Medicare Rx Drug Benefit
|
Federal Health Plan, Medicare Do Not Cover Routine HIV Screening as Recommended by CDC, Bloomberg Reports |
|
Federal Health Plan, Medicare Do Not
Cover Routine HIV Screening as Recommended by CDC, Bloomberg Reports |
|
|
| Medicare and federal health care plans that
provide coverage under the Federal Employees Health Benefit Plan do not
offer payment for routine HIV screening of people ages 13 to 64 – a practice
that was recommended by CDC in 2006 – Bloomberg reports. According to
Bloomberg, FEHBP provides coverage for 8.5 million employees, and Medicare
provides coverage for 7.1 million disabled people under age 65. CDC revised
its recommendations because risk-based HIV screening often was not covered
by insurance, and doctors often did not know which of their patients were
considered high risk. In addition, more people outside high-risk groups --
including women, minority groups and people living outside cities -- were
contracting the virus. FEHBP, which costs $35 billion annually, pays 230
regional health plans nationwide to provide care for federal workers,
including those employed by CDC, elected officials and their family members.
FEHBP does not follow the CDC HIV screening guidelines but instead adheres
to an alternative protocol adopted by the U.S. Preventive Services Task
Force, which only covers high-risk individuals. In order to support
screening recommendations, the task force requires that studies already have
demonstrated the testing provides benefits, Ned Calonge, chair of the task
force's advisory panel, said. He added that although the CDC guidelines aim
to identify more undiagnosed HIV cases, the agency has not proved yet that
the guidelines will be successful. "I don't think they have evidence that a
universal testing strategy is going to lead to lower infection rates and
less HIV," Calonge said, adding, "There are some indications to be
optimistic, but optimism and promise aren't proof." Bernard Branson of CDC
said that meeting the task force's requirements could take years. CDC
recommended universal testing for pregnant women in 1995, and the task force
did not adopt the guidelines for 10 years, Branson said, adding that during
those 10 years, studies showed the routine screening prevented thousands of
cases of mother-to-child HIV transmission. In addition, another reason to
support the CDC testing recommendations is that agency research has found as
many as 70% of new HIV cases are transmitted by people who are unaware of
their status, Branson said. Medicare also does not cover routine HIV
screening, according to a spokesperson. Although most Medicare beneficiaries
are older than age 65 -- the cut-off age under the CDC testing
recommendations – about seven million younger disabled beneficiaries should
be screened under the recommendations, Bloomberg reports. Cornelius Baker, a
policy adviser at the National Black Gay Men's Advocacy Coalition, said that
risk-based testing particularly endangers blacks in the U.S., about 2% of
whom are living with HIV. Many physicians do not ask patients about their
sexual behavior and make assumptions about who is at risk of HIV, Baker
said, adding that blacks who do not consider themselves at risk will not be
tested unless offered routine screening. "Some doctors are still making
irrational decisions about HIV testing, deciding whether to screen someone
based on what he or she looks like,' Baker said, adding, "I can't imagine
any African-American not being screened for sickle-cell disease; why not for
HIV, which is higher in prevalence?' According to Branson, not following the
CDC guidelines allows HIV to spread and prevents HIV-positive people from
early diagnosis and treatment. "It's a real paradox when one big federal
agency makes a recommendation that another big federal agency won't
support,' John Bartlett, a Johns Hopkins University physician, said. He
added, "I think they've got to catch up. It's a disease that's lethal, and
one of the major problems with HIV today is late entry into care." Some
private insurers -- including UnitedHealth Group, Aetna and Cigna -- began
covering routine HIV screening soon after the CDC guidelines were released,
according to Bloomberg (Lauerman/Goldstein, Bloomberg, 7/31). Access this story and related links online: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=53642 |
|
|
| © Copyright 1996 - 2008 HIVdent.org. All Rights Reserved. | ||