your medical history, and all of your current medical conditions, which one of those [medications] is the absolute best for you,” Milan previously said. 

A similar rules change was proposed under the Obama Administration in 2014 but was more narrow in scope and did not directly affect the HIV community.

When asked why these types of rules changes have been proposed under sDemocratic and Republican administrations Milan previously said: “The argument from the administration is that this could be a way of reducing drug costs to consumers. But we don't believe that is an effective way of assuring access to care and promoting the health and well being of people living with HIV.”

A slew of other health advocacy organizations opposed the changes including the American Cancer Society; Leukemia & Lymphoma Society; The Michael J. Fox Foundation; National Alliance on Mental Illness; National Council for Behavioral Health; and The AIDS Institute.

Marc Boutin, chief executive officer of National Health Council, celebrated the victory as well, but also believes its time for Congress to pass legislation that would limit out of pocket expenses seniors pay for their prescription drugs. 

“Since its launch in 2007, the Part D prescription drug program has been instrumental in expanding drug access for Medicare beneficiaries. However, it remains the only type of health insurance in our country that does not have a limit on out of pocket costs,” Boutinwrote in an editorial The Hill.

“Congress has expressed willingness to tackle the issue, as the bipartisan leaders of two House Committees released at the end of May a draft bill for stakeholder input. Additionally, President Trump signaled support for such a proposal in his budget earlier this year. While the details are evolving, a limit on out-of-pocket costs will be one of the most meaningful changes to the Medicare drug program since its inception.”