AIDS and Behavior

, 13:1 | Cite as

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

  • Moupali Das-Douglas
  • Elise D. Riley
  • Kathleen Ragland
  • David Guzman
  • Richard Clark
  • Margot B. Kushel
  • David R. Bangsberg
Original Paper


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/AIDS Medicare Adherence Treatment interruption Cost-sharing Cost-related medication nonadherence 



The authors thank Sheri Weiser M.D., M.P.H and Willi McFarland M.D., Ph.D. for their critical review of the manuscript and Christopher A. Douglas, J.D. for his Medicare Part D and health policy input. Funding Source: REACH Cohort study supported by NIMH 54907 and MD-D is supported by T32 MH19105. DRB receives support from NIAAA015287.


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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Moupali Das-Douglas
    • 1
    • 2
    • 3
    • 4
    • 5
  • Elise D. Riley
    • 4
  • Kathleen Ragland
    • 4
  • David Guzman
    • 4
  • Richard Clark
    • 4
  • Margot B. Kushel
    • 6
  • David R. Bangsberg
    • 1
    • 4
    • 5
  1. 1.Department of Medicine, Division of Infectious DiseasesUniversity of CaliforniaSan FranciscoUSA
  2. 2.Center for AIDS Prevention StudiesUniversity of CaliforniaSan FranciscoUSA
  3. 3.HIV Prevention Section, AIDS OfficeSan Francisco Department of Public HealthSan FranciscoUSA
  4. 4.Epidemiology and Prevention Interventions Center, San Francisco General Hospital, Division of Infectious DiseasesUniversity of CaliforniaSan FranciscoUSA
  5. 5.Positive Health Program, San Francisco General HospitalUniversity of CaliforniaSan FranciscoUSA
  6. 6.Division of General Internal Medicine, San Francisco General HospitalUniversity of CaliforniaSan FranciscoUSA

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