This month, President Trump announced a goal of ending HIV/AIDS in the United States by 2030. But the Centers for Medicare and Medicaid proposed changes to cut Medicare costs. Which could make it HARDER for HIV patients to get the medications they need. In NEW YORK CITY, more than 60,000 residents with HIV could qualify for Medicare. Camille Petersen has more on what the changes would mean for them.
PETERSEN 1: Tony is 72 and lives in Manhattan. He’s MOSTLY retired.
And he takes three medications every day.
(SOUND: pill bottles shaking)
This is actually the Descovy and the Isentris mixed into one bottle. These are
actually heart things.
PETERSEN 3: One for his heart and two for HIV. That’s why I’m only using his first name. There’s still a lot of stigma around HIV.
Tony says his medications cost thousands of dollars a month. Luckily, right now, a lot of his bills are covered by Medicare.
So let me show you the one…this is February. So my Isentris, the plan paid
$723.15 for my first prescription and I paid $646.05.
PETERSEN 4: His HIV medications are in a PROTECTED class. Medicare HAS to cover them.
But the new Medicare rules would change that. Sean Cahill studies HIV health care policy.
HE says the first big change would be prior authorization — DOCTORS would have to convince Medicare to cover a drug.
And so insurance companies are given a much bigger role than is appropriate in the provider-patient relationship.
PETERSEN 5: Cahill says the other changes would force patients to start on generic drugs which are often cheaper. And ONLY be prescribed brand label medications if the generics fail. Medicare would also be able to refuse coverage for some drugs if they’re considered too expensive.
All of those things make us concerned that removing the protected class status
for HIV medications is going to lead to delays, disruptions, and discontinuations in access to treatment.
PETERSEN 6: Cahill says there’s a reason why HIV medications have been in a protected class — HIV is complicated.
And it takes a while for the provider and patient to work out a good treatment
PETERSEN 7: Especially as patients age.
Dr. Harjot Singh treats HIV patients at New York Presbyterian.
As you age you may develop high blood pressure and then soon you develop
diabetes and then you might develop cholesterol problems. Every time you get a
condition you add another 1 or 2 pills.
PETERSEN 8: And doctors have to make sure all those pills can work together. PLUS, older patients can develop resistance to some HIV drugs. Which Singh says can cause an insurance hassle.
I have to call for those newer drugs and get prior authorization. It’s a very painful
PETERSEN 10: Tony, the retiree living with HIV, is worried that HIS doctor will lose control over his treatment.
So he wants to give me these medications and he can’t be authorized to give
them? I’d say that’s a big problem. Especially because these medications work.
PETERSEN 11: And he’s scared there could be serious consequences.
Well if they stop paying for this stuff? Well we’ll die. Simple as that.
PETERSEN 12: The Centers for Medicare and Medicaid is reviewing public comments before making a FINAL decision on the new rules.
Camille Petersen, Columbia Radio News.