Published Online: Wednesday, August 1, 2007

Thanks to Part D, Medicare is now the second largest source of federal funding for HIV care and treatment after Medicaid, offering prescription benefits to 100,000 individuals with HIV/AIDS?approximately one fifth of all Americans infected. Even so, AIDS health care workers told Congress that the program has proved to be "challenging, often disruptive, and more costly" for many patients with HIV.

"Patients have had trouble accessing antiretrovirals and treatment for opportunistic infections," and some have "gone without medications they can?t afford or can?t access through their new plans," Oakland, Calif, physician Steve O'Brien,MD, told the House Ways and Means Health Subcommittee.

Dr. O'Brien said that, in addition to placing "antiretrovirals in higher tiers, thereby making them more expensive or more difficult to access," some Part D plans have established cost barriers to non-AIDS drugs such as the antifungal fluconazole, which is used by HIV-positive patients to treat cryptococcal meningitis.

"Patients with excessive cost-sharing burdens for their drugs are sometimes choosing not to take some drugs or to take reduced dosing in order to save money."

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