GMHC among groups sounding alarm about drug coverage for 50,000 people with AIDS
Hundreds of AIDS, health, and disability groups across the country are calling on Senate Democrats to stop the Medicare drug bill that they charge will gut federal prescription drug benefits for their clients.
“GMHC is opposing the Medicare bill and urging New York State Senators Clinton and Schumer to oppose and filibuster the bill,” said David C. Wunsch, director of healthy policy at the Gay Men’s Health Crisis (GMHC). “Not only does the bill wholly undermine the Medicare program, but it does specific harm to HIV-positive folks who are on Medicare.”
An estimated 50,000 people with AIDS across the country, including 20,000 to 25,000 New Yorkers, receive health insurance from Medicare, a plan that traditionally covers health costs for seniors. Medicare does not pay for prescription drugs so Medicaid, the health insurance plan for the poor and disabled, pays for their drugs.
These so-called dual eligibles might see their drug coverage curtailed under a plan to add prescription drug coverage to Medicare that passed the Senate and the House earlier this year.
A conference committee drafted a single bill out of versions from both houses. That final bill was released on November 17 and it is expected to pass the House. Its future in the Senate is unsure. Sen. Edward Kennedy (D-Mass.) is leading opposition to the deal, which has the support of AARP.
Activists charge it will hurt people with AIDS.
“This bill would give the state the option to require dually eligible folks to get their drug benefit under Medicare,” Wunsch said.
The bill’s provisions require Medicare to pay for only two drugs per class. That means that the drug cocktails that combat HIV, typically made up of three drugs, would only be partially covered for dual eligibles.
“Medicare can have very restrictive formularies,” Wunsch said referring to the lists of covered drugs. “That is an absolute catastrophe for standard, state of the art HIV therapy which requires three drugs.”
Additionally, the bill bars states from using federal Medicaid funds to pay for additional Medicare drug coverage, or wrap around, for dual eligibles as they have done in the past.
“It would not allow states that cannot wrap around the formulary,” Wunsch said.
While states could likely use their own Medicaid funds to cover those expenses, most state governments are currently facing large deficits and they are cutting Medicaid expenditures.
The cash-strapped AIDS Drug Assistance Program (ADAP) might cover some of these dual eligibles, but many states have implemented waiting lists for ADAP and they are restricting the drugs they pay for. New York’s ADAP would be hard hit if it had to cover dually eligibles here.
“If they have to wrap around the 20,000 to 25,000 folks who are getting the inadequate drug benefit that would be a huge financial blow,” Wunsch said.
The activists plan a protest for Friday, November 21 at 1 p.m. near the offices of Senators Chuck Schumer and Hillary Clinton at 780 Third Avenue, at 48th Street, where they will demand the two stop the bill.