HIV/AIDS Community Unites Against Harmful Part D Proposal

Leading stakeholders within the HIV/AIDS community recently penned op-eds outlining the detrimental effects that the Trump administration's proposed drug pricing rule would have on patients. The authors astutely note that a "one-size-fits-all" approach is the wrong solution given the complexity of the disease as well as the individual needs of HIV patients. Stakeholders also emphasized that reliance on step therapy and prior authorization would create additional barriers to access for lifesaving treatments.   

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• STATNews: HIV care is threatened by proposed changes to Medicare Part D –​ "CMS has long demonstrated its understanding of the importance of unimpeded access to effective treatment for conditions that include HIV by requiring Part D drug insurance plans to cover all or nearly all drugs in six protected drug classes, including antiretroviral treatments for HIV. In recognition of the importance of an individualized approach to HIV treatment, HIV medications have had the added protection of being covered without restrictions. The proposed rule would change that. While still requiring that Part D plans cover the drugs, it would allow them to impose obstacles to some drugs based on cost. Those obstacles would include requiring prior authorization, a time-intensive process that forces doctors to justify the prescriptions they write to insurance company staff who often have no expertise in treating HIV. Prior authorization is not a good idea for treating HIV, due to the potential consequences of delaying the start of treatment and possibly causing dangerous lapses in treatment." – Dr. W. David Hardy, chair of the HIV Medicine Association. ​

• Tallahassee Democrat: Altering Medicare Part D could harm Floridians living with HIV –​ "Currently, HIV drugs classified as anti-retrovirals are considered one of the six 'protected classes' of medicine. This means that Part D plans are required to cover 'all or substantially all' medications within these classes without exception. The proposed changes, however, would undermine these protections and allow Part D plans to restrict the number of drugs offered under each class. Additionally, the proposal would allow plans to impose requirements for prior authorization and step-therapy for HIV medications. Step-therapy is a harmful practice that forces patients to prove that a cheaper medication failed to meet their needs before they are permitted to use a drug originally prescribed by their physician. This change strips doctors of their autonomy and undermines their ability to offer the medications that best fit patients’ specific needs. Step-therapy is not a practice endorsed by current HIV treatment guidelines." – Dr. Jonathan Appelbaum, Vice-chair of the American Academy HIV Medicine.

• Charlotte Observer: Trump Administration Proposal Threatens HIV Patients​ –​ "HIV medicine is not a one-size fits all approach. Under this new plan, Medicare would be able to ignore the treatment plan I have designed to meet a patient’s specific needs and provide him or her, instead, drugs that are cheaper and may not work as well. Patients may also not take the cheaper drugs as consistently, which can also lead to poorer health outcomes for my patients. Not only is this a personal health problem, but it has serious public health ramifications. When people living with HIV take their medications regularly, they are much less likely to transmit to others. Therefore, when government-induced alterations seek to undermine access in the name of cost-saving, we are all at risk. Today, HIV is no longer a death sentence, thanks to the advancement of antiretrovirals. To pull those protections would be taking an archaic step back. For health care providers like me, who have spent decades treating and caring for these individuals, this is simply unacceptable." – Dr. J. Wesley Thompson, Medical Director of HIV Care at Amity Medical Group 

• The Hill: Trump's Medicare Rule Change Threatens to Reignite AIDS Epidemic –​ "HIV medicine is not a one-size fits all approach. Under this new plan, Medicare would be able to ignore the treatment plan I have designed to meet a patient’s specific needs and provide him or her, instead, drugs that are cheaper and may not work as well. Patients may also not take the cheaper drugs as consistently, which can also lead to poorer health outcomes for my patients. Not only is this a personal health problem, but it has serious public health ramifications. When people living with HIV take their medications regularly, they are much less likely to transmit to others. Therefore, when government-induced alterations seek to undermine access in the name of cost-saving, we are all at risk. Today, HIV is no longer a death sentence, thanks to the advancement of antiretrovirals. To pull those protections would be taking an archaic step back. For health care providers like me, who have spent decades treating and caring for these individuals, this is simply unacceptable." – Jesse Milan Jr. CEO of AIDS United