NEW YORK - Sweeping changes to the nation's Medicare program, signed into law Monday by President George W. Bush, are facing a new round of criticism from AIDS activists who say that the new legislation is going to put tens of thousands of U.S. citizens living with AIDS in harm's way.
”Our government is finally bringing prescription drug coverage to the seniors of America,” Bush said as he signed the legislation, which provides prescription drug coverage to Medicare recipients through private insurance policies.
But according to Terje Anderson, executive director of the National Association of People with AIDS (NAPWA), millions of seniors will be trapped by a provision to prohibit wrap-around prescription drug coverage to Medicaid and Medicare so-called ”dual-eligibles”.
Many seniors and disabled people will face a huge gap in drug coverage. In a bill that's marketed as providing choice to consumers, comprehensive drug coverage is not really an option. That's a disappointment.
Gail E. Shearer, a health policy analyst at Consumers Union
Currently, dually eligible Medicare-Medicaid recipients have drug coverage under Medicaid. Once dually eligible recipients are forced into Medicare, they will not have the same body of prescription drug coverage they have now.
”The bill calls for some six million low-income elderly and disabled Medicare recipients who also receive Medicaid to be barred from access to Medicaid drug benefits when this bill takes effect in 2006,” said Anderson. ”Assurances made by the Bush administration that 50,000 people living with AIDS will not be harmed must be supported with concrete plans and specific program advice.”
The legislation has already faced a barrage of criticism for weaknesses in its highly touted drug benefit provision, including its plan to limit coverage by establishing a short list of preferred medicines in each drug class known as a formulary and refusing to pay anything for drugs left off the list.
While patients could appeal a denial of coverage, they could not buy private insurance to cover the costs of such drugs.
Under the standard Medicare drug benefit, the beneficiary would be responsible for a 250-dollar deductible, 25 percent of drug costs from 251 to 2,250 dollars and all of the next 2,850 dollars in drug costs. In theory, the bill establishes a limit of 3,600 dollars a year in out-of-pocket costs.
But if a beneficiary bought drugs not listed on the formulary, the bill says, those costs would not be counted toward the 3,600-dollar limit.
”HIV is a disease which requires careful prescribing, so limiting which medicines can be provided to people living with AIDS can threaten our health and lives,” says Anderson. ”Health care providers must have access to all antiretroviral medications approved by the Food and Drug Administration to provide U.S. Public Health Service standard of care.”
Another consequence of the legislation will be further pressure put on the already overburdened AIDS Drug Assistance Program (ADAP), part of the Ryan White CARE Act, a federal program serving as the payer of last resort to states and cities whose health care systems have been impacted by caring for low-income people living with HIV.
”If people with AIDS receiving Medicare can't get the drugs they need to survive from Medicaid, they will have to rely on ADAP,” says Anderson. ”Fifteen states and counting have waiting lists or other ADAP program restrictions.”
For example, California Governor Arnold Schwarzenegger recently proposed capping enrollment in California's ADAP starting next month.
”Many seniors and disabled people will face a huge gap in drug coverage. In a bill that's marketed as providing choice to consumers, comprehensive drug coverage is not really an option. That's a disappointment,” said Gail E. Shearer, a health policy analyst at Consumers Union.
Director of the Metro New York Healthcare For All Campaign Mark Hannay, who does not support the new Medicare legislation, said in a telephone interview, ”the greater issue for AIDS patients and anyone who requires several different prescription drugs is that the bill may decrease accessibility to a variety of drug therapies.”
In an interview at an AIDS vigil held last week, Charles King, CEO of Housing Works, Inc. which assists People Living With AIDS to find housing, said the new Medicare legislation came ”at the price of people living in poverty,” and is likely to heavily impact AIDS patients who are dually eligible for Medicare and Medicaid.
In New York State, the Medicaid AIDS formulary, the list of prescription drugs available to AIDS recipients, includes 140 different drugs. The new Medicare legislation requires private insurance policies to offer one generic and one name brand drug in each therapeutic class. Comparatively, this means dually eligible Medicare and Medicaid AIDS patients will have access to at least two drugs that treat AIDS.
Christina Lubinski, director of the HIV Medicine Association, said that it is important for AIDS patients to have access to a variety of drugs due to the mutating ability of the AIDS virus. Most AIDS patients must take a three drug cocktail or switch frequently between prescriptions in order to slow the progress of their disease. Lubinski said that, unlike heart disease, there is not a handful of drugs that work for everyone.
Lubinski added that AIDS treatment with antiretroviral and protease inhibitors can engender side effects, including diabetes and hypertension. She pointed out that drugs given to treat side effects must in turn be carefully matched with AIDS prescriptions because some have adverse effects when mixed.
The situation is complicated by the fact that the HIV population in the United States is growing and people with AIDS are living longer. The Centers for Disease Control and Prevention estimates 850,000 to 950,000 people are living with HIV/AIDS in the United States, with approximately 40,000 new infections every year.
According to a Kaiser Family Foundation study based on 2001 data, African Americans represent approximately 54 percent of new AIDS cases reported each year. Thirty-four percent of new cases in African Americans are diagnosed in women, up from 21 percent in 1991.
Meanwhile, Fred Griesbach, government affairs manager for the New York State American Association of Retired Persons, which supported the bill, said in a telephone interview, ”We shouldn't be deceived into thinking this (bill) is going to solve all of our problems.”
Griesbach explained that the 400-billion-dollar legislation would only cover a quarter of the nation's prescription costs over the next 10 years. In the end, Griesbach speculated ”something would have to give,” whether it be an increase in the importation of pharmaceuticals, the development of more generic drugs, or a decrease in the costs charged by HMOs.
Copyright 2003 IPS