The Trump-Pence administration announced a proposed rule that could have a devastating impact on people living with HIV.
In November, the Trump-Pence administration announced a proposed rule that could have a devastating impact on people living with HIV. This proposal would remove critical safeguards currently in place designed to ensure that people living with HIV and AIDS can access the medications they need. If this rule goes into effect it could result in the denial of coverage for life saving medications, including antiretrovirals.
The Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) announced it was proposing modifications to the Medicare Part D prescription drug program that would have a detrimental impact on program participants living with HIV and other life-threatening chronic conditions.
Currently, Part D is required to cover at least two medications in a given therapeutic class. This policy also requires that Part D sponsors provide coverage for all drugs for six specifically designated therapy classes including antiretrovirals. This policy was adopted more than a decade ago and is designed to ensure that patients have access to the medications they need. For people living with HIV, it is imperative that doctors have flexibility to prescribe any medication that works for individual patients.
The proposed rule change would allow providers to require a series of “cost-saving” steps including prior authorization. Experiences show that prior authorization is counterproductive and can delay access to early treatment and can make sticking with treatment harder. It can also also threaten patients achieving and sustaining viral suppression — which is key to ending the epidemic. The changes would allow Part D sponsors to exclude a protected class drug when the price for the drug rises faster than inflation over a designated period. This would in effect allow them to stop covering expensive HIV treatments. Zeroing out these protections could also lead to their eventual exclusion from Part D altogether — placing them out of reach for patients.
HHS is accepting public comments until this Friday, January 25. Tell HHS protect access to HIV and AIDS drugs today.