Specifics: Obamacare and HIV

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From Think Progress By Tara Culp-Ressler

new brief from the Kaiser Family Foundation reports that President Obama’s health care reform represents a significant step forward for Americans with HIV, helping to expand health insurance to many HIV-positive individuals who would be “otherwise unable to access affordable and stable health care coverage.” Representing hugely important tactics to continue addressing the HIV/AIDS epidemic, several of Obamacare’s provisions will have a directly positive impact on the estimated 1.1 million Americans who live with the HIV virus:

  • Obamacare will prevent insurance companies from denying HIV-positive Americans coverage simply based on their HIV status. The health care reform law prohibits insurance companies from discriminating based on pre-existing conditions, including HIV. Before Obamacare, Americans living with HIV often struggled to find insurance companies willing to take them on — according to the Kaiser Family Foundation, just 13 percent of HIV-positive individuals were covered under private insurance in 2010.
  • Obamacare’s expansion of the Medicaid program helps low-income Americans with HIV who otherwise wouldn’t qualify for coverage. Over 40 percent of HIV-positive Americans accessed their health insurance through the Medicaid program in 2010, and expanding Medicaid even further will extend additional coverage to this community. Furthermore, under Obamacare, HIV-positive individuals do not have to have to be diagnosed with AIDS as a precursor to qualifying for Medicaid coverage. Although this was an old eligibility requirement for the program, the health reform law ensures the states that accept Obamacare’s Medicaid expansion will not have to impose this restriction on Americans living with the HIV virus.
  • HIV-positive Americans will no longer reach limits on the amount of treatment their insurance companies are willing to cover. Obamacare eliminates lifetime coverage caps and phases out annual limits, which will help all Americans with chronic conditions — including the Americans who rely on treatment for HIV infections — continue to be able to afford the care they need without reaching an arbitrary cut-off set by their insurance companies.
  • HIV testing will likely be covered under Obamacare. This year, the U.S. Preventive Services Task Force is expected to recommend routine HIV screenings as a part of regular preventative care, similar to a routine blood pressure test. Since the health reform law requires insurers to cover the preventive services recommended by the Preventative Services Task Force, a new standard for HIV testing could ensure that it becomes a standard part of annual check-ups. The Centers for Disease Control estimates that about 20 percentof the total population of Americans who are infected with HIV don’t know they have the virus, so regular tests that don’t incur an out-of-pocket expense could help encourage more Americans to learn their status.
  • Since Obamacare helps close the prescription drug coverage gap for Medicare beneficiaries, HIV-positive individuals will be more likely to afford their drug treatments for the virus. By closing the “donut hole,” or the gap in coverage for expensive prescription drugs under the Medicare program, Obamacare will help ensure that older Americans living with HIV aren’t unable to afford any of the 26 antiretroviral drug treatments that can be used to combat HIV infections. Twelve percent of Americans with HIV relied on Medicare for their health coverage in 2010, and that number may rise significantly as the population of HIV-positive Americans continues to age.
  • Obamacare increases resources for HIV research and prevention. The health care reform law allocates $10 billion over ten years for a new fund that focuses on prevention, wellness, and public health activities. In 2010, $30 million from that fund was awarded to the Centers for Disease Control for HIV prevention activities, including new investments in HIV surveillance and testing among high-risk populations.

ADAP Watch 7.19.12

From NAPWA:

The Administration has pledged new money to end the waiting lists, but they will linger for some time. Making sure that everyone who needs ART drugs can get them is an obvious first step towards ending this country’s HIV/AIDS epidemic, but when the waiting lists are gone, we’ll have to move on to the hard work of changing attitudes towards people with HIV and ensuring access to health care for all Americans, not just those living with HIV.

It was grimly entertaining, explaining to Conference delegates from Canada and Germany what ADAP is and why we have waiting lists, when it’s so obviously better public health policy and so obviously more fiscally prudent to treat everyone with HIV who wants treatment. After she got past her initial disbelief, a German delegate gently suggested that there are better ways to handle this sort of thing. We wouldn’t need ADAPs, let alone have ADAP waiting lists, if we had a rationally designed national health care system.

Here are the latest numbers from our friends at NASTAD:

“All Adult HIV Patients Should Be Offered Antiretroviral Therapy”

From Science Daily:

Included in the 2012 International Antiviral Society-USA panel recommendations for human immunodeficiency virus (HIV) patient care is that all adult patients, regardless of CD4 cell count, should be offered antiretroviral therapy (ART), according to an article in the July 25 issue of JAMA, a theme issue on HIV/AIDS. Other new recommendations include changes in therapeutic options and modifications in the timing and choice of ART for patients with an opportunistic illness such as tuberculosis.

Melanie A. Thompson, M.D., of the AIDS Research Consortium of Atlanta, presented the findings of the article at a JAMA media briefing at the International AIDS Conference.

Journal of the American Medical Association

Journal of the American Medical Association (Photo credit: Wikipedia)

“Since the first antiretroviral drug was approved 25 years ago, improvements in the potency, tolerability, simplicity, and availability of ART have resulted in dramatically reduced numbers of opportunistic diseases and deaths where ART is accessible,” according to background information in the article. “New trial data and drug regimens that have become available in the last 2 years warrant an update to guidelines for ART in HIV-infected adults in resource-rich settings.”

The benefit of suppressing the virus, in my opinion, is greater than the possible toxicity of medication and navigating possible side effects. We know that as long as HIV is in the body, unchecked, it’s doing damage. It’s more likely than possible that people who start antiretroviral therapy early will have less problems with secondary conditions (joint pain, arthritis, memory problems) as they progress in their lives. I think this is tremendous news.

Full Story Here.

President’s Welcome Video To International AIDS Conference 2012

Some history and a commitment to continue progress:

Study: Preventative HIV Dosing Could Be Cost-Effective

Science Daily reports that giving preventative doses of the HIV drug Truvada to high-risk groups could prove to be cost-effective:

A once-a-day pill to help prevent HIV infection could significantly reduce the spread of AIDS, but only makes economic sense if used in select, high-risk groups, Stanford University researchers conclude in a new study.

The researchers looked at the cost-effectiveness of the combination drug tenofovir-emtricitabine, which was found in a landmark 2010 trial to reduce an individual’s risk of HIV infection by 44 percent when taken daily. Patients who were particularly faithful about taking the drug reduced their risk to an even greater extent — by 73 percent.

The results generated so much interest that the Stanford researchers decided to see if it would be cost-effective to prescribe the pill daily in large populations, a prevention technique known as pre-exposure prophylaxis, or PrEP. They created an economic model focused on men who have sex with other men, or MSM, as they account for more than half of the estimated 56,000 new infections annually in the United States, according to the Centers for Disease Control and Prevention.

“Promoting PrEP to all men who have sex with men could be prohibitively expensive,” said Jessie Juusola, a PhD candidate in management science and engineering in the School of Engineering and first author of the study. “Adopting it for men who have sex with men at high risk of acquiring HIV, however, is an investment with good value that does not break the bank.”

Although getting Congress to pass this- the same Congress who killed needle-exchange- is far from realistic. Even though (maybe even especially because) it makes sense.

ADAP Watch March 12, 2012

From our friends at NAPWA:

 

The President has called for The End of AIDS in America, and that means an end to ADAP waiting lists. Everyone who needs HIV antiretroviral medicines should be getting them, and we can reduce long-term health care costs by making sure they do.
This is an extraordinarily difficult political climate, though, so we don’t expect much movement on the waiting lists until after the elections. We’re grateful to the Administration for the new money that brought the counts down from 9,000-plus to just under 4,000, and we think it’s time for states like Virginia and Georgia to join the Administration and pay their fair share. Belly up to the bar, boys!
Here are the latest waiting list numbers from our friends at NASTAD. Let’s not forget that these are the visible waiting lists. Too many states have vanished PLWHA who used to qualify for ADAP assistance by setting income eligibility ceilings unreasonably low.

ADAP Watch 1/13/2012

ADAPs With Waiting Lists
(4,717 individuals in 12 states*, as of January 12, 2012)
State Number of Individuals on ADAP Waiting List Percent of the Total ADAP Waiting List Increase/Decrease From Previous Reporting Period Date Waiting List Began
Alabama 47 1% -44 October 2011
Florida 1,301 28% 135 June 2010
Georgia 1,275 27% -12 July 2010
Idaho 6 0.1% -3 February 2011
Louisiana** 628 13% 27 June 2010
Montana 11 0.2% -2 January 2008
Nebraska 17 0.4% 2 October 2011
North Carolina 126 3% 1 January 2010
Ohio 0 0% 0 July 2010
South Carolina 164 3% 0 March 2010
Utah 32 1% 0 May 2011
Virginia 1,110 24% 7 November 2010
* As a result of FY2011 ADAP emergency funding, Alabama, Florida, Georgia, Idaho, Louisiana, Montana, North Carolina, Ohio, South Carolina, Utah, and Virginia were able to reduce the overall number of individuals on their waiting lists.

** Louisiana has a capped enrollment on their program. This number represents their current unmet need.

 

ADAPs With Other Cost-Containment Strategies: Financial Eligibility
(445 Individuals in 6 States, as of November 9, 2011)
State Lowered Financial Eligibility Disenrolled Clients
Arkansas 500% to 200% FPL 99 clients (September 2009)
Illinois 500% to 300% FPL Grandfathered in current clients from 301-500% FPL
North Dakota 400% to 300% FPL Grandfathered in current clients from 301-400% FPL
Ohio 500% to 300% FPL 257 clients (July 2010)
South Carolina 550% to 300% FPL Grandfathered in current clients from 301-550% FPL
Utah 400% to 250% FPL 89 clients (September 2009)

ADAPs with Other Cost-containment Strategies (instituted since April 1, 2009, as of November 9, 2011)

Alabama: reduced formulary Arizona: reduced formulary Arkansas: reduced formulary Colorado: reduced formulary Florida: reduced formulary, transitioned 5,403 clients to Welvista from February 15 to March 31, 2011 Georgia: reduced formulary, implemented medical criteria, participating in the Alternative Method Demonstration Project Illinois: reduced formulary, instituted monthly expenditure cap ($2,000 per client per month), disenrolled clients not accessing ADAP for 90-days Kentucky: reduced formulary Louisiana: discontinued reimbursement of laboratory assays North Carolina: reduced formulary North Dakota: capped enrollment, instituted annual expenditure cap Ohio: reduced formulary Puerto Rico: reduced formulary Utah: reduced formulary Virginia: reduced formulary, restricted eligibility criteria, transitioned 204 clients onto waiting list Washington: instituted client cost sharing, reduced formulary, only paying insurance premiums for clients currently on antiretrovirals Wyoming: capped enrollment, reduced formulary, instituted client cost sharing

ADAPs Considering New/Additional Cost-containment Measures (before March 31, 2012***)

Alaska: reduce formulary Florida: lower financial eligibility Kentucky: reduce formulary Montana: reduce formulary Oregon: reduce formulary Puerto Rico: reduce formulary Tennessee: establish waiting list Wyoming: establish waiting list, lower financial eligibility, institute client cost sharing

Access to Medications (as of November 9, 2011)

Case management services are being provided to ADAP waiting list clients through ADAP (2 ADAP), Part B (9 ADAPs), contracted agencies (5 ADAPs), and other agencies, including other Parts of Ryan White (4 ADAPs).

For clients on ADAP waiting lists who are currently on or in need of medications, 11 ADAP waiting list states can confirm that ADAP waiting list clients are receiving medications through either pharmaceutical company patient assistance programs (PAPs), Welvista, or other mechanisms available within the state.

***March 31, 2012 is the end of ADAP FY2011. ADAP fiscal years begin April 1 and ends March 31. To receive The ADAP Watch, please e-mail Britten Pund at bpund@NASTAD.org.

“The Race To End AIDS”

On Today’s Morning Edition from NPR, a story about HIV Treatment As Prevention:

AIDS Awareness

2011 has been a momentous year in the 30-year-old AIDS pandemic.

The big breakthrough was the discovery that antiviral drugs can prevent someone who’s infected with HIV from passing the virus to others. It’s nearly 100 percent effective. That led President Obama to declare earlier this month that the U.S. will expand HIV treatment in hard-hit countries by 50 percent.

As recently as last year, many of those experts were saying that just giving more people with HIV more drugs would never work. “For every one person that was put on antiretroviral therapy or treatment, we would have two to three new infections identified,” Dr. Eric Goosby, U.S. Global AIDS coordinator, says.

It looked like a losing game, but not anymore.

The new research shows that antiviral drugs not only save the lives of infected people, they also stop people from spreading the virus and causing new infections, if the drugs can be given early enough after someone gets infected. The new strategy is called “treatment as prevention.”

“So we suddenly are looking at a moment where we can treat our way out of the epidemic,” Goosby says. “That’s the turning point that we’re looking at.” Still, it’ll take decades to end AIDS, according to experts. But many say the world has to be much more aggressive about treating HIV.

But just the fact that this is being reported on and is being taken seriously is a big deal.

You can read and/or listen to the whole story here

HIV 2fer: Early Treatment Works and Truvada Prevents

HIV DataToday’s HIV News shelf is crowded. Two stories on the HIV front involve good news about early HIV treatment and Pre-Exposure Prophylaxis(PrEP) to reduce infection rates among high-risk persons.

A study (popularly known as the Setpoint Study) finds that people newly-infected with HIV-1 who immediately start anti-retroviral therapy are more likely to have beneficial medical outcomes than those who wait until CD4 counts fall below medically acceptable levels (currently 350-500 depending who you talk to).

“This is very welcome news,” said Frank J. Oldham, NAPWA President and CEO. “The study supplies scientific confirmation of something we at NAPWA have always believed: the closer we can come to bringing all people living with HIV into treatment, and the earlier they start treatment, the better. We already knew this is true for populations as a whole: more and earlier treatment means fewer new infections. Now we know that – on the whole – it’s also better for individuals already infected.”

The news on the HIV front just keeps getting better. The setpoint study follows on the heels of a groundbreaking study which provides proof of HIV treatment as prevention: HIV-infected persons on medication with undetectable viral levels are 96% less likely to pass on the virus.

It also accompanies Gilead’s application to offer Truvada as the first drug marketed to prevent HIV:

Gilead Sciences Inc. announced that it has submitted a supplemental New Drug Application (sNDA) to the U.S. Food and Drug Administration (FDA)for the approval of once-daily Truvada (emtricitabine/tenofovir disoproxil fumarate) for pre-exposure prophylaxis (PrEP) to reduce the risk of HIV-1 infection among uninfected adults. Truvada was approved by the FDA in 2004 for the treatment of HIV-1 infection and is currently the most-prescribed antiretroviral treatment in the United States.

If the sNDA is approved, Truvada would be the first agent indicated for uninfected individuals to reduce the risk of acquiring HIV through sex, a prevention approach called PrEP. The sNDA is based on the results of two large placebo-controlled trials of Truvada as PrEP, sponsored by the U.S. National Institutes of Health (NIH) and the University of Washington. Several other clinical studies support the use of Truvada for HIV risk reduction.

“The data from these large-scale clinical trials suggest that Truvada may have a role to play in meeting the urgent public health need to reduce new HIV infections,” said John C. Martin, PhD, Chairman and Chief Executive Officer of Gilead Sciences. “Gilead is proud to have played a part in helping to define the use of Truvada as a potential new prevention tool and we commend the many institutions, investigators and study volunteers for their commitment to advancing this important area of research.”

Truvada is not currently labeled to reduce the risk of infection, it is labeled only for HIV treatment.

This could be an important step in slowing HIV. Around 50,000 people are still being infected with HIV every year in the U.S. according to the CDC. More than half of new infections (61%) occur among men who have sex with men, and nearly a quarter (23%) occur among women.

If Truvada can be given to high-risk persons (which includes negative partners in a sero-discordant relationship) and insurance companies will pay for it, it may, along with the groundswell of early treatment science, start a trend of slowing the progression of HIV in this country.

But only if we can get more high-risk people in for testing and treatment….

When was your last HIV test?