The growing cohort of seniors with HIV/AIDS: changing the scope of Medicare Part D

Abstract

HIV/AIDS medications are generally expensive and government assistance is often necessary to limit high out-of-pocket patient costs. Lowered patient out-of-pocket costs were the objective of government involvement in drug provision through legislation creating Medicare Part D. However, the Medicare program faces a surge in those beneficiaries living longer on more effective antiretroviral drugs. Higher prevalence of HIV/AIDS patients means more opportunity for transmission of the infection and recidivistic behavior such as non-adherence to medication regimens. Along with the resulting increased frequency of opportunistic infections in HIV/AIDS patients comes the requirement for aggressive pharmacological treatment. To meet this need, Medicare Part D provides drugs for the treatment of opportunistic infections occurring in HIV/AIDS patients. Problematically, though, Medicare Part D contains so many choices that it tends to overwhelm patients and sometimes even the providers and insurance companies as well. The multiplicity of choices in this highly complex program for the aged and infirm often leads to confusion and incorrect choices by beneficiaries. Furthermore, the advent of tiered cost-sharing or formulary management by Medicare Part D providers, besides controlling out-of-pocket costs, controls which medications are covered and limits the quantity that is dispensed. HIV/AIDS treatment in the present day requires a highly accessible medication provision program that is only now beginning to evolve as Medicare Part D.

Health Care Reform: What Does It Mean for People Living With HIV Infection?

“…The Medicare program anticipates a surge in HIV-infected seniors because of the effectiveness of antiretroviral drugs in extending life expectancy. Moreover, higher prevalence of HIV-infected elders means more opportunities for transmission of the infection, more non-adherence to treatment regimens, more opportunistic infections, and more people requiring aggressive drug therapies (Flaer, Benjamin, Malow, Morisky, & Parkash, 2010).…”

Understanding geriatric models of care for older adults living with HIV: a scoping review and qualitative analysis

“…The life expectancy for people living with HIV who have had early and sustained access to ART is now similar to that of HIV-negative populations [ 3 – 5 ]. Thus, there is now an increase in the number of individuals living with HIV into older age [ 6 ] and the number of older adults (aged ≥ 50 years [ 7 ]) living with HIV is expected to increase even further in the coming years [ 8 ]. The proportion of older adults living with HIV has nearly tripled since 2000 [ 9 ].…”

Low Utilization of Direct-Acting Antiviral Agents in a Large National Cohort of HIV and HCV Coinfected Medicare Patients in the United States: Implications for HCV Elimination

“…About 30% of PLWHA are covered by Medicare 22. As PLWHA age, it is expected that more PLWHA will be covered by Medicare and it is essential to understand DAA utilization in PLWHA enrolled in Medicare 23,24. Our study aimed to examine DAA initiation and completion in a large national cohort of HIV–HCV-coinfected patients in Medicare.…”