Jeffrey Levi, PhD, Center for Health Services Research and Policy, George Washington University, 2021 K Street, NW Suite 800, Washington, DC 20006, 202-530-2363, jlevi@gwu.edu

Issue: Medicare prescription drug coverage and the Ryan White CARE Act Description: New legislation enacted in 2003 adding prescription drug coverage to Medicare will likely have substantial impact on persons living with HIV. About 19% of people living with HIV/AIDS receiving care are Medicare beneficiaries, with many dually eligible for Medicaid and/or the CARE Act’s AIDS Drug Assistance Program (ADAP). This presentation describes the new benefit and potential implications for drug access by individuals with HIV. Lessons learned: The new benefit has substantial premiums, deductibles, and copayments that may be unaffordable for many people with HIV on Medicare, especially given the new law’s restriction on assistance with these payments by Medicaid, ADAP or other public programs. ADAPs would be prevented from adopting their usual policy of assisting clients with coinsurance payments and premiums. The new benefit may also have limited formularies, with the federal government restricted in its ability to regulate the scope of the benefit offered by pharmacy plans and plans will vary across the US. These factors combine to suggest that the new benefit might increase dependence on ADAP and other CARE Act services by Medicare beneficiaries since they may not have the resources (without support from another program) to pay the deductibles and copayments. Thus they may be unable to take advantage of the Medicare prescription drug benefit. Recommendations: Federal and state/local public officials may need to re-assess the level of dependence on ADAP by Medicare beneficiaries and/or seek changes in the new program.

Learning Objectives: At the conclusion of this session, the participant in this session will be able to

• Describe the new Medicare prescription drug benefit.
• Understand how the new benefit will affect people living with HIV who are also on Medicaid and/or ADAP.
• Describe the potential impact of the new benefit on other public programs, particularly ADAP.

Keywords: HIV/AIDS, Methadone Maintenance

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Handout (.ppt format, 314.0 kb)