A Mess Over the New Medicare Part D

Medicare Part D is creating major drug access problems for people with HIV, according to a new informal survey by two leading organizations of HIV medical providers. Bureaucratic roadblocks, exorbitant copays, and plans that fail to cover key drugs mean that this new program is failing an especially vulnerable population. Eighty-three percent of respondents to the survey said their patients had experienced problems having prescriptions filled'including prescriptions for antiretrovirals'since joining a Medicare Part D drug plan. Of these, 75% had patients who went without medications. 'People with HIV face serious health problems when forced to miss doses of their antiretroviral medications,' says Aimee Wilkin, MD, MPH, of Wake Forest University School of Medicine. 'The virus develops resistance and becomes harder and more expensive'or even impossible'to treat. Medicare Part D is supposed to help patients get access to lifesaving drugs, but for many of my patients, it has been a huge barrier to treatment.' The HIV Medicine Association and the American Academy of HIV Medicine, whose combined membership represents nearly all the nation's HIV medical providers, surveyed their members about their experiences and their patients' experiences with Medicare Part D. While limitations in the survey mean its conclusions can't be generalized to all HIV medical providers, the summary provides an illuminating snapshot of serious problems in the system. In addition to antiretrovirals, patients in Part D drug plans had problems with access to medications for infections brought on by their weakened immune systems, mental health, and cholesterol and hypertension control. Four out of five providers whose patients had problems getting prescriptions filled said prior authorization was the cause. Nearly half of those with Part D problems said that they had requested prior authorization for antiretrovirals'even though the Centers for Medicare & Medicaid Services specifically exempts all but one antiretroviral, Fuzeon, from prior authorization.