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

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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.

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Acknowledgements

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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Authors and Affiliations

  1. Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, 94143, USA

    Moupali Das-Douglas & David R. Bangsberg

  2. Center for AIDS Prevention Studies, University of California, San Francisco, CA, 94105, USA

    Moupali Das-Douglas

  3. HIV Prevention Section, AIDS Office, San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA, 94102, USA

    Moupali Das-Douglas

  4. Epidemiology and Prevention Interventions Center, San Francisco General Hospital, Division of Infectious Diseases, University of California, San Francisco, CA, 94143, USA

    Moupali Das-Douglas, Elise D. Riley, Kathleen Ragland, David Guzman, Richard Clark & David R. Bangsberg

  5. Positive Health Program, San Francisco General Hospital, University of California, San Francisco, CA, 94143, USA

    Moupali Das-Douglas & David R. Bangsberg

  6. Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, CA, 94143, USA

    Margot B. Kushel

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  1. Moupali Das-Douglas
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  2. Elise D. Riley
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  3. Kathleen Ragland
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Das-Douglas, M., Riley, E.D., Ragland, K. et al. Implementation of the Medicare Part D Prescription Drug Benefit is Associated with Antiretroviral Therapy Interruptions. AIDS Behav 13, 1–9 (2009). https://doi.org/10.1007/s10461-008-9401-5

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  • DOI: https://doi.org/10.1007/s10461-008-9401-5

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