HEALTH

Medicaid Should Make Longer Acting HIV Medication Accessible

Medicaid covers approximately 40% of non-elderly adults living with HIV in the United States. People living with HIV account for 1% of beneficiaries and 2% of spending. However, disparities in access and compliance in our society have increased the concentration of HIV transmission in Black, Latino, and transgender communities. Centers for Disease Control It recently published an estimate of PrEP use in 2022 that showed that one in four Latinos and less than one in five Black people who should take PrEP were using it.

Long-acting medications may hold promise for HIV prevention and compliance

Breakthroughs in HIV medications may be key to stopping transmission and improving compliance, according to a policy brief called The Big Idea by O'Neill Institute for National and Global Health Law at Georgetown University Law Center, In partnership with Amida Care and Cicatelli Associates (CAI) Click project.

The Big Idea summary says: “Advances in HIV clinical practice with the development of long-acting products for HIV treatment and prevention could be transformative and could lead to more sustained viral suppression, improved health outcomes, and reduced incidence of HIV infection.” Humanity However, unless Medicaid programs adapt and respond to these developments, the opportunity they provide will be missed.

Long-acting products can come in several forms:

    • Microarray correction
    • Longer acting injection
  • planting
  • Long-acting oral contraceptive pills

How Medicaid and states will need help

Medicaid decision makers and state officials are not keeping up with pharmaceutical developments that may positively impact the lives of HIV patients. The brief recommends that the Centers for Medicare and Medicaid Services (CMS) collaborate with the Department of Health and Human Services and even designate a dedicated person to be proactive, especially regarding prevention.

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According to Jeffrey S. Crowley, director of the Center for HIV and Infectious Disease Policy at the O'Neill Institute, said, “A few years ago, CMS issued guidance. A one-pill regimen for people with HIV requires four pills. It's all the medication in one pill, so it's one pill.” That was a big innovation, but taking that one pill was more expensive than taking all four pills, he explained, “and one of our recommendations in this brief is to say that you should do the same thing with long-acting products.”

Inequality in HIV

Crowley points out the larger inequalities surrounding HIV, especially when it comes to black, brown, and marginalized communities. “HIV has always been very unequal, and we have huge disparities. But for many people, the current treatments, the oral pills, work well, but not for everyone. “But I'm talking about long-acting products because now we have the injections, But we're going to get implants. “We'll have a bunch of stuff.”

Ideally, it is knowing what is best for each individual; Some people will never want to take one dose, and others will never want to take multiple tablets. “With HIV, there's this reason why you take it every day, but for PEP, it's like I don't have disease. Why would I take it every day? If you only have to do it twice a year, you might This helps with commitment.

“We want a silver bullet, and there isn't one. But we can continue to make progress, and as we make progress, we can reduce disparities, and it may look different. “Our challenge is that technology has taken us so far, that we have to keep people engaged . Who are the people who benefit 95% of the population? Who are these 5%, don't they need more support? So how do we keep people interested in giving them extra support, while recognizing that it's not just about access to healthcare? We talk about social determinants, and homelessness is just one of them. You know, there are all these other things, and we have to make more progress to overcome those barriers. So people can continue to participate in care.”

The brief proposes funding to expand HIV services.

  • Maximizing state Medicaid potential
  • Take advantage of health exchanges
  • Use Ryan White AIDS Support (and other social determinants of health program support)
  • EHE (Defunding the HIV Epidemic)

*The O'Neill Institute independently created the LEP project but has received support from Gilead Sciences, Merck, and ViiV Healthcare.



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