New York Times Examines Effects of Medicare Prescription Drug Plan on Patients, Including Those Living With HIV/AIDS
February 14, 2006
The New York Times on Tuesday examined how the new Medicare prescription drug benefit affects access to drugs for beneficiaries, including those living with HIV/AIDS. Under the drug benefit, numerous companies are under contract with Medicare to provide medications to beneficiaries. Many drugs are not available immediately because of limitations or conditions set by insurers, including formularies, a company's list of drugs covered under their specific plan. In addition, some plans require doctors and beneficiaries to acquire "prior authorization" for specific drugs on their formularies, the Times reports. Most states have more than 40 Medicare drug plans available to beneficiaries, and one plan could have 25 to 30 forms for prior authorization for different drugs, according to the Times. Doctors -- who are required to specify the viral load and white blood cell count of an HIV-positive patient to obtain coverage for some HIV/AIDS drugs -- say the requirements are cumbersome and can postpone or obstruct a patient's access to medications, according to the Times. President-elect of the American Medical Directors Association Steven Levenson said, "We have seen signs that Medicare drug plans are using management controls to deter access to medically appropriate drugs, including drugs in their own formularies." Independence Blue Cross implements "one standard prior authorization form" for its Medicare drug plans, which are available in 13 states under the name AmeriHealth, according to Daniel Lyons, the company's senior vice president. He said that the company also requires 17 forms for high-cost injectable drugs to treat conditions like HIV, cancer, hemophilia and rheumatoid arthritis. Lyons added that he would prefer "to simplify and standardize the prior authorization process" (Pear, New York Times, 2/14).