Don’t tamper with Medicare Part D

Affordable access to anti-HIV medication is more important than ever. Improving patients’ access to such treatment would prevent more than 9 in 10 new infections, according to a new study from the Centers for Disease Control and Prevention. 

Unfortunately, some Washington lawmakers didn’t get the message. Congress is set to tamper with the Medicare Part D prescription drug program, which helps over 130,000 HIV positive patients access their medications. The proposed changes could make existing HIV drugs unaffordable and discourage the development of new treatments. To protect patients with HIV and other serious diseases, Congress should reject these changes. 

{mosads}Since their 2006 rollout, Medicare Part D insurance plans have helped seniors and sick patients afford lifesaving medications. This year, premiums average just $32 per month. And 90 percent of enrollees are satisfied with their coverage.

Those satisfied beneficiaries can thank Part D’s “non-interference” clause for keeping premiums affordable. This rule blocks the government from meddling in negotiations between insurers, pharmacies, and drug makers. Instead, private insurers bargain with pharmacies and drug makers to purchase medicines at up to a 30 percent discount. Those savings are ultimately passed on to enrollees.

But now, some legislators want to repeal the non-interference clause. They believe that the government would be more effective at negotiating discounts for patients. The nonpartisan Congressional Budget Office disagrees. A CBO report warns that federal officials “would be unable to negotiate prices…that are more favorable than those obtained” by private insurers.

Allowing the government to negotiate Medicare Part D prices won’t lower patients’ healthcare costs, but it could drastically decrease access to medications. That’s because the proposed changes would allow regulators to deny certain drugs to patients via “fail-first” policies. Essentially, patients would have to try cheaper, less effective drugs first. Only after that treatment fails and they’ve become sicker would they be eligible to receive newer, more effective drugs. 

The CBO also raises the possibility that the government will outright refuse to cover certain drugs. That would leave retirees and chronically ill patients unable to afford the medicines they need.

If the federal government prices drugs out of reach, patients will skip doses or stop filling their prescriptions altogether. That’s dangerous. 

Failure to take prescriptions as directed can allow diseases to spiral out of control. A University of California San Francisco study shows that when HIV positive patients drop below 95 percent prescription adherence, their viral loads spike. When an HIV-positive person’s viral loads increase, the risk of passing along the infection to others greatly increases.

The proposed interference in Medicare Part D won’t just decrease adherence rates. It’ll also jeopardize the next generation of treatments for HIV and hundreds of other diseases. 

Researching, developing, and licensing new medicines isn’t cheap. In fact, the process costs $2.6 billion per drug, according to a Tufts study. Biotech firms are willing to spend such vast sums because they know that if a drug pans out, they’ll have a chance to sell it and recoup the cost of their investment. But if federal regulators have the power to exclude medicines from coverage, drug makers won’t have that chance. As a result, they’ll be less willing to invest in risky — but potentially groundbreaking — new treatments. 

Drug companies have more than 40 potential HIV medicines in the development pipeline. Needlessly altering Medicare Part D could prevent those treatments from ever reaching patients.

Government interference in Medicare Part D will make it harder for patients to access and afford their drugs. It will also discourage investment in new treatments and cures. Congress should stand up for patients and reject changes to Part D.

Hujdich is the executive director of HealthHIV.