CALIFORNIA: Some AIDS Drugs Not on Medicare Site

Important note: Information in this article was accurate in 2007. The state of the art may have changed since the publication date.

CALIFORNIA: Some AIDS Drugs Not on Medicare Site

Bay Area Reporter (San Francisco) (12.13.07) - Thursday, December 27, 2007
Heather Cassell

Some HIV/AIDS patients might not find newly approved medications through Medicare's Part D drug plan finder, say Courtney Mulhern-Pearson of the San Francisco AIDS Foundation and Anne Donnelly of Project Inform. Because the drug finder is not always current, newly approved medicines such as Isentress (raltegravir) might not show up. That does not mean they are not covered by individual prescription plans; HIV/AIDS drugs are a protected class. Medicare's open enrollment deadline is Dec. 31 for 2008 health care coverage.

"Individual private plans are required to cover these drugs," said Donnelly. "We actually want to know from folks if they really find a plan where it's not covered, even if it is a new drug and it doesn't have protected status, because we still can have some leverage on that." The state AIDS Drug Assistance Program (ADAP) will take care of them if there is a glitch or a problem, she said.

California's ADAP approved Isentress for coverage, according to Lea Brooks, spokesperson for the California Department of Public Health.

Donnelly said the process for drugs appearing on individual Medicare Part D plan formularies is lengthy if the Food and Drug Administration approves a drug after April of each year. Drug plans have 90 days after a medication is approved before April to be included in the formularies as a protected class. After April, it can take up to a year and a half for drugs in a protected class to appear in a plan. Donnelly said HIV/AIDS medications "generally get inclusion pretty quickly."

Mulhern-Pearson advised people to see a benefits counselor for questions about coverage.
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