mittee estimates that 58,697 individuals with HIV who are in need of but are not receiving highly active antiretroviral therapy (HAART) would begin antiretroviral therapy. As a direct result of receiving HAART, the Committee predicts that premature deaths among this cohort of individuals would fall over a 10-year period by more than half (55.9 percent). Put another way, an estimated 19,825 lives would be saved. The Committee estimates that the incremental cost of providing HAART to these individuals for 10 years in 2002 dollars is $2.65 billion, discounted (over 10 years). In the judgment of the Committee, this investment would be cost effective for the nation, yielding an estimated cost per quality-adjusted life year (QALY) saved of $42,972, less than one-fourth of the estimated cost per QALY of an annual mammography for women ages 55–65.
These estimates, combined with its analysis of current public programs and alternative options, persuade the Committee that establishment of a new federally funded, state-administered program for low-income individuals with HIV is the most appropriate policy direction at this stage of the epidemic. The Committee therefore makes a number of specific recommendations regarding the major structural elements of such a program: eligibility, benefits, provider payment, financing, administration, and cost containment. The Committee recognizes that these recommendations do not constitute a detailed set of specifications from which implementing legislation could be drafted. Instead, the Committee intends that its recommendations serve as a framework for a complete program design by policy makers.
The recommendations are:
Recommendation 6.1: The federal government should establish and fully fund a new entitlement program for the treatment of individuals with HIV that is administered at the state level.
Recommendation 6.2: The new program should extend coverage for treatment to individuals determined to be infected with HIV whose family incomes do not exceed 250 percent of the federal poverty level (FPL). Individuals with HIV infection whose family incomes exceed this standard should be allowed to establish eligibility for coverage by spending down or by buying in on a sliding scale basis.
Recommendation 6.3: The new program should entitle each eligible individual with HIV to a uniform, federally defined benefit package that reflects the standard of care for HIV/AIDS.
Recommendation 6.4: The new program should reimburse providers who elect to participate at rates comparable to those paid by Medicare for comparable services.
Recommendation 6.5: To ensure that the new program is a prudent purchaser of drugs used in the treatment of HIV/AIDS, the Congress