Action Alert re: Medicare Part D and ADAP

[Guest guest]

Even if don't care about saving the ADAP program money (and you should, if you benefit from it now or might in the future, because less ADAP funds will ultimately cost ADAP beneficiaries more), you should still phone your senator to ask that ADAP count for TROOP (True Out of Pocket costs) under Medicare in order to save yourself money. If you have non-ADAP medications, you are required to pay the full cost of them once you enter Medicare Part D's donut hole until the end of the year, unless you have Medicaid/MediCal or receive some other assistance other than ADAP. If you are not doing so now, it is probably because the insurance companies that participate in Part D haven't figured out that ADAP is not supposed to count toward TROOP, so they credit us with having paid

money ourselves that ADAP has paid. You can be sure that the insurance companies will catch on over time and close this glitch in their accounting, which will end up costing ADAP and those of us taking expensive non-ADAP drugs a lot more money each year. If we can get the Federal government to count ADAP expenditures toward TROOP, then we can save ADAP and ourselves a big chunk of change.

*HIV Medicaid/Medicare Working Group Action Alert**You Can Help Improve Treatment Access **for People with HIV/AIDS With OnePhone Call**What you can do:*Call your two U.S. Senators in their Washington, DC office. Ask to speak tothe legislative aide who handles health care issues. Whether you speak tohim/her live or leave a voicemail, say:"My name is _________ and I live in (your state). The Senate is working on aMedicare reform bill and I would like a provision included that would allowAIDS Drug Assistance Program spending to count towards Medicare Part D "trueout of pocket" costs. This would greatly help people with HIV/AIDS havebetter access to lifesaving treatment. It would also free up scarce White dollars to provide lifesaving treatment to uninsured people withHIV/AIDS.* *I urge Senator_____ _________ to do everything in his/her powerto make this important fix to the

Medicare drug benefit."To reach your Senators, call the Capitol Switchboard toll-free at *(800)828-0498. Ask to be connected to your Senator's office. If you don't knowwho your Senators are, go to www.congress. org and enter your zip code in theupper left corner.******If you can't make a phone call, please send an email to both of yourSenators with the same message. Go to www.senate.gov to find their websites,where you will find out how to email them.**Background: *HIV/AIDS advocates around the country are working hard to convince Congressto pass a law that would close an important gap in treatment access forpeople with HIV/AIDS.In 2008, many people who get their HIV drugs through the Medicareprescription drug benefit reach what is called the "donut hole" or coveragegap which can only be surpassed if they can afford a whopping $4,500required for them to reach

catastrophic coverage.They reach the donut hole after their total drug costs reach $2,510. Thishappens for many people with HIV/AIDS within the first two months of theircoverage. At that time, the individual must pay the full cost of their drugsor rely on another program, such as the AIDS Drug Assistance Program (ADAP).Once individuals have paid $4,050 out of pocket for their drug costs(referred to as true out of pocket costs or TrOOP), their Medicare Part Dcoverage resumes.Current law doesn't allow ADAP spending to count towards TrOOP. This meansthat when an ADAP helps a Medicare beneficiary pay for their drugs duringthe coverage gap, the client remains in the coverage gap for the remainderof the year. People with HIV/AIDS who should be able to get the full benefitof Medicare Part D are then forced to rely on the underfunded ADAP program,which in nearly all states also has a much more limited

drug formulary. Italso means that ADAPs around the country must spend money for these clientsthat could be used to expand access to other uninsured or underinsuredindividuals. *If ADAP were allowed to count as TrOOP, it would save about$50 million per year.*The U.S. Senate will soon debate Medicare reform legislation and can play amajor role in fixing this problem by including the ADAP as TrOOP provision.The House of Representatives has already approved this provision. The Senateneeds to hear that this is a priority for people with HIV/AIDS and a fixthat is badly needed. Please take the time to make these two importantcalls!For more information, contact Clary at rclary@projectinfor m.org.*The HIV Medicaid and Medicare Working Group (HMMWG) *HMMWG

is a coalitionof nearly 100 national and community-based AIDS service organizations thatrepresent HIV medical providers, advocates and people living with HIV/AIDSand provide critical HIV-related health care and support services. For moreinformation, contact the HMMWG co-chairs Hanen with the NationalAlliance of State and Territorial AIDS Directors at 202.434.8091 or Greenwald with the Treatment Access Expansion Project at 617.390.2584.