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Archive for the ‘HIV/AIDS’ Category

Using Drugs to Discriminate — Adverse Selection in the Insurance Marketplace

February 4, 2015 Comments off

Using Drugs to Discriminate — Adverse Selection in the Insurance Marketplace
Source: New England Journal of Medicine

Eliminating discrimination on the basis of preexisting conditions is one of the central features of the Affordable Care Act (ACA). Before the legislation was passed, insurers in the nongroup market regularly charged high premiums to people with chronic conditions or denied them coverage entirely. To address these problems, the ACA instituted age-adjusted community rating for premiums and mandated that plans insure all comers. In combination with premium subsidies and the Medicaid expansion, these policies have resulted in insurance coverage for an estimated 10 million previously uninsured people in 2014.

There is evidence, however, that insurers are resorting to other tactics to dissuade high-cost patients from enrolling. A formal complaint submitted to the Department of Health and Human Services (HHS) in May 2014 contended that Florida insurers offering plans through the new federal marketplace (exchange) had structured their drug formularies to discourage people with human immunodeficiency virus (HIV) infection from selecting their plans. These insurers categorized all HIV drugs, including generics, in the tier with the highest cost sharing.

Insurers have historically used tiered formularies to encourage enrollees to select generic or preferred brand-name drugs instead of higher-cost alternatives. But if plans place all HIV drugs in the highest cost-sharing tier, enrollees with HIV will incur high costs regardless of which drugs they take. This effect suggests that the goal of this approach — which we call “adverse tiering” — is not to influence enrollees’ drug utilization but rather to deter certain people from enrolling in the first place.

Vital Signs: HIV Diagnosis, Care, and Treatment Among Persons Living with HIV — United States, 2011

January 22, 2015 Comments off

Vital Signs: HIV Diagnosis, Care, and Treatment Among Persons Living with HIV — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)

Background:
Infection with human immunodeficiency virus (HIV), if untreated, leads to acquired immunodeficiency syndrome (AIDS) and premature death. However, a continuum of services including HIV testing, HIV medical care, and antiretroviral therapy (ART) can lead to viral suppression, improved health and survival of persons infected with HIV, and prevention of HIV transmission.

Methods:
CDC used data from the National HIV Surveillance System and the Medical Monitoring Project to estimate the percentages of persons living with HIV infection, diagnosed with HIV infection, linked to HIV medical care, engaged in HIV medical care, prescribed ART, and virally suppressed in the United States during 2011.

Results:
In 2011, an estimated 1.2 million persons were living with HIV infection in the United States; an estimated 86% were diagnosed with HIV, 40% were engaged in HIV medical care, 37% were prescribed ART, and 30% achieved viral suppression. The prevalence of viral suppression was significantly lower among persons aged 18–24 years (13%), 25–34 years (23%), and 35–44 years (27%) compared with those aged ≥65 years (37%).

Conclusions:
A comprehensive continuum of services is needed to ensure that all persons living with HIV infection receive the HIV care and treatment needed to achieve viral suppression. Improvements are needed across the HIV care continuum to protect the health of persons living with HIV, reduce HIV transmission, and reach prevention and care goals.

Implications for public health practice:
State and local health departments, community-based organizations, and health care providers play essential roles in improving outcomes on the HIV care continuum that increase survival among persons living with HIV and prevent new HIV infections. The greatest opportunities for increasing the percentage of persons with a suppressed viral load are reducing undiagnosed HIV infections and increasing the percentage of persons living with HIV who are engaged in care.

Notes from the Field: Occupationally Acquired HIV Infection Among Health Care Workers — United States, 1985–2013

January 12, 2015 Comments off

Notes from the Field: Occupationally Acquired HIV Infection Among Health Care Workers — United States, 1985–2013
Source: Morbidity and Mortality Weekly Report (CDC)

During 1985–2013, 58 confirmed and 150 possible cases of occupationally acquired HIV infection among HCWs were reported to CDC; since 1999, only one confirmed case (a laboratory technician sustaining a needle puncture while working with a live HIV culture in 2008) has been reported (1; Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, unpublished data, 2014) (Figure). Among the 58 confirmed cases, the routes of exposure resulting in infection were: percutaneous puncture or cut (49 cases), mucocutaneous exposure (five), both percutaneous and mucocutaneous exposure (two), and unknown (two). A total of 49 HCWs were exposed to HIV-infected blood, four to concentrated virus in a laboratory, one to visibly bloody fluid, and four to unspecified body fluids. Occupations of the HCWs with confirmed or possible HIV infection have varied widely (Table).

Only 3 in 10 Americans with HIV have virus in check

December 11, 2014 Comments off

Only 3 in 10 Americans with HIV have virus in check
Source: Centers for Disease Control and Prevention

Just 30 percent of Americans with HIV had the virus under control in 2011, and approximately two-thirds of those whose virus was out of control had been diagnosed but were no longer in care, according to a new Vital Signs report published today by the Centers for Disease Control and Prevention. The new study underscores the importance of making sure people with HIV receive ongoing care, treatment, and other information and tools that help prevent transmission to others, as well as the need to reach more people with HIV testing. Among those whose infection was not under control, more than three times the proportion (66 percent) were no longer in care as had never been diagnosed (20 percent).

The HIV epidemic continues to threaten the health and well-being of many Americans – with more than one million people living with the disease in the U.S. and 50,000 new infections each year.

HHS OIG — Medicare Paid for HIV Drugs for Deceased Beneficiaries

October 31, 2014 Comments off

Medicare Paid for HIV Drugs for Deceased Beneficiaries
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
Under the Medicare Part D program, CMS contracts with private insurance companies, known as sponsors, to provide prescription drug coverage to beneficiaries who choose to enroll. OIG has had ongoing concerns about Medicare paying for drugs and services after a beneficiary has died.
Drugs that treat the human immunodeficiency virus (HIV) can be a target for fraud, waste, and abuse, primarily because they can be very expensive. Although this report focuses on HIV drugs, the issues raised are relevant to all Part D drugs.

HOW WE DID THIS STUDY
We based this study on an analysis of Prescription Drug Event (PDE) records for HIV drugs in 2012. Part D sponsors submit these records to CMS for each drug dispensed to beneficiaries enrolled in their plans. Each record contains information about the drug, beneficiary, pharmacy, and prescriber. We used the Beneficiary Enrollment Database, the Social Security Administration’s Death Master File, and Accurint’s Death Records to identify beneficiaries’ dates of death.

WHAT WE FOUND
Medicare paid for HIV drugs for over 150 deceased beneficiaries. CMS’s current practices allowed most of these payments to occur. Specifically, CMS has edits (i.e., systems processes) in place that reject PDE records for drugs with dates of service more than 32 days after death. CMS’s practices allow payment for drugs that do not meet Medicare Part D coverage requirements. Most of these drugs were dispensed by retail pharmacies.
This review looked only at HIV drugs, which account for one-quarter of one percent of all Part D drugs in 2012. However, our findings have implications for all drugs because Medicare processes PDE records for all drugs the same way. Considering the enormous number of Part D drugs, a change in practice would affect all Part D drugs and could result in significant cost savings for the program and for taxpayers.

WHAT WE RECOMMEND
We recommend that CMS change its practice of paying for drugs that have a date of service within 32 days after the beneficiary’s death. CMS should eliminate or-if necessary for administrative processing issues-shorten the window in which it accepts PDE records for drugs dispensed after a beneficiary’s death. Such a change would prevent inappropriate payments for drugs for deceased beneficiaries and lead to cost savings for the program and for taxpayers. CMS concurred with our recommendation.

Census Bureau Updates Interactive HIV/AIDS Database; New Prevalence Estimates from More Than 100 Countries

July 22, 2014 Comments off

Census Bureau Updates Interactive HIV/AIDS Database; New Prevalence Estimates from More Than 100 Countries
Source: U.S. Census Bureau

The U.S. Census Bureau today released its annually updated interactive global resource on the prevalence of HIV infection and AIDS cases and deaths. First developed in 1987, the database now holds more than 164,000 statistics, an increase of approximately 5,900 new estimates in the last year, and is the most comprehensive resource of its kind in the world.

The Census Bureau database is maintained with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID).

The tool consists of a library of statistics from more than 14,900 sources in international scientific and medical journals, individual countries’ annual HIV/AIDS surveillance reports, and papers and posters presented at international conferences. China represents 28 percent of the new records in the database, the largest increase by a single country.

The menu-driven access tool enables users to search for statistical information in countries and territories across the world, as well as by subpopulation, geographic subarea (such as urban and rural), age, sex and year from the 1960s to 2013.

UNAIDS report shows that 19 million of the 35 million people living with HIV today do not know that they have the virus

July 17, 2014 Comments off

UNAIDS report shows that 19 million of the 35 million people living with HIV today do not know that they have the virus
Source: Joint United Nations Programme on HIV/AIDS (UNAIDS)

A new report by UNAIDS shows that 19 million of the 35 million people living with HIV globally do not know their HIV-positive status.

The UNAIDS Gap report shows that as people find out their HIV-positive status they will seek life-saving treatment. In sub-Saharan Africa, almost 90% of people who tested positive for HIV went on to access antiretroviral therapy (ART). Research shows that in sub-Saharan Africa, 76% of people on ART have achieved viral suppression, whereby they are unlikely to transmit the virus to their sexual partners. New data analysis demonstrates that for every 10% increase in treatment coverage there is a 1% decline in the percentage of new infections among people living with HIV.

The report highlights that efforts to increase access to ART are working. In 2013, an additional 2.3 million people gained access to the life-saving medicines. This brings the global number of people accessing ART to nearly 13 million by the end of 2013. Based on past scale-up, UNAIDS projects that as of July 2014 as many as 13 950 296 people were accessing ART.

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