Illinois health care advocates are blasting the Illinois Medicaid system for removing a popular AIDS drug from its preferred list.
The drug, Atripla, was removed from the preferred list on Monday reportedly as a means to cut costs. Under the change, new patients entering the Fee-For-Service program will have to take extra steps to get access to the single-tab regimen (STR), namely a prior authorization process that critics say is "onerous." Additionally, coverage is not guaranteed after having undergone the process.
"Not covering the newest HIV drugs under Medicaid, and restricting access to Atripla, denies highly vulnerable, low-income people with HIV access to the newest and most effective treatments," said Ramon Gardenhire, AIDS Foundation of Chicago's vice president of policy and advocacy. "Increasing access to single-pill HIV medications will save Illinois money by reducing hospitalizations and improving overall health outcomes. It will also drastically improve the lives and productivity of people living with HIV, as well as reduce additional transmissions. We urge Medicaid to immediately cover HIV medications without bureaucratic prior authorization requirements."
Atripla was the only single-tab regimen available on the Illinois Department of Healthcare and Family Services' (IHFS) Medicaid preferred drug list and is the oldest STR on the market. Health care advocates say the decision to move Atripla to the alternate regimen option list could have negative health implications due to decreased medication adherence and "will result in denying people living with HIV access to the approved life-saving therapies."
"The state's move to require prior authorization of Atripla, and not cover newer one-pill drugs, will actually raise overall health care costs," said Magda Houlberg, M.D., Howard Brown Health's chief clinical officer. "One study showed that people with HIV taking a single pill were 24 percent less likely to be hospitalized than patients receiving three or more pills per day. Another found that single-pill HIV medications cut hospitalizations by 23 percent and overall healthcare costs by 17 percent."
The AIDS Foundation and Howard Brown are calling on STR manufacturers, Gilead and Viiv, to provide the suggested discounts to Medicaid providers. The groups are also pressing Gov. Bruce Rauner to reconsider IHFS' decision to remove Atripla from the preferred drug list.