title: Implementation of the Medicare Part D prescription drug benefit is associated with antiretroviral therapy interruptions.
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.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, 94143, USA. moupali.das-douglas@ucsf.edu.
authors.forename: Moupali
authors.initials: M
authors.lastname: Das-Douglas
authors.forename: Elise D
authors.initials: ED
authors.lastname: Riley
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ragland
authors.forename: David
authors.initials: D
authors.lastname: Guzman
authors.forename: Richard
authors.initials: R
authors.lastname: Clark
authors.forename: Margot B
authors.initials: MB
authors.lastname: Kushel
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D017047:Cost Sharing / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D054524:Medicare Part D / Q000706:statistics & numerical data; D008875:Middle Aged; D012959:Socioeconomic Factors; D014481:United States; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents