https://www.cidrap.umn.edu/hivaids/cost-hiv-drugs-medicare-projected-skyrocket-2035
The cost of HIV drugs for Medicare is projected to skyrocket by 2035
Sarah Boden
Today at 3:45 p.m.
HIV/AIDS
Medicare is the federal health insurance program for older Americans and people with disabilities. The analysis, published today in JAMA Network Open, projects that 63% of the cumulative cost to Medicare for older beneficiaries living with HIV will be to pay for ART, which is the lifelong treatment that suppresses the virus to non-detectable levels. Without these antiviral medications, HIV goes from a chronic to a fatal condition.
The study based its cost projections on current ART prescribing patterns, healthcare-associated inflation, and data showing that more people with HIV are living into their 70s and 80s because of ART.
The findings surprised lead author Emily P. Hyle, MD, a Boston-based infectious disease physician at Mass General Brigham and associate professor at Harvard Medical School.
People with HIV tend to have a higher risk of certain cancers and heart disease, so she assumed these comorbidities contributed more to the overall cost of care for HIV patients, she told CIDRAP News. It turns out that, because ART drugs are so expensive, the biggest hurdle Medicare faces in maintaining costs for HIV patients is the price of these medications.
Cost-saving strategies
The analysis explored two cost-containment strategies that could bring down the price of ART for Medicare.
The Inflation Reduction Act (IRA), passed in 2022, allows Medicare to negotiate with pharmaceutical companies on the price of certain high-cost medications, including Biktarvy, a popular ART pill that combines three drugs. For Biktarvy alone, researchers found that Medicare could save a cumulative $12.7 billion over the next 10 years if the minimum IRA-proposed discounts were accepted.
Also, if generic versions were immediately available for all ART medications, Hyle and her colleagues estimate that could reduce all HIV-related costs for Medicare by 60%. This would lower overall Medicare spending for beneficiaries with HIV by 38%.
Unintended consequences
But lower drug costs for Medicare might incur unintended consequences, warned the study authors.
The 340B drug program allows hospitals, community health clinics, and other healthcare organizations to buy pharmaceuticals at heavily discounted prices and then bill health insurance, including Medicare, at standard rates. These entities are allowed to keep the difference, which many HIV programs use to subsidize other services.
At a time when funding is increasingly precarious, Hyle worries that lowering the overall price that Medicare must pay for ART could diminish an important funding source for organizations caring for people living with HIV. These include vital safety net services for Americans who lack health insurance.
The fact that people with HIV can have normal life expectancies is a triumph of both medical science and advocacy, said Hyle.
“We are fortunate to have a growing population of people aging successfully with HIV, and therefore we need to figure out the best way to provide comprehensive, excellent care,” she said.
The cost of HIV drugs for Medicare is projected to skyrocket by 2035
Sarah Boden
Today at 3:45 p.m.
HIV/AIDS
As more people with HIV reach retirement age, the annual cost of antiretroviral therapy (ART) for Medicare for people 65 or older is projected to nearly triple over the next decade, from $6.4 billion in 2026 to $17.8 billion by 2035.Medicare is the federal health insurance program for older Americans and people with disabilities. The analysis, published today in JAMA Network Open, projects that 63% of the cumulative cost to Medicare for older beneficiaries living with HIV will be to pay for ART, which is the lifelong treatment that suppresses the virus to non-detectable levels. Without these antiviral medications, HIV goes from a chronic to a fatal condition.
The study based its cost projections on current ART prescribing patterns, healthcare-associated inflation, and data showing that more people with HIV are living into their 70s and 80s because of ART.
The findings surprised lead author Emily P. Hyle, MD, a Boston-based infectious disease physician at Mass General Brigham and associate professor at Harvard Medical School.
People with HIV tend to have a higher risk of certain cancers and heart disease, so she assumed these comorbidities contributed more to the overall cost of care for HIV patients, she told CIDRAP News. It turns out that, because ART drugs are so expensive, the biggest hurdle Medicare faces in maintaining costs for HIV patients is the price of these medications.
Cost-saving strategies
The analysis explored two cost-containment strategies that could bring down the price of ART for Medicare.
The Inflation Reduction Act (IRA), passed in 2022, allows Medicare to negotiate with pharmaceutical companies on the price of certain high-cost medications, including Biktarvy, a popular ART pill that combines three drugs. For Biktarvy alone, researchers found that Medicare could save a cumulative $12.7 billion over the next 10 years if the minimum IRA-proposed discounts were accepted.
Also, if generic versions were immediately available for all ART medications, Hyle and her colleagues estimate that could reduce all HIV-related costs for Medicare by 60%. This would lower overall Medicare spending for beneficiaries with HIV by 38%.
Unintended consequences
But lower drug costs for Medicare might incur unintended consequences, warned the study authors.
The 340B drug program allows hospitals, community health clinics, and other healthcare organizations to buy pharmaceuticals at heavily discounted prices and then bill health insurance, including Medicare, at standard rates. These entities are allowed to keep the difference, which many HIV programs use to subsidize other services.
At a time when funding is increasingly precarious, Hyle worries that lowering the overall price that Medicare must pay for ART could diminish an important funding source for organizations caring for people living with HIV. These include vital safety net services for Americans who lack health insurance.
The fact that people with HIV can have normal life expectancies is a triumph of both medical science and advocacy, said Hyle.
“We are fortunate to have a growing population of people aging successfully with HIV, and therefore we need to figure out the best way to provide comprehensive, excellent care,” she said.