Administration Proposes Dangerous Access Barriers for HIV Drugs

Reprinted from The AIDS Institute
Media Contact:  Carl Schmid: (202) 669-8267

Proposed Medicare Part D Rule Ignores Treatment Protocols

Washington, DC – Today, the Trump Administration proposed to add unprecedented access restrictions to lifesaving HIV drugs that, if finalized, will jeopardize our Nation’s efforts to provide treatment to Medicare beneficiaries living with HIV. In the proposed rule, the Centers for Medicare and Medicaid Services (CMS), would allow plans to institute dangerous prior authorization and step therapy requirements.

This proposal runs contrary to current US government HIV treatment guidelines, which state that prior authorizations for HIV drugs “result in fewer prescriptions filled and increased nonadherence…. and have substantially reduced timely access to medications.”

Step therapy is unheard of in the treatment of HIV due to the danger of developing resistance to an entire class of drugs and potential side effects.

We now have the drugs to keep people with HIV healthy and alive, and once on treatment, suppress their virus to such a level that they cannot transmit HIV to others.  This proposal conflicts with public health recommendations and efforts to expand treatment to everyone living with HIV.

Not all HIV medications are the same, and not very person living with HIV is the same.  Providers are best able to prescribe the HIV drug that works best for the patient, who may have resistance to certain drugs, comorbidities, or side-effects that dictate the drug that they are able to take. The Medicare Part D Program is working well for people living with HIV, and there is no reason to take these draconian actions.


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