We are excited to report victory in our efforts to fight back attempts to restrict access to lifesaving HIV medications for Medicaid recipients. Earlier this year, the Governor and state lawmakers proposed restricting access to the most effective, one-pill a day HIV medications such as Atripla, Truvada, or Kaletra by imposing a cumbersome, arbitrary prior authorization requirement.
In late June, after consulting with HIV advocates, the state Medicaid agency announced that only two additional medications will be subject to prior authorization: Selzentry and Fuzeon. Both have clear medical criteria for their use, and we believe small numbers of patients will be impacted by this requirement. In addition, Complera will continue to require prior authorization.
This is an important policy victory that preserves access to care for people living with HIV/AIDS across Illinois. This victory was possible thanks to language added at the request of AFC and partners that required the state to consult with people with HIV, health care providers, and others before instituting prior authorization. As a result, advocates had the opportunity to explain the critical role access and adherence plays in controlling HIV drug costs.
AFC thanks Governor Quinn, Illinois Department of Healthcare and Family Services Director Julie Hamos, Representatives Greg Harris and Sara Feigenholtz, State Senator Heather Steans (D-Chicago), and other members of the General Assembly for their work preserving access to lifesaving HIV medications through Medicaid. We also thank the AFC Medical Advisory Committee members for their assistance developing recommendations for the state.
Additional Information
Medicaid’s Selzentry prior approval criteria
Medicaid’s Fuzeon prior approval criteria
List of Drugs for Prior Authorization
Medical Advisory Group Recommendations on HIV Drug Cost in SMART Act
