Medicare and Part D

FOR IMMEDIATE RELEASE:
HIV Medicaid/Medicare Working Group Press Release —
Senate committee fails to protect people
with HIV/AIDS In Medicare bill

June 6, 2008

Contact:  
Ann Lefert, 202-489-9787; Robert Greenwald, 617-877-3223

Washington, DC—The HIV Medicaid and Medicare Working Group criticized Congress today for failing to fix a major flaw in Medicare legislation that leaves people with HIV/AIDS stuck in the Part D “donut hole” and at risk of going without essential medications.

“Congress has turned its back on people with AIDS by failing to address their needs in Medicare reform legislation,” said Kali Lindsey, vice president of federal government affairs at the National Association of People with AIDS. “Saving lives would cost the country next to nothing. We call on Congress to show leadership in the fight against AIDS and correct this flaw immediately.”

Medicare is the second-largest source of HIV/AIDS care in the United States, serving 100,000 people with AIDS.  Unfortunately, the Medicare Part D drug benefit was not designed with people with HIV/AIDS in mind. Because of the high costs of their many prescriptions, and the large percentage of these costs they are required to share, beneficiaries quickly end up in the donut hole. They are forced to rely on state AIDS Drug Assistance Programs (ADAP)—underfunded programs with more limited formularies than Medicare.

To make matters worse, because ADAP benefits do not count toward a beneficiary’s “true out-of-pocket” (TrOOP) costs, beneficiaries never reach the threshold where Medicare will pick up nearly all of their drug costs. They remain stuck in the donut hole.

Senate Finance Committee chair Max Baucus (D-MT), has crafted a Medicare bill that fixes several other problems with Medicare Part D but ignores this problem, which is inexpensive to fix.

For people living with HIV/AIDS, the current policy has real impacts. “In California, most people with HIV/AIDS receive two months of partial coverage under Medicare before they go into the donut hole,” said Anne Donnelly, health policy director at Project Inform, a California-based HIV/AIDS advocacy group. “For the rest of the year ADAP covers some of the drugs they need, but not medications to treat heart disease, high blood pressure, or some forms of cancer, which are common among Medicare beneficiaries with HIV/AIDS. At the same time, the California state budget crisis has forced the Governor to propose cuts to the current ADAP formulary.”

It is a little-known fact that in America there are uninsured people with HIV/AIDS who go without lifesaving medications because of limited ADAP funding.  Every dollar that ADAPs spend on Medicare beneficiaries is a dollar they cannot spend on medications for these uninsured people. According to the Congressional Budget Office (CBO), the cost of fixing the ADAP-as-TrOOP issue and giving the same treatment to Indian Health Service programs would cost only $100 million over five years—less than one percent of the Medicare package unveiled today in the Senate. 

“Over the last several years, ADAPs have struggled to keep up with client demand due to limited funding from Congress,” said Julie Scofield, executive director of the National Alliance of State and Territorial AIDS Directors, whose members administer ADAPs. “Congress has denied an opportunity to provide critical relief for ADAPs by extending their reach to more individuals who have no other source of coverage for their HIV-related medications. This is a very inexpensive fix that would have a huge impact for people living with HIV/AIDS and ADAPs alike.”    

“The high cost sharing for the Medicare drug benefit has left some of our patients worse off and leaves them vulnerable to going without lifesaving treatment,” said Michael S. Saag, MD, vice chair of the HIV Medicine Association and director of the Center for AIDS Research at the University of Alabama at Birmingham. “Continuous and reliable access to medications is the difference between life and death for our patients with HIV/AIDS. Congress must count ADAP costs as TrOOP so people with HIV/AIDS are not denied medications they absolutely need.”

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HMMWG is a coalition of nearly 100 national and community-based AIDS services organizations that represent HIV medical providers, advocates, public health workers and people living with HIV/AIDS committed to ensuring that people living with HIV/AIDS have access to quality, cost-effective health care and drug treatment.  

The following federal, state, and local HIV/AIDS organizations and their supporters support this call to action:

AIDS Action Baltimore, Maryland
AIDS Action Committee of Massachusetts, Inc.
AIDS Action Council, Washington, DC
Alabama, Birmingham, AL
AIDS Foundation of Chicago, Illinois
AIDS/HIV Health Alternative North Hollywood, CA
AIDS Project Los Angeles, California
American Academy of HIV Medicine, Washington, DC
American Health Services, Los Angeles, CA
Bronx AIDS Services, New York
Columbus AIDS Task Force, Columbus, OH
Community HIV/AIDS Mobilization Project (CHAMP), New York, NY
FOUND Los Angeles, CA
Gay Men’s Health Crisis, NY, NY
Harlem United Community Aids Center, NY
Health & Disability Advocates, Chicago, IL
HIV Medicine Association, Arlington, VA
Human Rights Campaign, Washington, DC
Indiana Minority Heath Coalition
Kentucky HIV/AIDS Advocacy Action Group, Henderson, KY
Legal Action Center, NY, NY
Log Cabin Republicans, Washington, DC
Matthew 25 AIDS Services, Henderson, KY
Minnesota AIDS Project, Minneapolis, MN
National Alliance of State and Territorial AIDS Directors, Washington, DC
National Association of People with AIDS
National Minority AIDS Council, Washington, DC
New York AIDS Coalition, NY
Project Inform, San Francisco, CA
Recovery Options Los Angeles, CA
San Francisco AIDS Foundation, CA
Sunshine Social Services, Inc., Fort Lauderdale, FL
The AIDS Institute, Washington, DC
TII CANN - Title II Community AIDS National Network, Washington, DC
Treatment Access Expansion Project, Boston, MA
Western Pacific Med/Corp, Glendale, CA