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Trump Proposes Limiting HIV Meds’ Medicare Coverage

Officials say plan would reduce costs, but advocates fear treatment havoc

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Advocates are sounding alarms after the Trump administration on Monday unveiled a proposal that, if implemented, would lower the number of HIV drugs available to Medicare recipients beginning in 2020.

The proposal, which also reduces the drugs available to people with cancer, depression, and other health conditions, is being framed by the Trump administration as a cost-cutting initiative by creating leverage for Medicare-contracted insurance companies in negotiations with drug manufacturers. Those insurance providers are currently required to cover substantially all drugs in six different classes of treatments, but under the new plan they’d be able to stop covering some drugs if they’re too pricey.

Many fear the plan would wreak havoc on the healthcare of vulnerable populations by throwing off their existing drug regimens crucial to keeping them healthy.

Carl Schmid, who serves as the deputy executive director of the AIDS Institute, a Washington-based research and advocacy non-profit group, said the plan is especially dangerous because it would implement prior authorization and step therapy, which forces patients to use cheaper drugs first. This, he said, is unheard of in HIV medicine and runs against current treatment guidelines.

“Doctors prescribe the drugs they feel is best for that patient,” he explained. “People have resistance to certain things so they can’t take some HIV drugs. Every drug is different and every person is different. People even have different side effects to different drugs.”

Despite the federal Department of Health and Human Services’ endorsement of the restrictions proposal, its own guidelines for the use of antiretroviral therapy in people living with HIV note that prior authorizations result in fewer prescriptions being filled and include hidden costs. Complicating things further, prior authorization can delay treatment at times when beneficiaries need their medication.

“If they do fail on a particular regimen, you want to get them on another drug as quickly as possible,” Schmid added. “The authorizations would take too much time.”

The Trump administration argues that the proposal would reduce out-of-pocket expenses and allow insurance companies to negotiate lower drug prices. Yet, drugs that see an increase in price beyond the rate of inflation could be pulled altogether, leaving patients without the drugs they need.

Advocates stifled a similar proposal by the Obama administration in 2014, but that plan did not involve any changes to HIV medication coverage. Instead, it would have stopped requiring insurance companies from providing certain antidepressants and some immunosuppressants for transplant patients.

Schmid said the AIDS Institute will fight the proposal and plans to turn to Congress to rally lawmakers against it. Several local health groups contacted had not yet been able to study the Trump initiative as Gay City News went to press.

Updated 4:20 pm, November 28, 2018
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