what you used to pay for brand-name prescription drugs. And if ADAP pays for your medications, those payments now count toward bringing you up to the Medicare range where nearly all your costs are covered. In addition, beginning in 2014, the infamous Medicare “doughnut hole,” in which you have to pay all of your drug costs until you reach a certain amount, will be gradually eliminated.
What does the Affordable Care Act mean for me? The Affordable Care Act (ACA) was passed by Congress in 2010, and the majority of its provisions were upheld by the Supreme Court in 2012. With most of its big provisions going into effect in 2014, the ACA means that: ■
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THROUGH THE RYAN WHITE CARE ACT AND THE AIDS DRUG ASSISTANCE PROGRAM (ADAP) The Ryan White CARE Act is the largest federally funded program for people with HIV. It provides care and support services to people who don’t have insurance or don’t have enough coverage through their other plans. Ryan White also provides funding for ADAP. About a third of Americans in care for HIV get their meds through this federal-state partnership. But income requirements, plus exactly what ADAP covers, vary greatly by state. Find your state’s ADAP info on the map on the following page and call to see if you qualify. Even with new insurance coverage options through the ACA, Ryan White will still play a huge role to help with gaps in coverage and affordability. But the funding for this program depends on Congress, so it’s important to advocate for its reauthorization. In recent years, some states have had to create waiting lists for ADAPs. THROUGH PATIENT ASSISTANCE PROGRAMS (PAPS) Finally, as a last resort, the pharmaceutical companies have banded together to offer free or heavily discounted drugs to help people with low-incomes who do not qualify for any other insurance or assistance programs. About 30,000 Americans with HIV get their meds this way. You and your doctor can find the application form you need at hab.hrsa.gov/patientassistance. In addition to PAPs, some pharma companies offer co-pay assistance for their drugs, including non-HIV drugs. For info on PAPs and co-pay programs, visit poz.com/drugassistance.
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Insurers can’t deny you coverage because you have HIV or any other pre-existing condition, or based on your health status or gender. Insurers can’t cut off your coverage when you hit a certain cost ceiling. States will set up health “exchanges” where you can buy insurance if don’t already have it. (If the state chooses not to set up such an exchange, one will be available through the federal government.) If you make less than approximately $45,000 for an individual or $92,000 for a family of four, tax credits and subsidies can make insurance coverage more affordable for you. You no longer have to have an AIDS diagnosis to qualify for Medicaid. If you are covered through Medicare, you will pay half of what you’re paying now for brand-name drugs. Plus, you’ll no longer fall into Medicare’s drug-payment “doughnut hole” where you have to pay big bucks for your meds until you hit a certain cost point.
What about generic drugs? A generic version of a drug can be sold in the United States when the patent for the brand name expires. Generic drugs are approved by the Food and Drug Administration with the same strict standards as brand-name drugs and are generally the same quality. The primary difference is the price. So what does that mean for you? It depends on your current treatment regimen. If you are taking one of the newer drugs on the market, a generic version will not be available. If you are on an older regimen, you may be able to take a generic version of one or more of your drugs and save money on your co-pays. But you might have to take two or three different generic drugs rather than a combo version that’s still on patent. When deciding on a treatment regimen, you and your doctor need to pick the one that’s best for you. If generics are an option, talk to your doc about the pros and cons of switching. Odds are you won’t notice the difference between the two, but if you do notice any changes after switching to a generic, be sure to discuss them with your doctor immediately.
Can I advocate for better access to care and treatment? Check out these sites to learn more and find out how you can get involved: Treatment Access Expansion Project (TAEP) taepusa.org AIDS Treatment Action Coalition (ATAC) atac-usa.org Treatment Action Group (TAG) treatmentactiongroup.org Project Inform projectinform.org ADAP Advocacy Association (aaa+) adapadvocacyassociation.org
PAYING FOR CARE AND TREATMENT POZ FOCUS 3