The AIDS Foundation of Chicago (AFC) and Howard Brown Health commend the recent decision by Felicia Norwood, Director of the Illinois Department of Healthcare and Family Services (HFS), on conducting a comprehensive review of HIV medications covered on the fee-for-service formulary, and adding new HIV treatments to the preferred drug list (PDL). Specially, HFS added an antiretroviral class to the PDL. Included in that class and chosen for the formulary are the preferred agents Desovy and Genvoya.
The latest additions result from a series of meetings between AFC and Howard Brown Health officials and Director Norwood and HFS. The meetings addressed advocates' and providers’ concerns regarding new proposed restrictions placed on Medicaid beneficiaries’ access to single tablet regimens (STR) prescribed for HIV treatment.
AFC and Howard Brown Health support the department’s decision to add an antiretroviral class to the PDL and inclusion of Desovy and Genvoya as preferred agents. However, other first line STR’s were not included on the state’s PDL formulary, including Triumeq and Stribild. Both are once-daily, life-saving first line STRs. Since they are non-preferred, providers will have to undertake cumbersome prior approval before prescribing the medications.
Both organizations urge the state to follow the U.S. Department of Health and Human Services (DHHS) HIV Treatment Guidelines, which are assembled by a national panel of expert HIV clinicians and advocates and represent the best medical evidence to treat HIV. Furthermore, advocates urge the state to ensure access to all FDA-approved STRs without prior-authorization restrictions. Research indicates STRs improve treatment adherence toward maximum viral suppression and are proven to be effective at reducing treatment failures, resistance and new transmissions.
“Howard Brown Health and AFC and applaud HFS for this significant step forward by inclusion of an antiretroviral class and meeting with advocates and providers to address our concerns,” says Howard Brown Health’s President and CEO David Ernesto Munar. “We will continue to work with HFS to develop guidelines and policies that make HIV treatment accessible and affordable to as many people as possible.”
“However,” said John Peller, President and CEO of AFC, “as providers and advocates working with vast numbers of Medicaid clients living with HIV who are highly vulnerable, we believe STRs are essential to improving the health of people living with HIV and lowering costs to the state. We urge the Illinois’ Medicaid program to allow access to all STRs without prior authorization, and most importantly, two STRs that are listed as ‘recommended’ by the DHHS HIV treatment guidelines, Stribild and Triumeq,” said Peller.
“We continue to have conversations with HIV drug treatment makers, such as ViiV, about the need for stronger partnerships with state Medicaid programs that will result in expanded access to HIV medications without prior authorization,” noted Peller.
Lastly, although HFS also reviewed coverage for medication that cure Hepatitis C, the agency did not make any changes to that medication class. Most problematically, HFS did not change the existing prior authorization criteria that severely limited access to the Hepatitis C cure. AFC and Howard Brown Health believes Illinois’ hepatitis cure medication criteria are overly restrictive and violate federal law.
AFC mobilizes communities to create equity and justice for people living with and vulnerable to HIV and related chronic diseases. AFC aspires to create a world in which people living with HIV and related chronic diseases will thrive and new HIV infections will be rare. More at: aidschicago.org.
Howard Brown Health exists to eliminate the disparities in health care experienced by lesbian, gay, bisexual and transgender people through research, education and the provision of services that promote health and wellness. More at: howardbrown.org.
Categorized under Advocacy, Health insurance and Illinois.