Trump's Final Blow to Patients with HIV

This post originally appeared in the Washington Blade on February 19, 2021

The day before Donald Trump left the White House, his administration dealt one final, brutal blow to some of America’s most vulnerable patients. The Centers for Medicare and Medicaid Services announced a policy that, if implemented, will put numerous lifesaving drugs off-limits to Medicare recipients.

Medicare provides health insurance to 63 million seniors and people with disabilities. Trump’s gut punch affects Part D, the section of Medicare that covers most prescription drugs. The last-minute policy change would allow the private insurance companies that sponsor Part D plans to stop covering many medications in Part D’s “six protected classes” as early as 2022.

The protected classes include anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants — drugs that treat conditions including epilepsy, depression, cancer, and HIV. The protected categories exist because these types of drugs are not easily interchangeable. An antipsychotic that treats one person’s schizophrenia, for instance, may be ineffective in another patient. Patients often have to try multiple treatments until they find one that works well for them.

Today under Part D, insurers must cover “all or substantially all” of the drugs that fall into those six classes. But under the proposed new policy, insurers would only have to cover one drug per class, starting next year. The policy makes one exception, for antiretrovirals to treat HIV, which would remain protected until 2023.

I live with HIV and depression, conditions I manage with drugs in the protected classes. So I know from personal experience that there is no one-size-fits-all pharmaceutical solution to my health challenges. It can be hard enough to find a prescription that helps treat one condition, and having two conditions means I have to find medications that work together effectively.

More than 47 million Americans depend on Part D plans, and many of them need medicines from the protected classes. If the new policy goes into effect, doctors and patients will lose options, and some will even find themselves suddenly cut off from trusted treatments. It’s a cruel thing to do to sick people.

Thankfully, I’m able to manage my HIV with medication. But the consequences of stopping treatment could be deadly for me, as it could for any of the estimated 1.2 million Americans living with the virus. This is a population, moreover, that is disproportionately Black. Whereas Blacks make up 13.4 percent of the U.S. population, they account for 42 percent of new HIV cases.

President Biden has promised to make healthcare “a right for all, not a privilege for just a few,” vowing to prioritize health care for people of color. He can do that by scrapping this callous policy.

The former administration’s reforms admittedly weren’t all bad. Last year, the Department of Health and Human Services proposed closing a legal loophole that allows middlemen in the drug supply chain to pocket rebates offered by biotech companies without passing those savings on to patients at the pharmacy. Allowing this “rebate rule” to take effect would make drugs more affordable.

But aside from scattered exceptions like the rebate rule, the Trump administration’s policies need to be reversed. The Biden administration can start with the disastrous, last-minute proposal to sabotage the six protected classes.