Bay Area Reporter (San Francisco) (04.19.07) - Thursday, April 26, 2007
Bob Roehr

Medicare is regulated by the Centers for Medicare and Medicaid Services, which designated antiretrovirals as one of the six drug classes in which insurers must cover "all or substantially all" available drugs. Insurers are allowed to require prior authorization only for Fuzeon, the most expensive therapy.

Even so, four out of five doctors said prior authorization is a barrier to getting prescriptions filled. Eighty-three percent of physicians surveyed said their patients were having trouble getting prescriptions filled under Part D, and 75 percent of those with a problem had gone without medications. "We're currently processing at least 25 prior authorizations per week," said Dr. Michael Saag, director of the HIV clinic at the University of Alabama-Birmingham. "The only ones who benefit are the insurance companies."

Some patients are "dual eligible," qualifying for Medicare and Medicaid, and are served by a variety of programs, including the AIDS Drug Assistance Program. All eligible ADAP patients were required to be enrolled in Part D as of January 2006.

The providers surveyed said 48 percent of dual eligible patients were worse off under Part D in terms of the drugs covered, while 9 percent were better off. Out-of-pocket expenses for co-pays were higher for 58 percent and lower for 5 percent.

In their recommendations, AAHIVM and HIVMA ask Congress to act to deal with prohibitive co-pays and to ensure that Part D covers all drugs. They also want regulators to enforce existing rules on prior authorization.

To access the full report, "HIV Medical Provider Medicare Part D Survey," visit www.aahivm.org.
070426
AD070875

Copyright © 2007 - Information, Inc., Bethesda, MD. The CDC National Center for HIV, STD and TB Prevention provides the following information as a public service only. Providing synopses of key scientific articles and lay media reports on HIV/AIDS, other sexually transmitted diseases and tuberculosis does not constitute CDC endorsement. This daily update also includes information from CDC and other government agencies, such as background on Morbidity and Mortality Weekly Report (MMWR) articles, fact sheets, press releases and announcements. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC HIV/STD/TB Prevention News Update should be cited as the source of the information. Contact the sources of the articles abstracted below for full texts of the articles.

AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted funding from Boehringer Ingelheim, Bridgestone/Firestone Charitable Trust, Bristol-Myers Squibb Company, Elton John AIDS Foundation, the National Library of Medicine, Roche and Trimeris, and donations from users like you. Always watch for outdated information. This article first appeared in 2007. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2007. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .