PI Action alerts & updates ... 2008

HIV Medicare and Medicaid Working Group Action Alert:
Call your Senators NOW: Help improve
medical treatment for people with HIV/AIDS

June 6, 2008

HIV/AIDS advocates around the country have been working hard to convince the Senate Finance Committee to pass a law that would close an important gap in treatment access for people with HIV/AIDS by allowing ADAP expenditures to count towards Medicare Part D true out of pocket costs. The Committee has chosen to ignore the needs of people living with HIV/AIDS by failing to include this provision in a Medicare reform bill. This provision would cost far less than 1% of what the Senate proposes to spend on other Medicare improvements and would improve the lives of countless people living with HIV/AIDS around the country.

What you can do:
Call your two U.S. Senators in their Washington, DC office. Ask to speak to the legislative aide who handles health care issues. Whether you speak to him/her live or leave a voicemail, say:

If your Senator is a Democrat:
"My name is ___________ and I live in (your state). The Senate’s Medicare physician fix bill will be voted on this week. The Senate Finance Committee has left out a vital provision that would allow AIDS Drug Assistance Program spending to count towards Medicare Part D “true out of pocket” costs. This would greatly help people with HIV/AIDS have better access to lifesaving treatment. It would also free up scarce Ryan White dollars to provide lifesaving treatment to uninsured people with HIV/AIDS. Please have Senator ___________ call Finance Chairman Max Baucus and ask him to include the ADAP provision in a Manager’s Amendment to the bill."

If your Senator is a Republican:
"My name is ___________ and I live in (your state). The Senate’s Medicare physician fix bill will be voted on this week. The Senate Finance Committee has left out a vital provision that would allow AIDS Drug Assistance Program spending to count towards Medicare Part D “true out of pocket” costs. This would greatly help people with HIV/AIDS have better access to lifesaving treatment. It would also free up scarce Ryan White dollars to provide lifesaving treatment to uninsured people with HIV/AIDS. Please have Senator ___________ call Finance Ranking Member Charles Grassley and ask him to include the ADAP provision in Medicare legislation that he supports."

To reach your Senators, call the Capitol Switchboard toll-free at (800) 828-0498. Ask to be connected to your Senator’s office. If you don’t know who your Senators are, go to www.congress.org and enter your zip code in the upper left corner.

If you can’t make a phone call, please send an email to both of your Senators with the same message. Go to www.senate.gov to find their websites, where you will find out how to email them.

Background:
In 2008, many people who get their HIV drugs through the Medicare prescription drug benefit reach what is called the “donut hole” or coverage gap which can only be surpassed if they can afford a whopping $4,500 required for them to reach catastrophic coverage.

They reach the donut hole after their total drug costs reach $2,510. This happens for many people with HIV/AIDS within the first two months of their coverage. At that time, the individual must pay the full cost of their drugs or rely on another program, such as the AIDS Drug Assistance Program (ADAP). Once individuals have paid $4,500 out of pocket for their drug costs (referred to as true out of pocket costs or TrOOP), their Medicare Part D coverage resumes. 

Current law doesn’t allow ADAP spending to count towards TrOOP. This means that when an ADAP helps a Medicare beneficiary pay for their drugs during the coverage gap, the client remains in the coverage gap for the remainder of the year. People with HIV/AIDS who should be able to get the full benefit of Medicare Part D are then forced to rely on the underfunded ADAP program, which in nearly all states also has a much more limited drug formulary. It also means that ADAPs around the country must spend money for these clients that could be used to expand access to other uninsured or underinsured individuals. If ADAP were allowed to count as TrOOP, it would save about $50 million per year.

The Senate Finance Committee has recently introduced legislation focuses on Medicare physician fixes and other reforms. However, it failed to include a provision to fix the ADAP as TrOOP issue. The U.S. Senate will soon debate the Medicare legislation and you can play a major role in fixing this problem by urging the Chair and Ranking Member of the Finance Committee to introduce a “Manager’s Amendment” with the ADAP as TrOOP provision. The Senate needs to hear that this is a priority for people with HIV/AIDS and a fix that is badly needed. Please take the time to make these two important calls!

For more information, contact .

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.