As I See It: Preserving Medicare Part D is vital to patients living with HIV

Telegram & Gazette (Worcester, MA)

The number of individuals living with HIV who receive their health insurance from Medicare almost tripled from 1997 to 2014, with about 120,000 HIV-positive Americans now dependent on the program. This means about one quarter of all U.S. HIV patients are on Medicare. Many of these individuals rely on a critical component of Medicare, the Part D program, which provides coverage for prescription medications.

While the ability to access prescription drug coverage alone is a major necessity for all patients, within the Part D program is a clause known as the six protected classes that is especially important to those living with HIV. Under this clause, providers are required to cover "all or substantially all" medications that fall within the six protected classes of medicine. These classes include vital drugs that treat mental illness, cancer, organ transplant and of course, HIV.

Several months ago, the administration proposed changes to Part D that would allow plans to institute prior authorization and coverage exemptions of antiretroviral medications that treat HIV. Changing the protected class status for antiretrovirals could undermine the substantial progress we have made in HIV care over the past two decades. Not only could this lead to delays, disruptions and discontinuations in access to treatment, but it could also increase transmission to others.

Fortunately, public outcry from the LGBTQ community, patient advocacy groups and health care stakeholders has pushed the Department of Health and Human Services to walk back these changes and preserve the six protected classes. This proposal, like many other Medicare changes currently being considered, place government savings over patient needs. Often, Medicare beneficiaries suffer from multiple chronic conditions, making access to medications and continued research and development of new therapies vital.

The medical community has made great strides in the treatment of HIV and other serious illnesses through the access and affordability that Medicare Part D provides, as well as the U.S.' leadership in medical innovation. However, policies that would restrict or deny access to certain medications will stifle investment in research and development needed to discover and produce new breakthrough treatments. In fact, the federal Department of Commerce estimates that foreign pricing policies – which are also under consideration by HHS and Congress – could decrease private sector investment in medical research and development by as much as 16%, not just here in the U.S. but worldwide.

That is an unacceptable reality. The important role HIV medications play in helping patients live and thrive as they age, as well as its importance in preventing new infections, demonstrates the need for policies that protect access to these crucial antiretroviral medications and foster new medical discoveries. As Congress continues to explore health care reform, they must ensure their policies preserve the high level of care Part D provides to the consistently underserved HIV community as well as all Medicare beneficiaries.