level of access available to people with HIV across the country. More information is needed to understand how these financing systems interact and how they can better work together to increase program efficiency and enhance access to care for people with HIV. A recently proposed “HIV/AIDS Integrated Services Project,” a joint initiative of HRSA, CMS, and CDC, will explore ways to blend federal funding streams and better coordinate care for people with HIV/AIDS on a demonstration basis; however, when exploring options to blend federal funding streams, it is important to maintain the level of individual entitlement to coverage for basic health services that each Medicaid or Medicare beneficiary now has.
Prescription drugs are one of the fastest growing components of health care spending. They also represent a key component of HIV/AIDS care. As such, rising prescription drug costs will continue to present challenges to people with HIV and the programs that provide for their care, especially Medicaid and the AIDS Drug Assistance Program, which have already seen sharp rises in expenditures for AIDS drugs. As a result, some state Medicaid programs and ADAPs have taken steps to control drug expenditures, which could limit access (e.g, Medicaid prescription drug limits and cost controls, ADAP waiting lists). Analysis indicating that Medicaid, the largest public purchaser of HIV/AIDS drugs, is paying higher prices for these drugs than other government purchasers also presents challenges for policymakers seeking to balance cost containment and access. It is also unclear how incentives in the new Medicare prescription drug law will impact drug prices over the long-term, particularly for breakthrough drugs for which there is little competition, and if the new law will affect the price paid for drugs by Medicaid (as it stands to lose purchasing power after prescription drug benefits for dual eligibles are transferred to Medicare in 2006).
Current care financing mechanisms do not offer clear incentives to provide prevention services in the clinical setting. Yet an estimated 40,000 people still become infected with HIV each year in the United States, indicating the importance of continued prevention efforts targeting those at risk. In addition, people already infected with HIV need access to prevention services to help prevent the further spread of HIV, which is the focus of the CDC’s Serostatus Approach to Fighting the Epidemic (SAFE) and the CDC’s new prevention initiative, Advancing HIV Prevention. A recent study showing that a significant proportion of people with HIV are already covered by Medicaid or other public payers at time of diagnosis underscores