Public Statement 8/2/24

Equitas Health Says Medicare’s PrEP Reclassification Could Reduce Access to Medication for Seniors

COLUMBUS, Ohio – This week, Equitas Health warned that – unless the federal government makes changes to its proposal to reclassify an HIV prevention drug – pharmacies may encounter significant obstacles that could hinder seniors’ access to the medication.

As noted by the Centers for Disease Control and Prevention (CDC), pre-exposure prophylaxis (PrEP) for HIV prevention “reduces the risk of getting HIV from sex by about 99% when taken as prescribed.” But, access to care could be disrupted, if the Centers for Medicare & Medicaid Services (CMS) finalize a proposed decision to move PrEP coverage from Medicare Part D (drug coverage) to Medicare Part B (medical insurance).

As Equitas Health noted this spring, many pharmacies – from small, independent operations to large, retail-chain stores – are unable to bill effectively and accurately to Medicare Part B. To advocate for access to care, Equitas Health co-drafted a public letter to CMS. The agency has continued to work alongside a national coalition of HIV/AIDS advocacy organizations, trade organizations, and professional associations. In summer, CMS released a fact sheet outlining the their recommendations for pharmacies who lack the ability to bill to Medicare Part B, but that guidance failed to address all of the coalition’s concerns.

Now, CMS is expected to issue its final coverage reclassification for PrEP by late September. While CMS has addressed some technical questions about the proposed change, the final National Coverage Determination (NCD) is expected to be similar to the one that they initially proposed in July 2023.

If pharmacies are unable to overcome these unnecessary administrative barriers, seniors may experience unexpected issues with accessing their medication. And of course, such issues will adversely affect men who have sex with men (MSM), people of color, and others who are over-represented among seniors living with HIV.

Considering the unintended effects of this change, Jacquelyn Risner-Kissel, PharmD, RPH, Associate Director of Clinical Pharmacy at Equitas Health, said: “Placing PrEP medications on Part B not only places unnecessary administrative burdens on pharmacies, but it also decreases patient access across the nation, as many pharmacies cannot even bill to Part B. Because of this change, patients will come to their pharmacy, expect to pick-up their prescription, and be turned away – sometimes with no other options to access their medication.”

Regarding access to care for LGBTQ+ seniors, Rhea Debussy, PhD, Director of External Affairs at Equitas Health, said: “In an effort to increase access to care, CMS and the federal government have actually done the opposite. Moving PrEP from Medicare Part D to Part B puts dangerous barriers between our LGBTQ+ elders and the medical care that they deserve.”

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ABOUT EQUITAS HEALTH

Established in 1984, Equitas Health is a regional nonprofit community healthcare system. A federally-designated Community Health Center, it is one of the largest LGBTQ+ and HIV/AIDS serving healthcare organizations in the United States. With 22 offices in 13 cities, Equitas Health serves tens of thousands of patients in Ohio, Kentucky, and West Virginia each year through patient-centered, integrated, and cutting edge services, including primary and specialized medical care, pharmacy, dentistry, mental health and recovery, HIV/STI treatment and prevention, PrEP/PEP, Ryan White/HIV case management, care navigation, advocacy, and other community health initiatives. The Equitas Health Pharmacy is an integral and essential part of the health center’s comprehensive care and business models, reinvesting 100% of profits back into the organization’s programs and services. Equitas Health operates pharmacies serving patients in Ohio and Texas. For more information, visit equitashealth.com or find them on Facebook, Twitter, or Instagram.