In the news ... 2008

Senate committee fails to protect people
with HIV/AIDS in Medicare bill

June 13, 2008

Project Inform, along with our advocacy partners, has worked hard this year to convince Congress to pass a law that would make an important fix to the Medicare prescription drug benefit (Medicare Part D) and close a gap in treatment access for people with HIV/AIDS.

Many who get their HIV drugs through the Medicare Part D benefit quickly reach what is called a “donut hole” (meaning they have no coverage at all for drugs) which can only be surpassed if they can afford $4,500 out of their own pocket. If they pay the $4500, Medicare will kick in with meaningful coverage, paying about 95% of their drug costs. Most people with HIV/AIDS reach the coverage gap within the first two months of the Medicare plan year. In the gap, people must pay the full cost of their drugs or rely on another program, such as the AIDS Drug Assistance Program (ADAP).

However, current law doesn’t allow ADAP spending to count towards Medicare out of pocket drug costs, known as True Out Of Pocket (TrOOP) spending. This means that when ADAP helps a Medicare beneficiary pay for their drugs, the client will stay in the coverage gap for the rest of the plan year.

People with HIV/AIDS who should be able to get full benefit of Medicare Part D are then forced to rely on underfunded ADAPs, which in nearly all states have a much more limited drug formulary than Medicare.

Most Medicare beneficiaries with HIV/AIDS have significantly advanced HIV disease and often have drug needs that are not met by state ADAPs. These ADAPs must also spend money for these clients that could be used to expand treatment access to other insured or underinsured people. If ADAP expenditures were allowed to count as TrOOP, people on Medicare would have access to the drugs they need and it would save about $50 million per year.

The Senate Finance Committee recently introduced legislation that focuses on Medicare physician reimbursement fixes and other reforms. It chose to turn its back on people with HIV/AIDS by failing to include a provision to fix the ADAP as TrOOP issue — even though it would cost less than 1% of the Medicare reform package. Project Inform and our partners reacted quickly by issuing a press release and placing an ad in Congressional Quarterly highlighting this failed leadership. We are also urging the Senate to pass an amendment to this legislation that would allow ADAP to count towards TrOOP.

The Senate will soon debate the Medicare legislation and you can play a major role in fixing this problem by acting on this Action Alertand calling your two U.S. Senators. 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!