Medicaid Must Make Crucial Changes to Get Ahead of the HIV Epidemic

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Greater CMS involvement could be the key to ending the HIV epidemic, according to an issue brief published on July 15. This call to action is the result of a partnership between Jeffrey S. Crowly and Kirk Grisham from the O’Neill Institute for National and Global Health Law at Georgetown University Law Center,Lyndel Urbano and Shakira Croce from the not-for-profit community health plan Amida Care and Cicatelli Associates (CAI) TAP-in project, a healthcare consulting firm.

Although Medicaid serves about 40% of non-elderly adults with HIV, people with HIV account for less than 1% of Medicaid beneficiaries and less than 2% of federal Medicaid spending. To combat this,the partnership has identified five ways CMS can increase benefits.

• CMS should designate an official in the Administrator’s office to coordinate HIV policy and increase collaboration with other parts of HHS.
• CMS should issue policy guidance on Medicaid’s role in supporting uptake and persistence of PrEP use.
• CMS and HHS partners should develop a comprehensive update to their 2016 Informational Bulletin on HIV prevention and care delivery.
• State Medicaid programs should revisit managed care contract standards to support LA implementation.
• State Medicaid programs should ensure access to all covered ART medications across all health plans.

There are currently only two FDA-approved, long-acting treatments for HIV. Apretude (cabotegravir) was approved in January 2021. It is used aspre-exposure prophylaxis (PrEP) and given as two injections one month apart and then every two months after. Sunlenca (lenacapavir) is approved to treat HIV-positive individuals and is an antiretroviral. The starting dose is a combination of pills and injections and afterward, it is administered in office every six months.

The authors write that the development of more long-acting HIV treatments will lead to more durable viral suppression, fewer HIV cases and greater health outcomes overall.

There are currently a handful of long-acting options in development. If approved, options will someday include a greater variety of pills and injections, subcutaneous implants, microarray patches (micro needle patches) and vaginal rings.

“The promise of a growing array of [long-acting] products provides a very significant opportunity to do even more to support sustained HIV viral suppression and improve health and quality of life for people with HIV, and also to more effectively prevent HIV,” the release reads. “To seize this opportunity, we need greater federal and state Medicaid leadership, and we need it now.”