Medicare

Are your patients having trouble filling prescriptions under the new Medicare drug program? Report it to the Centers for Medicare and Medicaid Services (CMS) and HIVMA.

The open enrollment period for the Medicare Part D program is November 15 to December 31. The fact sheet developed by the HIV Medicaid and Medicare Working Group (HMMWG) includes important information for Medicare beneficiaries to keep in mind as they compare their Medicare drug coverage options. The HIV Open Enrollment Brochure and Medicare Part D Overview presentation were produced by Abbott Laboratories with input from members of the HIV Medicaid and Medicare working group, including HIVMA.

Medicare beneficiaries with HIV/AIDS have not been immune to the widely reported problems that people are having getting their prescriptions through Medicare Part D. Here is a list of issues and information to help your patients deal with the problems.

Contact your state's SHIP for one-on-one assistance with Medicare including Medicare Part D and other health insurance enrollment and coverage questions.

CMS worked with the American Medical Association and others to develop a standard form for physicians to use to request exceptions -- the first step in the Medicare Part D grievance and appeals process. Part D prescription drug plans are encouraged but not required to use the form. Physicians may request "exceptions" for coverage of non-formulary drugs, to have utilization management policies waived and for drugs to be made available at lower cost sharing tiers. Plans are expected to process "expedited" exceptions requests in 24 hours and "standard" exceptions within 72 hours.

Illinois will expand eligibility for its state pharmacy assistance program (SPAP), Illinois Cares Rx, to cover people with AIDS beginning next year. Under a bill passed last month, the state will shift people with incomes above $13,000 who qualify for the AIDS Drug Assistance Program (ADAP) and Medicare to Illinois Cares Rx. The move will ensure that people with AIDS can afford their HIV medications while also saving the state money.

HIVMA letter to the House and Senate Energy and Health Committees and Subcommittees in support of the Children's Health and Medicare Protection act (CHAMP).

HIVMA chairman submitted comments to the Centers for Medicare and Medicaid Services on the 2007 draft formulary guidance for Medicare Part D drug plans. Dr. Kuritzkes called on CMS to require drug plans to cover all ARVs including those approved after April 17 as proposed in the guidance; enforce plan compliance with current formulary requirements; and develop a uniform, easy to navigate prior authorization process.

In a letter to Dr. Mark McClellan of the Centers for Medicare and Medicaid (CMS), HIVMA Chairman Dr. Daniel Kuritzkes urged CMS to strengthen and make permanent the current Medicare Part D formulary protections for antiretroviral medications.

HIVMA Board Chair Paul Volberding sends a letter to Senators DeWine and Bingaman, cosponsors of the legislation to end the 2-year waiting period for Medicare beneficiaries. For updated information, click here.

This fall the American Academy of HIV Medicine (AAHIVM) and the HIV Medicine Association (HIVMA) conducted a joint survey of their memberships to ascertain how the Medicare Part D program is working for HIV medical providers and their patients living with HIV/AIDS. This document provides a summary of the findings.

HIV Medicare and Medicaid Work Group synopsis of the HIV community’s recommendations and the outcome either in the final rule or accompanying documents such as the formulary review criteria guidance document that CMS will use to evaluate the prescription drug plan formularies. Brief table format.