PROJECT INFORM IN OTHER MEDIA ... 2007
Some AIDS drugs not on Medicare site
by Heather Cassell
(mention of Project Inform in bold below)
Some people living with HIV/AIDS searching through the Medicare
Part D drug plan finder might not locate some newly approved
medications, but that doesn't mean the drugs aren't covered
by Medicare's individual prescription plans, local AIDS advocates
said.
The apparent problem is that the plan finder isn't always
current, especially with drugs newly approved by the Food and
Drug Administration, like Isentress (raltegravir), which was
approved October 12, according to Courtney Mulhern-Pearson,
policy analyst of the San Francisco AIDS Foundation, and Anne
Donnelly, director of health care advocacy of Project Inform.
Medicare's open enrollment period deadline is December 31
for 2008 health care coverage.
Donnelly told the Bay Area Reporter that in spite
of a drug not appearing on a Medicare Part D drug plan formulary
it doesn't mean that the drug isn't included in the individual
plan.
"Individual private plans are required to cover these drugs," said
Donnelly. "We actually want to know from folks if they really
find a plan where it's not covered, even if it is a new drug
and it doesn't have protected status, because we still can
have some leverage on that. A person can file an exception
to get access to that drug, so we always want to know. But
the fallback is that ADAP is going to take care of them if
there is a glitch or a problem or something like that."
The AIDS Drug Assistance Program approved Isentress for coverage
November 21, according to Lea Brooks, spokeswoman for the California
Department of Public Health.
Medicare representatives did not respond to a request for
comment.
According to Donnelly, the process for drugs appearing on
individual Medicare Part D plan formularies is lengthy if the
FDA approves a drug after April of each year. Drug plans have
90 days after a medication is approved by the FDA prior to
April of each year to be included in the formularies as a protected
class. If drugs are approved after April it can take up to
a year and a half for drugs in a protected class to appear
in a plan. HIV/AIDS drugs are a protected class.
But Donnelly hasn't seen very many instances where
AIDS medications haven't been covered after the FDA approves
them. They "generally
get inclusion pretty quickly," she said.
"We haven't seen a whole lot of trouble that we are aware
of with drugs of this kind being covered," said Donnelly.
SFAF hasn't been alerted to any problems either, according
to Mulhern-Pearson and Ellen Novogrodsky, a SFAF financial
benefits counselor. Mulhern-Pearson told the B.A.R. that
some of the foundation's clients were already receiving Isentress
through Medicare Part D plan providers.
"The best way to compare plans for a person living with HIV/AIDS
is to compare their drugs that aren't on ADAP," said Donnelly. "It
will make it much simpler and much clearer."
Mulhern-Pearson advised people to speak with a benefits counselor
if they have questions about coverage. Novogrodsky also advised
that it's a good idea to follow up with Medicare or the insurance
provider after receiving the online enrollment confirmation
to check to make sure enrollment applications have been processed.
For more information about the open enrollment period, Project
Inform and the East Bay Community Law Center will present "Medicare
Part D Update," today (Thursday, December 13), from 12:30 to
3:30 p.m. at the Office of AIDS Administration, Gary Harmon
Conference Room, 1970 Broadway, 11th Floor, in Oakland (near
19th Street BART station). The event is free to the public
and lunch will be served.
For Medicare Part D health benefits assistance, see www.ebar.com and
scroll down for the list of contacts.
