Op-Ed

Trump wants to end HIV transmission by 2030. That means, he should withdraw proposal that undercuts treatment.

A volunteer hangs red ribbons, the universal symbol of awareness and support for those living with HIV.
A volunteer hangs red ribbons, the universal symbol of awareness and support for those living with HIV. AP

There are more people over age 65 living in Florida than any other state in the country. We are also home to one of the largest populations of residents living with HIV — more than 100,000 people — many of whom use Medicare Part D to access the medication they need to continue treatment and maintain a healthy life.

That’s why the recent Trump administration proposal, giving insurance companies the power to force people living with HIV off the medication they currently use, could be particularly harmful to Floridians. Currently, Medicare Part D has six “protected classes” of medications, which includes antiretroviral drugs used to manage HIV. People living with HIV are able to access this life-saving treatment without insurance interference. Under the Trump administration’s proposal, insurance companies would be able to create bureaucratic hoops through which people living with HIV and their doctors would have to jump before getting the treatment best for them.

Trump’s proposal would allow for policies like “step therapy,” where patients are forced to try lower-priced drugs and prove that they are ineffective before they can receive the medication that is right for them. It could also allow insurers to require prior authorization, forcing providers to get approval from insurance companies before prescribing medications. Delayed treatment and inaccurate medications can have potentially devastating health consequences on people living with HIV.

For example, Eric, who lives on Florida’s Treasure Coast, has fought to get the medication he needs to keep him healthy for a decade. At times, he even paid for his life-saving HIV medication out-of-pocket because his insurance company denied him coverage for the most effective regimen for him. Now that he is covered under Medicare Part D, Eric has had access to that most effective treatment, which keeps him healthy and the virus suppressed. If he is forced to change his medication because of the administration’s proposed rule change, Eric fears it could be life threatening. He’s not alone.

In 2016, Florida had six of the top 10 cities with the highest rates of new HIV diagnoses in the nation. Today, Miami retains the highest HIV transmission rate in the entire country — more than double the rate of New York, San Francisco and Los Angeles. The problem is so dire that earlier this year Mario Stevenson, with University of Miami Miller School of Medicines, called Miami “the epicenter for HIV epidemic in this country.”

As the leading LGBTQ organization in the state, we are speaking out because this new policy will have a disproportionate impact on LGBTQ Floridians. The S\state is already struggling to curb HIV transmissions and new diagnoses among gay/bisexual men and transgender women, which remain stubbornly high. Implementing this rule will be a major setback in the nation’s effort to eradicate HIV by 2030.

The effort to stop HIV transmissions is a crucial component of any approach to end HIV. When a person is in effective HIV treatment, carefully selected by their doctors, they become undetectable, which means the virus is suppressed and they cannot sexually transmit the virus to others. However, this treatment must remain consistent and uninterrupted, otherwise the person living with HIV might regain a viral load, which would compromise their treatment. This directly contradicts public health goals and harms the HIV transmission prevention efforts necessary to protect the community at large.

As the fight to end HIV continues, we all must support policies that make access to the right medications easier, not harder, for those living with HIV. Florida is at the center of the current fight against the HIV in the nation, and the Trump administration’s proposal threatens hard-fought progress and the lives of all Floridians. It’s critical that we call on our members of Congress, urging them to oppose this disastrous new rule to Medicare Part D.

Nadine Smith is the co-founder and CEO of Equality Florida. Alejandro Acosta is the HIV Advocacy Project Coordinator, which Equality Florida launched in 2017 to educate and advocate for people living with HIV.

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