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JAN18

Trump Administration Medicare Proposed Rule Would Remove Protections for HIV Medications

The Trump Administration has proposed their latest attack on health care, and this time, people living with HIV are directly named as the intended victims: the Centers for Medicare & Medicaid Services (CMS) have proposed a rule change that would take away prescription drug policies that protect access to antiretroviral medications for people aging with HIV.

Since 2006, Medicare Part D has helped Medicare-eligible Americans access prescription drugs at more affordable prices. In the legislation, Members of Congress included six “protected classes” of drugs, subject to even more requirements of health plans to cover all medications within them, including immunosuppressants (to facilitate transplants), antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics (cancer treatment drugs). These protections allow people with certain health conditions, including HIV, to access what they and their medical professionals determine to be the best medication therapies for them and prohibit health insurance companies from making any treatment options unavailable.

CMS officials recently proposed, in an effort to rein in drug prices, stripping these drug classes of their protections, which would allow health plans to subject them to utilization management techniques – such as step therapy or other types of prior authorization policies – that are used to increase profit margins for other drug therapies. Under the potential guidelines, insurance plans could also decline to cover certain medications if drug companies increased their prices outpacing inflation or introduced a new formulary – even if older formularies are taken off of the market.

If enacted, the Administration’s proposed rule change could clear the way for insurance companies to control decisions about patients’ access to drugs, rather than providers working directly with the patients they treat. This could harm the health of the quarter of all Americans living with HIV who rely on Medicare – more than 250,000 people – forcing many off the medications they currently rely on and requiring newly diagnosed people to use therapies that may not be right for them.

AIDS United is fighting to stop this proposed rule, but we need advocates and allies to help us. Visit MyStatusMyMedicare.com to learn more and submit a comment to CMS opposing this rule. The more unique comments we are able to gather, the better chance we’ll have at convincing the Administration to abandon this harmful proposal.

Check back in to the AIDS United Policy Update regularly for all the latest in HIV funding, legislation, and regulation.




Posted By: AIDS United, Policy Department - Friday, January 18, 2019



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