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January 9, 2019


Protect Antiretrovirals from Medicare Coverage Restrictions

As part of the “six protected classes” of drugs under Medicare Part D, antiretrovirals have been exempted from prior authorization or other utilization management techniques. Now, however, in its Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out of Pocket Expenses proposed rule, the Centers for Medicare and Medicaid Services has proposed allowing Part D plans to apply prior authorization and utilization management including step therapy to the antiretroviral drug class (under the rule, plans will still be required to cover all or nearly all drugs in the six protected classes). HIVMA and IDSA believe that efforts to control costs should not come at the expense of patients’ health. Approximately 25 percent of people with HIV who are in care rely on Medicare for coverage, and the protections have been critical to sound, accessible HIV care for these beneficiaries.
The proposed rule change is open for public comment until Jan. 25 at 5 pm ET. Please consider weighing in to urge CMS not to allow restrictions on Medicare Part D coverage of antiretrovirals. HIVMA has developed this background information, including customizable template comments, and a link to the CMS comments submission page.

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