by Bob Roehr
WASHINGTON, DC –
AIDS advocates are outraged that the proposed Senate version of Medicare reform does not correct technical problems that have created a gap or "donut hole" of coverage in the prescription drug benefit known as Medicare Part D, for people living with HIV.
"Congress has turned its back on people with AIDS by failing to address their needs," said Kali Lindsey of the National Association of People with AIDS (NAPWA). "Saving lives would cost the country next to nothing. We call on Congress to show leadership in the fight against AIDS and correct this flaw immediately."
Medicare provides healthcare coverage for about 100,000 people with AIDS in the U.S. It is the second largest provider in the country. Medicare Part D was created to cover prescription drug costs, with beneficiaries making a copayment until they reach a certain dollar threshold and then Medicare picks up nearly all of the costs.
Unfortunately expenditures under the AIDS Drug Assistance Program (ADAP) are not counted toward those out of pocket expenses, so people with AIDS are stuck in the donut hole. They are not able to reach the threshold where Medicare will pick up the full cost of their drugs.
Project Inform's Anne Donnelly explained, "In California, most people with HIV/AIDS receive two months of partial coverage under Medicare before they go into the donut hole." ADAP can cover HIV drugs but not drugs used to treat high blood pressure, cancer, diabetes and other conditions that occur more frequently among those living with HIV.
She said the state budget crisis "has forced the Governor to propose cuts to the current ADAP formulary," so it won't be able to pick up the slack.
AIDS advocates have pushed for a solution to this technical problem. Senate Finance Committee chairman Max Baucus (D-Montana) put forward a Medicare reform bill last week that addresses many technical issues but not this one. The estimated cost is less than one percent of the entire Medicare package.
Baucus is taking the unusual step of bringing the bill to the floor without a vote in committee where there is bipartisan support to correct the problem. It is perhaps a coincidence that Montana has one of the lowest incidences of HIV infection in the country.
"You can't blame this on the White House or the Republicans," said Carl Schmid with the AIDS Institute, Baucus did it on his own. The House version of the bill contains the desired changes but it is unclear what version of the legislation will serve as the basis for conference to resolve differences between the two chambers."
Julie Scofield, executive director of the National Alliance of State and Territorial AIDS Directors (NASTAD) said, "ADAPs have struggled to keep up with client demand due to limited funding from Congress."
She called on Congress to provide critical relief for ADAPs by changing Medicare. "This is a very inexpensive fix that would have a huge impact for people living with HIV/AIDS and ADAPs alike."
