Action Alert - 9/28/04

Fight for the Rights of People With AIDS in the New Medicare Drug Program

Thousands of Community Comments Needed

BACKGROUND: Due to the new Medicare law enacted by Congress and President Bush last year, more than 80,000 Americans living with HIV/AIDS will become eligible for a new prescription drug benefit under Medicare. The vast majority of these individuals (some 60,000 nationwide) are currently receiving prescription drug coverage through Medicaid and will lose these benefits on December 31, 2005. They will then be forced to enroll in the new and potentially less comprehensive Medicare drug program.

The federal Centers for Medicare and Medicaid Services (CMS) recently released a 2,000-page draft document detailing how the government will implement the complex, new benefit. AIDS advocates are concerned that the proposal short-changes people with HIV/AIDS and could severely compromise their health by interrupting HIV treatments and offering them sub-standard healthcare.

AIDS advocates urge CMS to ensure the following concerns are addressed in the final implementation rules:

• People with HIV/AIDS risk life-threatening illness if drug plans are allowed to limit the number of HIV drugs covered. Drug plans must carry all the drugs people with HIV/AIDS need.
• Because restricted access to needed HIV/AIDS medications could lead to drug resistance or severe medical complications, Medicare should treat people with HIV/AIDS as a "special needs population" and require drug plans to offer them an "open formulary."
• Individuals eligible for both Medicaid and Medicare (know as "dual-eligibles") may get fewer benefits under Medicare than they now receive in Medicaid. CMS should ensure that new benefits are of equal or greater quality than those provided by Medicaid.
• With the law cutting off Medicaid drug benefits for dual-eligibles on December 31, 2005, but not automatically enrolling them in the new Medicare drug program, dual-eligibles will be at risk for interruptions in drug coverage. Dual-eligibles with HIV/AIDS cannot risk a gap in coverage during the transition from Medicaid to Medicare, which would severely compromise their health.
• The draft grievance and appeals process is inadequate and must be enhanced to provide greater protections for Medicare recipients. Grievance and appeal processes must be effective and easy-to-access, and must include the right to get an emergency supply of medications while an appeal is under way.
• Proposed rules allow drug plans access to the names and medical histories of Medicare recipients in order to aid their marketing and enrollment strategies. Drug plans should not violate the privacy of people with HIV/AIDS and other Medicare beneficiaries.

TAKE ACTION: Please respond to the request for public comments THIS WEEK. AFC encourages concerned organizations to:

1. Sign onto comments being circulated by the AIDS Foundation of Chicago. See AFC's letter at www.aidschicago.org/advocacy/test_9_27_04.php. Email Karen Reitan at kreitan@aidschicago.org no later than 11:00 a.m. on Friday, October 1 with your organization's name, address, telephone number, and the name of the official authorizing the sign-on.

2. Sign onto comprehensive comments being circulated by the HIV Medicaid/Medicare Working Group. Click on "HIV Coalition Comments" at www.hivma.org to access the 18-page letter. Email Ann Lefert at alefert@nastad.org no later than 11:00 a.m. on Friday, October 1 with your organization's name, address, telephone number, and the name of the official authorizing the sign-on.

Concerned individuals and organizations are also urged to make separate comments online. Go to www.cms.hhs.gov/regulations/ecomments/. Click SEND electronic comments, then click GO located to the right of: CMS-4068-P Medicare Program; Medicare Prescription Drug Benefit. It will be self-explanatory from there. You may want to use one of the draft letters above to help ensure your comments are made in the appropriate sections. The deadline is Monday, October 4, 2004

For more information on this issue, visit www.familiesusa.org or contact Karen Reitan by email or phone at 312-922-2322.

Sign-on to AFC's letter

Sign onto comments circulated by the HIV Medicaid/Medicare Working Group

Send your own separate comments