Thirty-four years ago, I decided to devote my life to working with people living with HIV, providing them the medical care they needed and deserved. Today, as the medical director of HIV care at Amity Medical Group in Charlotte, I realize that goal every day by serving more than 600 patients with HIV. Our practice serves as a one-stop shop for these high-risk patients — including medical examinations and treatments, a pharmacy and counseling services — to ensure that patients across North Carolina can easily access comprehensive, high quality care.
As of December 2017, there were more than 40,000 people living with HIV in North Carolina, including an estimated 5,000 who have not yet been tested and diagnosed. Making HIV treatment accessible to all who need it is vitally important, not only to those living with the virus, but also to our community more broadly. Currently, Medicare Part D — the government program that provides prescription drug coverage for those over 65 and/or disabled — covers many of the medications we use to treat HIV. This coverage is critical considering that at least 25 percent of people living with HIV rely on Medicare as their sole insurer.
In fact, HIV prevention drugs, or antiretrovirals, are so important, they are considered one of the “six protected classes” of medicine. Medicare Part D is required by law to make medicines in the protected class available to Medicare recipients who need them with no restrictions whatsoever.
Recently, however, the Trump Administration has proposed making changes to Medicare Part D, stripping out the protections for antiretrovirals and other medications in other protected classes. This proposed plan would impose a step therapy-type structure for HIV medications, which means Medicare can require patients under my care to fail on cheaper medications before being supplied by Medicare with the medication that I, as their medical provider, prescribed as the optimal medication for that person’s health.
Essentially, these changes could allow Medicare to determine what kinds of drugs my patients are able to use throughout their treatment journeys instead of me, a professional fully qualified to prescribe medications based on the individual needs of my patients. HIV medicine is not a one-size-fits-all approach, especially when you consider the co-morbidities occurring in those that are disabled or over the age of 65. Under this new plan, Medicare would be able to ignore the treatment plan I have designed to meet a patient’s specific needs and provide him or her, instead, drugs that are cheaper and may not work as well. Patients may also not take the cheaper drugs as consistently, which can also lead to poorer health outcomes for my patients.
Not only is this a personal health problem, but it has serious public health ramifications. When people living with HIV take their medications regularly, they are much less likely to transmit to others. Therefore, when government-induced alterations seek to undermine access in the name of cost-saving, we are all at risk.
Today, HIV is no longer a death sentence, thanks to the advancement of antiretrovirals. To pull those protections would be taking an archaic step back. For healthcare providers like me, who have spent decades treating and caring for these individuals, this is simply unacceptable.
My goal is not just for patients to survive, but to thrive in North Carolina and across the country. Changes to Medicare Part D could have detrimental effects for HIV patients, other patients in need, and ultimately, our local community here in Charlotte. By continuing to provide access to care, our community will remain healthy, happy and prosperous. That undoubtedly trumps any cost-saving that may occur through these harmful changes to Medicare Part D.
Protected classes protect my patients.
J. Wesley Thompson, MHS, PA-C, AAHIVS, DFAAPA, has practiced medicine for 34 years and has been a board certified physician assistant. Thompson was the first physician assistant to be certified as an HIV specialist in the State of North Carolina and one of the first in the United States. He lectures extensively and serves on the boards of directors for multiple HIV community organizations.