Medicaid covers roughly 40% of non-elderly adults with HIV in the United States. People with HIV make up 1% of beneficiaries and 2% of spending. However, disparities in access and compliance in our community have led to an increased concentration of HIV transmissions in Black, Latino, and transgender communities. The Centers for Disease Control recently published an estimate of PrEP use in 2022 that showed one in four Latinos and fewer than one in five Black people who should be taking PrEP were using it.
Long-Acting Medications May Hold Promise For HIV Prevention and Compliance
Breakthroughs in HIV medications may be key to stopping transmission and improving compliance, according to a policy brief called The Big Idea by the O’Neill Institute for National and Global Health Law at Georgetown University Law Center, in partnership with Amida Care and Cicatelli Associates (CAI) TAP-in project.
The Big Idea brief says, “Advances in HIV clinical practices with the development of longer-acting (LA) products for HIV treatment and prevention could be transformative and could lead to more durable viral suppression, improved health outcomes, and fewer HIV cases. However, unless Medicaid programs adapt and respond to these developments, the opportunity they provide will be missed.”
Long-acting products can come in several forms:
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- Microarray Patch
- Longer-Acting Injection
- Implant
- Longer-Acting Oral Pill
How Medicaid and States Would Need to Help
Medicaid policymakers and state officials are not keeping abreast of pharmaceutical breakthroughs that may positively impact the lives of HIV patients. The brief recommends that the Centers for Medicare & Medicaid Service (CMS) partner with the Department of Health and Human Services and even appoint a dedicated point person to be proactive, particularly regarding prevention.
According to Jeffrey S. Crowley, director of the Center for HIV and Infectious Disease Policy at the O’Neill Institute, “A few years ago, CMS put out guidance. A single-tablet regimen for people with HIV treatment takes four pills. It’s all the medication in one pill, so it’s a single tablet. That was a big innovation, but it was more expensive to take that one pill than the four pills,” he explained. “And one of our recommendations in this brief is to say you must do the same thing with longer-acting products.”
The Inequity of HIV
Crowley points to larger inequities that surround HIV, particularly when it comes to Black, Brown, and marginalized communities. “HIV has always been very unequal, and we have large inequities. But for many people, the current treatments, oral pills, work well, but not for everybody,” he says. “But I talk about long-acting products because we have injectables now, but we’re going to have implants. We’re going to have a range of things.”
Ideally, it is figuring out what will be best for each individual; some people will never want a shot, and others won’t like multiple pills. “With HIV, there’s this reason why you’re taking medication every day, But for PrEP, it’s like, I don’t have a disease. Why am I taking it daily? If you only have to do it a couple of times a year, that could help with adherence,” according to Crowley.
“We want a silver bullet, and there isn’t one. But we can keep making progress, and as we make progress, we can reduce disparities, and it could look different.”Crowley continued. “Our challenge is that technology is getting us so far that we must keep people engaged. Who are the people that 95% of the population is benefiting from? Who are those 5%, and don’t they need much more support? So how do we keep people invested in giving them the extra support, recognizing that it’s not just access to healthcare? We talk about social determinants, and homelessness is just one of them. You know, there’s all these other things, and we must make much more progress to overcome those barriers. So that people can remain engaged in care.”
The brief proposes Braided Funded to Extend the Reach of HIV Services.
- Maximize State Medicaid Potential
- Tap into Health Exchanges
- Use Ryan White AIDS Program Support (And Other Social Determinants of Health Program Support)
- EHE (Ending the HIV Epidemic Funding)
*The O’Neil Institute independently created the Longer-Acting Policy Project but received support from Gilead Sciences, Merck, and ViiV Healthcare.
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