PI Action alerts & updates ... 2004

Medicare Prescription Drug Benefit: Letter to Congress

The Medicare Prescription Drug Benefit has passed into law and will be implemented in 2006. The law contains provisions of great concern to people living with HIV/AIDS. Medicare beneficiaries who are currently eligible for both Medicare and Medicaid will lose their comprehensive Medicaid prescription coverage. Many could find themselves with an inadequate benefit under Medicare because their drugs may not be included on the plan formulary (drugs covered under the benefit). The proposed co-pays and cost sharing obligations could make effective treatment regimens too expensive for many. And the patient protections offered through the appeals process appear to be inadequate and unclear.

The HIV Medicaid/Medicare Work Group, a work group of the Federal AIDS Policy Partnership, recently sent this letter to key members of Congress. In addition the group sent a position paper, “The Medicare Prescription Drug Benefit – Issues for Beneficiaries living with HIV/AIDS” to Congress as well as staff in the administration and the Centers for Medicaid and Medicare Services (CMS), the agency that administers the Medicare program. The position paper outlines concerns specific to people living with HIV/AIDS and recommendations for changes and clarifications to the law or statute governing the Medicare prescription drug benefit and the way in which it is regulated by the federal government. Project Inform is a member of the steering committee of the HIV Medicaid/Medicare Work Group.

Letter to Congress
July 5, 2004

Dear Senator/Representatives:

We are writing to share our key concerns with the implementation of the MedicareModernization Act and its impact on prescription drug coverage for Medicare beneficiaries living with HIV/AIDS, and to ask for your help in ensuring that the prescription drug needs of Medicare beneficiaries with HIV/AIDS are met through the new Medicare Part D drug benefit.

As you are aware, highly active antiretroviral therapy (HAART) is the linchpin of treatment for HIV/AIDS, which has resulted in dramatic reductions in mortality and morbidity. Moreover, continuity in the use of these medications is vital to arrest HIV disease progression, to maintain the medications’ effectiveness for the individual and to protect our nation’s public health by limiting drug resistance and infectivity.

In addition, most persons living with HIV/AIDS require a number of additional medications to respond to the side effects of therapy and HIV disease, and to treat co-morbidities such as Hepatitis C and mental illness. We are gravely concerned that Medicare beneficiaries with HIV/AIDS may not have access to the comprehensive drug regimen they need under the new Part D benefit, and that many who are dually eligible for Medicare and Medicaid with HIV/AIDS will be worse off with this new benefit.

We have shared these concerns with Administration officials and hope that some of the issues will be ameliorated through the Notice of Proposed Rulemaking scheduled for release sometime this summer. We welcome your assistance in advocating with senior Administration officials, including Administrator Mark McClellan, MD and Secretary Tommy Thompson for the recommendations included in the attached document. In addition, when the final regulations are released we ask that you evaluate their responsiveness to the concerns raised in the attached memo. Some issues highlighted in the attached document will likely require legislative fixes. As you consider needed changes to the Medicare Modernization Act, we hope that you will support modifications that are responsive to our concerns.

We would be happy to discuss these issues with you or your staff. If you have questions or comments about these concerns or wish to set up a meeting, please contact Christine Lubinski of the HIV Medicine Association at 703-299-1215 or by e-mail at Clubinski@idsociety.org. Thank you in advance for your consideration.

Sincerely,

The HIV Medicaid & Medicare Work Group Steering Committee *

The AIDS Institute, Tampa, FL
AIDS Treatment Data Network, New York City, NY
American Academy of HIV Medicine, Los Angeles, CA
Gay Men's Health Crisis, New York City, NY
HIV Medicine Association, Alexandria, VA
Housing Works, New York, NY
National Alliance of State and Territorial AIDS Directors, Washington, DC
National Health Law Project, Los Angeles, CA
Project Inform, San Francisco, CA
Treatment Access Expansion Project (TAEP), Boston, MA

* The HIV Medicaid & Medicare Work Group is a coalition of more than 75 national and community-based AIDS service organizations that represent HIV medical providers, advocates and people living with HIV/AIDS. They provide critical HIV-related healthcare and support services.