Implications of the new Medicare Part D prescription drug benefit for people with HIV/AIDS

Aug 3 2006

The Kaiser Family Foundation today released a report on the implications of the new Medicare Part D prescription drug benefit for people with HIV/AIDS.

The report looks at the coverage and cost of antiretroviral drugs under the new private, stand-alone Medicare drug plans.

Medicare has historically been an important source of health insurance coverage for many people with HIV/AIDS, estimated to cover nearly one in five (19%) of those in the United States receiving HIV/AIDS care. Medicare also accounts for the second largest share of federal spending on HIV/AIDS care in the U.S. after Medicaid. Starting this year, all people on Medicare, including those with HIV/AIDS, were given access to the new Medicare drug benefit.

The new report, "The Role of Part D for People with HIV/AIDS: Coverage and Cost of Antiretrovirals Under Medicare Drug Plans," finds that all Part D plans examined in the study cover approved antiretroviral drugs, consistent with Medicare's formulary guidelines. However, plans do not necessarily cover all formulations of each antiretroviral drug, and the amount that enrollees are required to pay for each medication varies significantly across plans. The report also examines the implications of the coverage gap, or "doughnut hole," which requires enrollees to pay the full cost of their medicines until the benefit's catastrophic coverage takes effect.

The full report is available online.