Survey: Medicare Part D Failing People With AIDS

People with HIV/AIDS are faring poorly under the Medicare Part D plan, according to a survey of members of the American Academy of HIV Medicine (AAHIVM) and the HIV Medicine Association (HIVMA).

Medicare is regulated by the Centers for Medicare and Medicaid Services, which designated antiretrovirals as one of the six drug classes in which insurers must cover "all or substantially all" available drugs. Insurers are allowed to require prior authorization only for Fuzeon, the most expensive therapy.

Even so, four out of five doctors said prior authorization is a barrier to getting prescriptions filled. Eighty-three percent of physicians surveyed said their patients were having trouble getting prescriptions filled under Part D, and 75 percent of those with a problem had gone without medications. "We're currently processing at least 25 prior authorizations per week," said Dr. Michael Saag, director of the HIV clinic at the University of Alabama-Birmingham. "The only ones who benefit are the insurance companies."

Some patients are "dual eligible," qualifying for Medicare and Medicaid, and are served by a variety of programs, including the AIDS Drug Assistance Program. All eligible ADAP patients were required to be enrolled in Part D as of January 2006.

The providers surveyed said 48 percent of dual eligible patients were worse off under Part D in terms of the drugs covered, while 9 percent were better off. Out-of-pocket expenses for co-pays were higher for 58 percent and lower for 5 percent.

In their recommendations, AAHIVM and HIVMA ask Congress to act to deal with prohibitive co-pays and to ensure that Part D covers all drugs. They also want regulators to enforce existing rules on prior authorization.

To access the full report, "HIV Medical Provider Medicare Part D Survey," visit www.aahivm.org.

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