AIDS and Behavior

, 13:1

Implementation of the Medicare Part D Prescription Drug Benefit is Associated with Antiretroviral Therapy Interruptions

Authors

    • Department of Medicine, Division of Infectious DiseasesUniversity of California
    • Center for AIDS Prevention StudiesUniversity of California
    • HIV Prevention Section, AIDS OfficeSan Francisco Department of Public Health
    • Epidemiology and Prevention Interventions Center, San Francisco General Hospital, Division of Infectious DiseasesUniversity of California
    • Positive Health Program, San Francisco General HospitalUniversity of California
  • Elise D. Riley
    • Epidemiology and Prevention Interventions Center, San Francisco General Hospital, Division of Infectious DiseasesUniversity of California
  • Kathleen Ragland
    • Epidemiology and Prevention Interventions Center, San Francisco General Hospital, Division of Infectious DiseasesUniversity of California
  • David Guzman
    • Epidemiology and Prevention Interventions Center, San Francisco General Hospital, Division of Infectious DiseasesUniversity of California
  • Richard Clark
    • Epidemiology and Prevention Interventions Center, San Francisco General Hospital, Division of Infectious DiseasesUniversity of California
  • Margot B. Kushel
    • Division of General Internal Medicine, San Francisco General HospitalUniversity of California
  • David R. Bangsberg
    • Department of Medicine, Division of Infectious DiseasesUniversity of California
    • Epidemiology and Prevention Interventions Center, San Francisco General Hospital, Division of Infectious DiseasesUniversity of California
    • Positive Health Program, San Francisco General HospitalUniversity of California
Original Paper

DOI: 10.1007/s10461-008-9401-5

Cite this article as:
Das-Douglas, M., Riley, E.D., Ragland, K. et al. AIDS Behav (2009) 13: 1. doi:10.1007/s10461-008-9401-5

Abstract

Antiretroviral (ARV) treatment interruptions are associated with virologic rebound, drug resistance, and increased morbidity and mortality. The Medicare Part D prescription drug benefit, implemented on January 1st, 2006, increased consumer cost-sharing. Consumer cost-sharing is associated with decreased access to medications and adverse clinical outcomes. We assessed the association of Part D implementation with treatment interruptions by studying 125 HIV-infected homeless and marginally housed individuals with drug coverage receiving ARV therapy. Thirty-five percent of respondents reported Medicare coverage and 11% reported ARV interruptions. The odds of ARV interruptions were six times higher among those with Part D coverage and remained significant after adjustment. The majority of Part D-covered respondents reporting ARV interruptions cited increased cost as their primary barrier. Directed interventions to monitor the long-term effects of increased cost burden on interruptions and clinical outcomes and to reduce cost burden are necessary to avoid preventable increases in morbidity and mortality.

Key words

HIV/AIDSMedicareAdherenceTreatment interruptionCost-sharingCost-related medication nonadherence

Copyright information

© Springer Science+Business Media, LLC 2008