Partners' Feedback - HIV Medication Access Report

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Please take the time to read the DRAFT Blueprint of the Final Report to be summited to the Legislature. You can find the full DRAFT here: https://bit.ly/3nYupS0 . We ask that you provide your feedback to each one of the six (6) issues the facilitating team has identified by Tuesday, September 28th at midnight. The facilitating team will take your comments and feedback in consideration when preparing for the next Workgroup meeting scheduled for October 4th. Please not that in order to complete this form providing your name is OPTIONAL, however, you must select what partner/stakeholder group you represent. Thank you for your prompt feedback.

First and Last Name (Optional)

Partner/Stakeholder Group Represented (you can select more than one) *

Person living with HIV (PLWH)

Healthcare Provider (physician, pharmacist, nurse, PA, mental health provider, etc.)

Case Manager or Social Worker

Service Agency Representative (non-profits serving PLWH)

Health Care Authority Representative

Department of Health Representative

Pharmaceutical Representative

Community Advocate

Other:

Required

Issue 1: The implications of shifting to an ‘open access’ system are not well understood. An individual patient can receive different antiretroviral (ARV) drugs depending on whether the patient has private insurance, is on Medicaid, has drugs provided through a program funded by the DOH, or receives treatment via Medicaid the HCA (“Apple Health”). Many on the Workgroup believe this is fundamentally inequitable. Some within the Workgroup believe the HCA could move to an open access approach in order to address, at least partially, inequities in the system. The HCA notes the ARV drugs readily available to patients through the prior-authorization program have been shown to be clinically effective. As such, the HCA believes there is no clinical reason to go to an open access system. Some participants on the Workgroup believe a controlled clinical setting only insight into one aspect of overall efficacy. Given that the HCA finds no clinical difference between the efficacy drugs available through the HCA and those available through other programs, some on the Workgroup suggest there are other barriers that should be addressed. Some question whether an open access system needs to be a part of addressing the barriers. Some members of the Workgroup note that new drugs can be added to the HCA prior-authorization list, and that individuals and their health care providers can petition the HCA to allow different drugs to be used if warranted for an individual patient.

Issue 2: Actual costs need to be comprehensively analyzed and understood. The HCA notes that the current system of using a prior-authorization list of clinically effective ARV drugs saves money for State taxpayers, thus making health care dollars go farther. Several Workgroup members believe the cost of drugs is but one aspect of overall cost. There is complex and competing information on the overall costs and savings associated with having a prior-authorization system. Several Workgroup members seek a comprehensive analysis of cost, with a closer look at assumptions in the analysis. While all Workgroup participants are appreciative of the efforts made thus far to catalog and analyze actual costs, several have observed that an in-depth and comprehensive study is beyond the purview of busy health care professionals and administrators would have to fit this in as an ancillary task. In other words, there should be funding available to do this work.

Issue 3: The ‘fail-first’ system may create obstacles that have implications for both individual and public health. HCA has a program for patients and providers to petition to be able to use drugs not on the prior-authorization list, and/or to receive drugs without going through the ‘fail first’ system. HCA believes this covers the problem. Some Workgroup members believe this does not solve the problem; that it ignores or minimizes the burden providers and patients must bear when preparing materials and justifications necessary to make the petition. Others suggest the petition process interferes with the relationship between patient and health-care provider. Others believe the petition system is more likely to be needed by those who are already marginalized in the health care system.

Issue 4: Lift the veil on drug pricing, drug costs and the role of rebates. It is profoundly disturbing to many in the Workgroup that drug prices in are negotiated through confidential agreements between pharmaceutical companies, agencies, institutions, and insurers. And that, consequently, actual drug prices are unknown. The rebate system is similarly opaque, even though Federal and State guidelines for rebates are publicly available. It is unclear why some organizations and agencies accept rebates while others do not. For the general public, and even for the well-informed layperson, it is inscrutable why one patient with one form of insurance will receive drugs that qualify for a rebate while another patient with identical characteristics but different insurance receives drugs that receive different rebates. Workgroup members understand the reality of opaque costs is unlikely to change anytime soon. But they ultimately hope for change in Federal and State policies to allow more transparency on drug pricing, drug costs and the role of rebates. Some on the Workgroup are concerned about the role of advertising in drug choice, and consequently drug costs.

Issue 5: Pay attention to those who are left behind. By the numbers, Washington State is doing well in our efforts to address HIV. Many Workgroup members indicate that while the numbers are hopeful, it is essential to look at who is not being served, who is not getting necessary treatment necessary. This is a fundamental equity issue that has implications for the overall health and well-being of all in Washington State.

Issue 6: The goals of the 2016 Report titled End AIDS 2020 have not been met. Topic II. from the budget provisio (“Impact of drug access on public health and the statewide goal of reducing HIV transmissions.”) suggests that the Workgroup could review how the goals of the 2016 Washington State report titled “End AIDS 2020” have – or have not – been met. Several Workgroup members offered opinions and insights about this during discussions. None believe the goals have been fully met, but the reasons why and what should be done about it were beyond the scope of the Workgroup.

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