AIDS Advocates Say Medicare Reforms Will Prevent Thousands of HIV-Positive People From Accessing Drugs

AIDS advocates are criticizing Medicare reform legislation that President Bush recently signed into law, saying that the measure will "put into harm's way" tens of thousands of people living with AIDS, Inter Press Service reports (Hager, Inter Press Service, 12/10). Bush on Monday signed the Medicare legislation (HR 1) that Congress passed last month. In a signing ceremony, Bush noted that the legislation creates a new Medicare prescription drug benefit, the creation of health savings accounts for individuals and Medicare coverage of routine physical examinations. He said, "You are here to witness the greatest advance in health care coverage for America's seniors since the founding of Medicare" (Kaiser Daily Health Policy Report, 12/9). However, according to Terje Anderson, executive director of the National Association of People with AIDS, the new Medicare law prohibits millions of seniors and disabled people who are eligible for both Medicare and Medicaid from continuing to receive "wrap-around" prescription drug coverage under Medicaid, Inter Press Service reports. "The bill calls for some six million low-income elderly and disabled Medicare recipients who also receive Medicaid to be barred from access to Medicaid drug benefits when this bill takes effect in 2006," Anderson said, adding, "Assurances made by the Bush administration that 50,000 people living with AIDS will not be harmed must be supported with concrete plans and specific program advice" (Inter Press Service, 12/10).

Drug Coverage
Under the Medicare legislation, people who are dually eligible for Medicare and Medicaid could experience higher out-of-pocket drug costs under the new drug benefit because state Medicaid programs typically cover all or nearly all prescription drug costs, while the Medicare legislation would require cost sharing (Kaiser Daily Health Policy Report, 12/1). Anderson said that as a result, state AIDS Drug Assistance Programs, which are "already overburdened," will face additional pressures, Inter Press Service reports (Inter Press Service, 12/10). As of the beginning of November, 16 states had waiting lists or access restrictions on their ADAPs, with 679 people on waiting lists nationwide, according to the latest "ADAP Watch List" released on Nov. 3 by the National Alliance of State and Territorial AIDS Directors (Kaiser Daily HIV/AIDS Report, 11/26).

Limiting Access
Private plans offering coverage under the new Medicare drug benefit plan may restrict such coverage to a short list of "preferred" medicines in each drug class, according to Inter Press Service. If a drug is not on the list, Medicare will not cover it. "HIV is a disease which requires careful prescribing, so limiting which medicines can be provided to people living with AIDS can threaten our health and lives," Anderson said. It is possible that not all HIV/AIDS medications will be covered under the new drug benefit. Christine Lubinski, director of the HIV Medicine Association, said that it is important that AIDS patients have access to a variety of antiretroviral drugs because of the possibility of drug resistance and side effects. Most patients must take a three-drug combination and some must switch medications frequently. Fred Griesbach, government affairs manager for the New York AARP, which supported the Medicare bill, said, "We shouldn't be deceived into thinking this bill is going to solve all of our problems" (Inter Press Service, 12/10).

The Kaiser Family Foundation on its Web site offers several resources related to the new Medicare drug benefit, including a summary of the legislation. In addition, a drug calculator that allows users to enter their drug costs and determine what they would pay out of pocket under the plan is available online.