Thursday, January 11, 2018

NASTAD Releases Updated 2017 ADAP Formulary Database

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

Allowing people living with HIV/AIDS ("PLWHAs") to make informed decisions about their own healthcare has been a cornerstone of the ADAP Advocacy Association's mission since the organization launched in 2007. All too often, local service providers and advocacy organizations take a paternal approach to PLWHAs, evidenced by the complaints expressed directly by the people themselves. One organization should be commended for their efforts to put important treatment-related information directly at the fingertips of PLWHAs, specifically as it relates to drug formularies under the AIDS Drug Assistance Program ("ADAP").

Two pill capsules, one with the word "rejected" and one with the word "accepted" on them
Photo Source: lookfordiagnosis.com

The National Alliance of State & Territorial AIDS Directors ("NASTAD") announced late last year that it had updated its Online AIDS Drug Assistance Program (ADAP) Formulary Database (2017 version). According to NASTAD, its database provides "an online, searchable, publicly available resource detailing state-by-state ADAP coverage of medications both individually and by drug class including HIV antiretroviral ("ARV") treatments, A1 Opportunistic Infections ("A1 OI") medications, treatments for hepatitis B and C, mental health and substance use treatment medications, and various vaccines and laboratory tests."[1]

The database offers the following:[2]

  • General Information
  • Antiretroviral medications
  • ARV Generic Equivalents
  • “A 1” opportunistic infection medications
  • Hepatitis B treatments
  • Hepatitis C treatments
  • Substance use treatment medications
  • Mental health treatment medications
  • Other medication categories
  • Vaccines
  • HIV & STD diagnostics
  • Hepatitis C diagnostics

NASTAD's 2017 Online AIDS Drug Assistance Program Formulary Database is available online at https://www.nastad.org/adap-formulary-database.

Making such a valuable resource available directly to PLWHAs (and others) cannot be under-estimated in its importance. Access to timely, appropriate care and treatment is essential to achieving improved medication adherence, greater peace-of-mind, and better health for people living with any chronic health condition. Yet we know one of the most stressful things for PLWHAs are their medications. More efforts like NASTAD's database should be implemented across the treatment cascade.

In fact, that is the very reason why we launched our ADAP Directory. It offers PLWHAs (and others) a one-stop online resource center for the latest ADAP information for better decision-making for HIV/AIDS care; improved quality of HIV/AIDS information; and assistance for advocates and medical staff. It also includes an ADAP Eligibility Calculator. The ADAP Directory is available online at http://adap.directory.

Yes, that was a shameless plug for our flagship program. Now back to NASTAD's efforts...

NASTAD's database is very comprehensive. Some key findings from the updated 2017 ADAP Formulary Database include:[3]
  • 12 ADAPs have “open formularies” in which all FDA-approved medications are included, excluding designated exceptions
  • 39 ADAPs cover one or more hepatitis B treatment medication
  • 40 ADAPs cover one or more hepatitis C ("HCV") treatment medication
  • 34 ADAPs cover one or more of the curative direct acting antiviral ("DAA") HCV treatment medications
  • 46 ADAPs cover one or more of the most frequently prescribed mental health treatment medications
  • 27 ADAPs cover one or more substance use treatment medication
Any questions about NASTAD's database should be directed to Amanda Boyles at abowes@NASTAD.org. Kudos, NASTAD! Kudos!

NASTAD logo

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[1] Penner, Murray (2017, November 29); NASTAD Releases Updated 2017 ADAP Formulary Database; National Alliance of State & Territorial AIDS Directors (NASTAD). 
[2] National Alliance of State & Territorial AIDS Directors (2017, November 29); 2017 ADAP Formulary Database; National Alliance of State & Territorial AIDS Directors (NASTAD); page 4. 
[3] Penner, Murray (2017, November 29); NASTAD Releases Updated 2017 ADAP Formulary Database; National Alliance of State & Territorial AIDS Directors (NASTAD). 


Thursday, January 4, 2018

Gary was One for the Roses

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

In late 2006, Bill Arnold approached me about starting a national organization whose mission would be solely dedicated to promoting and enhancing the AIDS Drug Assistance Program (ADAP). Long before anyone else, Bill predicted the "Perfect Storm" that would befall the increasingly cash-strapped program. The idea behind the ADAP Advocacy Association was putting into place a platform to educate and mobilize people living with HIV/AIDS (and others) long before this storm rolled in. Next, Bill said, "If we're going to do it, then we're going to need Gary Rose on board."

Bill was right!

Gary Rose, after all, had years of specialized experience working to improve access to care and treatment for people living with HIV/AIDS, as well as viral hepatitis and leukemia. As a consultant, Gary worked closely with Millennium Pharmaceuticals, Roche, GlaxoSmithKline, Bristol-Myers Squibb and others to advance key advocacy programs and policies in oncology, rare disorders and other conditions with serious impacts on patients and their carers. He also worked with the U.S. Department of Health and Human Services Office of National AIDS Policy. In the late nineties through 2004, Gary served as Senior Vice President with Hyde Park Communications. His work included health systems consulting for clients including Hoffmann-La Roche, Bristol-Myers Squibb, Pfizer, and the TAEP Project. In the 1990s, he served as the Research and Treatment Coordinator for the AIDS Action Council in Washington, DC. While at AIDS Action, Gary helped to form the ADAP Working Group and the Patients' Coalition for Responsible FDA Reform. He also served as a co-chair of the National Associations Responding to AIDS (NORA).

Gary R. Rose, JD
Gary R. Rose, JD
After I had learned about Gary's accomplishments and experience with so many big organizations, I was skeptical at the time that Gary would be interested. But he was thrilled with the idea of starting the ADAP Advocacy Association! I remember his exact words when Bill approached him about it. Gary said, "I'm in."

Throughout the early part of 2007, Gary served on the Organizing Committee charged with laying the foundation for the organization (along with Bill Arnold, John D. Kemp, Esq., Joyce Turner Keller, Keita Simmons, Philip A. Haddad, MD, and Rani G. Whitfield, MD). This Organizing Committee eventually was seated as the first Board of Directors after the organization was legally established on July 6, 2007.

Gary immediately left his imprint on me when he proposed a set of value statements. In his words, "They would be the foundational ideals under which the ADAP Advocacy Association operates." To this day the value statements are listed on our website, and they include:

  • That the organization consistently strives to achieve them, while encouraging its supporters to do the same.
  • That the voice of persons living with HIV/AIDS shall always be at the table and the center of the discussion.
  • That HIV/AIDS advocates should welcome the opportunity to join the skills, experience and voices with others on issues of disability and access to adequate healthcare for all Americans.
  • That advocacy efforts targeted to our federal government shall always carry the needed messages applicable at the state and local level.
  • That messages and information shall be in accessible formats understandable to - and also deliverable by - grassroots advocates in any setting.

Gary only served on our Board of Directors for one year, but he left his lasting mark on the organization in so many ways. Gary understood the importance of people living with HIV/AIDS being front and center on all advocacy efforts. In fact, he felt it was one area where some existing national organizations had lost their way. He constantly reminded us that an HIV organization cannot represent people living with the disease if they're not seated at the table, making the tough decisions. He also embraced the need to engage the broader disability advocacy movement because the two had gone their separate ways after the Americans with Disabilities Act was signed into law. Finally, Gary often lamented on the division within the HIV community itself, and stressed the need for the new organization to strive to bring all stakeholders together. That is why the following statement is also embedded in our work: The ADAP Advocacy Association works with advocates, community, health care, government, patients, pharmaceutical companies and other stakeholders.

On December 30th, Gary left us to go meet his Maker. I'm sure upon entering the pearly gates, Gary was looking how to make Heaven a better place because that is how he lived his life here on Earth. Gary was our friend, our colleague, our mentor, our leader and often times, our conscience. Gary was one for the roses, and that much is certain. Gary, you will be missed...

Gary R. Rose speaking at SAVE ADAP event
Gary R. Rose speaking at SAVE ADAP event in Wash-DC




Thursday, December 14, 2017

Closing the Book on 2017

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

This year, 2017, marked the ADAP Advocacy Association's 10th Anniversary, and it certainly wasn't without new accomplishments by our efforts, as well as plenty of political fireworks in Washington. It is clear that the uncertainty present at the start of the year remains as this year comes to a close. In fact, World AIDS Day — often viewed as an opportunity to reflect and grow — was widely tempered by the uncertainly being perpetuated by the man occupying the White House. Closing the book on 2017 is bitter sweet!

Our World AIDS Day Message to President Donald J. Trump sums up the "bitter" part of that statement. It really needs no further commentary, at this time.


But the year wasn't without the "sweet" moments, and that much should be celebrated! We were proud to partner with the Professional Association of Social Workers in HIV/AIDS to educate social workers and other key stakeholders about some key issues impacting our community. They included experts presenting on various issues, such as patient assistance programs, housing, transgender health, and substance abuse. The webinar archives are available online.

Our 10th Annual Conference lived up to its reputation as being the premier event for people living with HIV/AIDS concerned about the AIDS Drug Assistance Programs. With one of our most diverse line-up of conference speakers, it certainly challenged conference attendees to think outside of the box in the Age of Trump! This year we had advocates from 23 states in attendance, while also funding 50 scholarships!

In 2017, improving access to care among transgender men & women living with HIV/AIDS under Ryan White/ADAPs was one of our focus areas. To that end, we made a available a series of important resources  including an infographic, policy white paper, and Twitter chat. We were proud to partner with RAD Remedy to accomplish these important tasks. We applauded RAD Remedy earlier this year when they issued their National Standards of Care for TGIQ Health.

Of course, there was plenty of other advocacy activities throughout the year. They can be viewed on our website at adapadvocacyassociation.org. The New Year will be upon us rather quickly, and we look forward to continuing our work with you.

Friday, December 8, 2017

You Wanna Buy Some Death Sticks?

By: Jonathan J. Pena

At the age of 15, I took a drag off of my first cigarette and like many teens it was a response to a curious nature that was coupled heavily by peer pressure. The cool menthol taste coating my throat gave me excitement knowing that in a few seconds I would be exhaling a puff of cascading smoke in front of my peers. From that point on, I can remember smoking up to two packs of cigarettes a day. My lungs hurt just thinking about it now. Smoking cigarettes, as we all know, is a terrible habit to pick up. It has many damaging chemicals and compounds that can lead to some serious illnesses that can be fatal. Living with HIV requires a focus on living a healthier life, so it begs the question: what are the consequences of lighting up while on antiretroviral treatment?

Star Wars scene with Obi-Wan Kenobi
Photo Source: Star Wars: The Clone Wars
In the United States, more than 4 in 10 people living with HIV are smokers, and people within this population are at great risk of dying from lung cancer according to a recent article published in POZ magazine. They also highlighted findings from a preceding published Danish research study in 2012 indicating that those who smoked and also were HIV-positive would lose 12 years of life in comparison to nonsmokers.[1] Poof, up in smoke! 

An additional study was noted by POZ Magazine from the research team at Massachusetts General Hospital that published their findings in JAMA Internal Medicine. They were interested in finding the estimated risk of lung cancer with people living with HIV in the United States. Through computer simulation the parameter of interest also include current, former smokers and those who never smoked. The study estimated that 25 percent of people who were smokers, HIV-positive and adherent to their antiretroviral (ARV) therapy would die of lung cancer. That number is estimated to be 6 percent if a smoker quits by 40 years of age.[2]

Some additional information was published by NAM's AIDS Map that further illustrates the growing concern with smoking and being HIV-positive. They indicated that in 2015, 40 percent of people living with HIV/AIDS in the United States were smokers. This was in contrast to only 15 percent of the general public. Additionally, what their finding show is that those who are adherent to their medication are 6 to 13 times more likely to die of lung cancer instead of an AIDS related sickness.[3]

I smoked for many years even after my HIV-positive diagnosis. I can understand why so many people living with HIV smoke. As a former smoker, I saw smoking as the one vice that I was able to allot myself because, heck, I was already HIV-positive so why the hell not? Thankfully, through fantastic leaps in modern medicine and no small amount of personal maturity, I am able to light up my life with healthier alternatives like exercising, eating well and continuing to adhere to my medication.

We owe it to ourselves to be more health conscious on what we put into our bodies, especially for those of us living with the virus. Our hands have the ability to do so many great things that involve creation, innovation, and love but all of that would be diminished or lost if we decide to replace it with "death" sticks.



Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

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[1] POZ Magazine (2017, September 18); 1 in 4 Smokers on Successful HIV Treatment Projected to Die of Lung Cancer. Retrieved from https://www.poz.com/article/1-4-smokers-successful-hiv-treatment-projected-die-lung-cancer.
[2] POZ Magazine (2017, September 18); 1 in 4 Smokers on Successful HIV Treatment Projected to Die of Lung Cancer. Retrieved from https://www.poz.com/article/1-4-smokers-successful-hiv-treatment-projected-die-lung-cancer.
[3] Alcom, Keith. (2017, September 19). Smokers with HIV doing well on treatment now at greater risk of lung cancer than AIDS. NAM Publications. Retrieved from https://www.aidsmap.com/Smokers-with-HIV-now-at-greater-risk-of-lung-cancer-than-AIDS/page/3173651/.

Friday, December 1, 2017

A World AIDS Day Message to President Donald J. Trump

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

It has been less than one year since Donald J. Trump was sworn into office as the 45th President of the United States. In that short period of time, Trump has wreaked havoc in the hearts and minds of the people living with HIV/AIDS in the United States because he has continually demonstrated a flagrant disregard for the public health system designed to help them. The hashtag #SaveOurCare has come to symbolize the very real concerns felt by people living with HIV/AIDS (and many others) in this country. However, World AIDS Day provides a unique opportunity to send a stern message to him that it will not be tolerated by the 1.1 million people in the United States living with HIV/AIDS.

President Donald J. Trump
Photo Source: businessinsider.com

Aside from the insistence on repealing the Affordable Care Act, or Obamacare (which certainly has its share of problems), Trump has sought to undermine the marketplace exchanges. These exchanges have proved vitally important to people living with HIV/AIDS by linking them to health insurance purchased via the AIDS Drug Assistance Program (ADAP), as well as other means. Aside from being more cost effective than direct purchase options, it also affords people living with HIV/AIDS more supports and services. Why would he want to take that away from us?

At numerous times during the debate over the healthcare law, it was even suggested that the protections for pre-existing conditions be rolled back to the pre-Obamacare era. This would probably be one of the single most detrimental changes in healthcare-related public policy for this already underserved population. According to HIV.gov, "Insurers also are prohibited from cancelling or rescinding coverage because of mistakes made on an application, and can no longer impose lifetime caps on insurance benefits."[1] People living with HIV/AIDS already face a disproportionate share of discrimination and stigma without having to worry about being denied access to care and treatment. Why would he want to take that away from us?

Trump has also sought to undermine Medicaid, which is one of the most troubling aspects of his so-called healthcare reform agenda. Again, according to HIV.gov, "Medicaid is the largest payer for HIV care in the United States, and the expansion of Medicaid to low-income childless adults is particularly important for many gay, bisexual, and other men who have sex with men (MSM) who were previously ineligible for Medicaid, and yet remain the population most affected by the HIV epidemic."[2] In fact, Medicaid serves as a lifeline for many of our peers. Why would he want to take that away from us?

To make matters worse, Trump's proposed budget was riddled with cuts to the public health safety net on numerous fronts. Our blog earlier this year, "Trump's Proposed Federal Budget Puts Bullseye on People Living with HIV/AIDS (and many other chronic conditions)," spelled out these problematic proposed cuts. Although his budget flat-funded ADAPs, it called for draconian funding cuts to numerous federal programs specifically designed to assist people living with HIV/AIDS (including some authorized under the very same Ryan White).[3] Why would he want to take that away from us?

Most recently, Trump's plan to address the opioid epidemic in this country (which we applaud) was also accompanied by a significant zinger against the HIV/AIDS community. The plan came with no new money to fund the national emergency response, rather seeking to take the needed funding from existing programs. In other words, robbing Peter to pay Paul. Drew Gibson's op-ed laid out a stinging indictment against the possibility of taking money away from serving people living with HIV/AIDS to fund this initiative.[4] Why would he want to take that away from us?


World AIDS Day
Photo Source: desicomments.com

On World AIDS Day, let us collectively send a message to our government that ENOUGH IS ENOUGH. We have lost too many lives...we have made so much progress...and we are so close to ending the epidemic! Our message is a simple one: Save Our Care!

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[1] HIV.gov. (2017, January 31). The Affordable Care Act and HIV/AIDS. United States Department of Health and Human Services. Retrieved from https://www.hiv.gov/federal-response/policies-issues/the-affordable-care-act-and-hiv-aids.
[2] HIV.gov. (2017, January 31). The Affordable Care Act and HIV/AIDS. United States Department of Health and Human Services. Retrieved from https://www.hiv.gov/federal-response/policies-issues/the-affordable-care-act-and-hiv-aids.
[3] ADAP Blog. (2017, May 25). Trump's Proposed Federal Budget Puts Bullseye on People Living with HIV/AIDS (and many other chronic conditions). ADAP Advocacy Association. Retrieved from http://adapadvocacyassociation.blogspot.com/2017/05/trumps-proposed-federal-budget-puts.html.
[4] Gibson, Drew. (2017, October 31). President Trump's Opioid Response Could Reduce Ryan White HIV/AIDS Funds by $21 Million. TheBody.com. Retrieved from: http://www.thebody.com/content/80551/president-trumps-opioid-response-could-reduce-ryan.html?ic=tbhtrump.

Friday, October 27, 2017

Improving Access to Care Among Formerly Incarcerated Populations with HIV/AIDS under the AIDS Drug Assistance Program

By: Brandon M. Macsata, CEO, ADAP Advocacy Association & Marcus J. Hopkins, HIV/HCV Co-Infection Watch Project Director, Community Access National Network

The ADAP Advocacy Association announced earlier this month that it has launched a new project to improve access to care and treatment for correctional inmates living with HIV/AIDS who are transitioning back into community life. The project – “Improving Access to Care Among Formerly Incarcerated Populations with HIV/AIDS under the AIDS Drug Assistance Program (ADAP)” – aims to raise awareness about issues confronting formerly incarcerated populations living with HIV/AIDS (and/or Hepatitis C) who also access care and treatment (or whom could benefit from such care and treatment) under the AIDS Drug Assistance Program (ADAP), as well as provide useful resources and tools to the communities serving them.

The data on the number of formerly incarcerated populations infected with HIV/AIDS (and/or HCV), in many cases, simply isn’t available. In fact, most states’ epidemiology reports that did report HCV numbers didn’t account for incarcerated populations. What data is available is woefully out of date, using data four years or older. The data on HIV isn’t much better.

The Centers for Disease Control and Prevention (CDC) website, updated on March 14, 2017, cites numbers from 2010 – seven years prior to the most recent update.[1] The data cited is obtained from a 2012 report by the Bureau of Justice Statistics (BJS) – revised in March 2015 – that looked at HIV in prisons and jails from 2001-2010.[2] What used to be an annual report with yearly updates from 1993-2008, has apparently been shelved, over the past decade. Moreover, there doesn’t seem to be much in the way of a replacement from any government agency.

The BJS report indicated a few very important findings:

  • In 2010, there were 20,093 inmates in state and federal prisons infected with HIV, representing 1.5% of the total incarcerated population. 3,913 of those inmates were living with an AIDS diagnosis.
  • Of the total HIV-infected population, 91% were male. African-American (AA) men were 5 times as likely to be diagnosed than White men, and twice as likely as Hispanic/Latino men. AA women were more than twice as likely to be diagnosed with HIV than both White and Hispanic/Latino women.
  • Rates of AIDS-related deaths among state and federal prisoners declined an average of 16% a year from 2001 to 2010, from 24 deaths/100,000 in 2001 to 5/100,000 in 2010.

Other than those numbers, there isn’t a lot of information that is readily available to the public, which is troubling for a number of reasons.
Among them:

  1. HIV remains a deadly disease that, when left untreated and/or undiagnosed, can lead to numerous life-threatening complications and death; 
  2. Incarceration settings are notorious for being hotbeds of transmission for a host of sexually transmitted diseases; and
  3. This failure to present regular data updates may mean that prisons and jails are not complying with regulations requiring that all inmates be screened for HIV.

The CDC does, however, tout support for a number of community-based pilot projects, including Project START, Project Power, a partnership with Emory University (based in Atlanta) focused on juvenile AA girls aged 13-17, and a partnership with Morehouse Medical School to counsel AA male jail inmates about high-risk sexual behaviors and how to reduce them.  These programs are designed to help male and female inmates understand the risk associated with certain behaviors, as well as prevention strategies to be used both within and outside of incarceration settings.

One of the most frustrating aspects of conducting any research is the lack of information available to the public. Disease statistics are the foundation for making good policy at all levels of government, which means that, in order for citizens, legislators, and executives to craft data-driven, meaningful legislation and regulations, these data must be present. The data must be easily accessible, regularly updated (annually), and reliable.  At this point, that data is simply unavailable, which further leads to the need for greater awareness, and clearer guidelines on linkages to care.

What makes this approach vitally important is that access to care and treatment for HIV-infection (and/or HCV) is something that is sorely lacking in the areas that are hardest hit; not just HIV education, really – healthcare literacy in general is an issue. As such, there is a need to work on ways to get people to actually care about their health; help to identify the appropriate linkages to care; and engage in successful care and treatment strategies that will lead them to be Virally Suppressed. 

Available supports and services are going unused in too many ADAP jurisdictions, evidenced by data shared in the 2017 National ADAP Monitoring Project Annual Report (as seen in the charts below).[3] 

There exists a need to raise awareness among key stakeholders – among them, ADAP Directors, community service providers, and state/local advocacy organizations – about existing and emerging issues confronting formerly incarcerated populations. Furthermore, there is a need to model existing best practices to ADAP across the 50 states and territories in the United States. 

To that end, key elements of the project include:

1. Community Forum on Formerly Incarcerated Populations & Provider Friendly Care;
2. Animated Video on Formerly Incarcerated Populations & Linkages to Care;
3. Infographic on Ryan White/ADAP Serving Formerly Incarcerated Populations;
4. White Paper on Model Policy for Ryan White/ADAP Serving Formerly Incarcerated Populations; and
5. Twitter Chat on Ryan White/ADAP Serving Formerly Incarcerated Populations.

The project will execute all of the key elements between September 1, 2017 and March 31, 2018.

To learn more about the ADAP Advocacy Association's Correctional Health Project, please email info@adapadvocacyassociation.org.

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[1]  Centers for Disease Control and Prevention (CDC). (2017, March 14). HIV Among Incarcerated Populations. Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention: Division of HIV/AIDS Prevention. Retrieved from: https://www.cdc.gov/hiv/group/correctional.html
[2] Bureau of Justice Statistics. (2012, September 13). HIV in Prisons, 2001-2010 (NCJ 238877). Washington, DC: United States Department of Justice: Office of Justice Programs: Bureau of Justice Statistics. Retrieved from: https://www.bjs.gov/content/pub/pdf/hivp10.pdf
[3] National Alliance of State & Territorial AIDS Directors (2017, May 18); 2017 National ADAP Monitoring Project Annual Report; p. 24. Retrieved from http://www.nastad.org/sites/default/files/2017-national-adap-monitoring-project-annual-report.pdf



Thursday, October 12, 2017

Ins and Outs of the Successful Medicare Part D Program

By: Jennifer W. Cline, Advocacy & Strategic Alliances, PhRMA

****Reprinted with permission****

Medicare is the federal government program that insures many of America’s retirees and people with disabilities. Medicare Part D was implemented in 2006 to provide affordable prescription drug coverage to seniors and people living with disabilities. There are many parts to this very successful program.

Today, more than 40 million Medicare beneficiaries in the United States benefit from this program. In 2017, there are, on average, 22 Part D plan choices available in every region across the country.[i] This allows beneficiaries to choose a plan that best meets their individual coverage and financial needs and, in turn, they are better able to adhere to prescribed treatment regimens.

As we enter the fall and open enrollment season, it is important to keep Medicare Part D protected, so it can continue to serve the vulnerable American populations who need it most.

Did You Know Medicare Part D offers financial assistance to those who qualify under the “Extra Help” or “Low Income Subsidy (LIS)” Program?
  • The program helps about 11.5 million low-income Part D beneficiaries by waiving or lowering their premiums and deductible, and reducing their cost sharing for individual prescriptions.
  • On average, LIS beneficiaries are in poorer health than non-LIS patients.[ii] LIS beneficiaries often have multiple conditions or diseases and are more likely to be disabled than beneficiaries overall.[iii] Additionally, the overall disease burden is greater for LIS enrollees than non-LIS enrollees across multiple disease categories, including diabetes, chronic heart failure, chronic kidney disease and COPD.[iv]
  • Unfortunately, harmful changes to this important aspect of the Part D program have been proposed, including increasing copays for brand medicines used by beneficiaries who receive Extra Help.
  • Proponents of this idea say it is intended to increase use of generic medicines, however even MedPAC has noted that generic drug use among Part D enrollees – including beneficiaries receiving Extra Help – is already high. In fact, according to MedPAC, in 2014 83 percent of prescriptions filled by beneficiaries receiving Extra Help were for generics.[v]
  • Higher copays for Extra Help beneficiaries could also limit patient and provider choice, forcing changes in prescribed treatment even if it is not medically appropriate. In many therapeutic classes, substitution between a brand name drug and a chemically different generic is not medically appropriate. Policies that put patients at risk by forcing them to take a medicine other than the one their physician prescribes may do more harm than good by reducing adherence, which could in turn lead to poor health outcomes and increase total health care spending.
Did you know that negotiations already happen in the Part D program, helping reduce overall costs?
  • Part D is a competitive private market, rather than a system with government-set pricing. Private Part D plans negotiate substantial discounts and rebates with drug manufacturers, without the government meddling. According to a recent study, these substantial rebates have resulted in an average 35.3 percent discount from manufacturer list prices across 12 widely used therapeutic areas in Part D.[vi]
  • The Medicare Trustees have also repeatedly said negotiated discounts and rebates are substantial and continue to grow. In fact, the 2017 report shows rebate levels increased to 18.2 percent in 2015.[vii] There is broad agreement the Secretary of HHS could not negotiate lower prices. The Congressional Budget Office (CBO) has repeatedly found that “the Secretary would be unable to negotiate prices across the broad range of covered Part D drugs that are more favorable than those obtained by [Prescription Drug Plans (PDPs)] under current law.”[viii] And the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) has come to the same conclusion.
Did you know that Part D’s competitive structure has kept costs affordable and beneficiary satisfaction rates high?
  • Medicare beneficiaries have enjoyed relatively stable monthly Part D premiums. CMS estimates that the average monthly Part D premium for 2018 will decrease to $33.50 – roughly a dollar less than the average monthly premium in 2017.[ix]
  • Part D costs are $349 billion (or 45 percent) less than initial 10-year projections, and Part D made up just 13.7 percent of total Medicare spending in 2016.[x]
  • 87 percent of Part D prescriptions are generic[xi] (up from about 50 percent before the program was implemented)[xii], keeping costs low.
  • Multiple studies have shown about 9 in 10 Medicare beneficiaries are satisfied with their Part D coverage.[xiii]
And did you know that the affordable access provided by Part D helps improve beneficiaries’ overall health and reduces the use of other costly and avoidable health care services?
  • A recent study found, since 2006, nearly 200,000 Medicare beneficiaries have lived at least one year longer, with an average increase in longevity of 3.3 years. On average, 22,100 lives were saved each year between 2006 and 2014, primarily from fewer deaths from medication-sensitive conditions like diabetes and cardiovascular disease.[xiv]
  • A study in the National Bureau of Economic Research reported gaining Medicare Part D coverage was linked to an 8 percent decrease in hospital admissions for seniors.[xv] Gaining coverage also helped improve treatment adherence for enrollees with congestive heart failure, leading to more than $2.3 billion in annual Medicare savings.[xvi]
Medicare Part D helps retirees and people with disabilities live longer, healthier lives and is a vital component of our nation’s health care system.  Serving people who need it most, Part D must be protected and strengthened in the years to come.


Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.


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[i] Kaiser Family Foundation, “Medicare Part D: A First Look at Prescription Drug Plans in 2017,” October 2016. http://kff.org/report-section/medicare-part-d-a-first-look-at-prescription-drug-plans-in-2017-findings/
[ii] Medicare Payment Advisory Commission, “Report to Congress: Medicare Payment Policy,” March 2012.
[iii] Ibid. 
[iv] Stuart BC, et al. University of Maryland and PhRMA Chartbook: Medication Utilization Patterns and Outcomes Among Medicare Part D Enrollees with Common Chronic Conditions. September 2014. p. 16-17. https://www.pharmacy.umaryland.edu/media/SOP/wwwpharmacyumarylandedu/centers/lamy/pdf/Part_D_Chartbook_Final_2014.pdf.; BC Stuart et al. Why Do Low-Income Subsidy (LIS) Recipients Have Higher Part D Drug Spending? Poster presentation at AcademyHealth Annual Research Meeting, June 2014 San Diego. 
[v] Medicare Payment Advisory Commission, “Report to Congress: Medicare Payment Policy” March 2017, p. 410. 
[vi] QuintilesIMS Institute, “Estimate of Medicare Part D Costs After Accounting for Manufacturer Rebates,” October 2016. http://www.imshealth.com/files/web/IMSH%20Institute/Reports/IIHI_Estimate_of_Medicare_Part_D_Costs.pdf
[vii] https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2007-Press-releases-items/2007-01-11.html
[viii] Remarks of CBO Director Dr. Douglas Elmendorf before the Senate Finance Committee, February 25, 2009 https://www.finance.senate.gov/imo/media/doc/62182.pdf
[ix] CMS press release, “Medicare Issues Projected Drug Premiums for 2018,” August 2, 2017.
[x] See CBO Medicare Baselines available at www.cbo.gov
[xi] Medicare Trustees. The 2017 annual report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. July 2017:143(footnote 66).
[xii] Pharmaceutical Research and Manufacturers of America analysis based on IMS Health, Vector One®: National Audit data. Data extracted September 21, 2012.
[xiii] Morning Consult Survey for Medicare Today, “Nearly Nine in10 Seniors Satisfied with Medicare Part D,” July 2016; MedPAC, Report to Congress: Medicare Payment Policy, March 2013, p. 345.
[xiv] Semilla, et al., “Reductions in Mortality Among Medicare Beneficiaries Following the Implementation of Medicare Part D,” The American Journal of Managed Care, Vol. 21, No. 9, Sup., July 2015.
[xv] Kaestner R, Long C, Alexander C. Effects of prescription drug insurance on hospitalization and mortality: evidence from Medicare Part D. The National Bureau of Economic Research. http://www.nber.org/papers/w19948. Published February 2014.
[xvi] Dall et al., “The Economic Impact of Medicare Part D on Congestive Heart Failure,” The American Journal of Managed Care, May 2013.