San Francisco AIDS Foundation Helps Clients Transition to New Medicare Prescription Drug Program

Late last year, William Pino wasn't sure how to choose a new prescription drug plan among the more than 30 plans available to him. Like millions of other Americans making the switch to the new Medicare drug benefit (known as Medicare Part D), he could not determine which plan was likely to give him the most comprehensive access to the drugs he needs to control his HIV disease.

"The system is so complicated!' says Pino. "Without the help of the San Francisco AIDS Foundation, I'm not sure how I would have figured it out. I was scared that I might have trouble getting my medications and I was so thankful for the assistance the AIDS Foundation's counselors provided to me."

January 1, 2006, marked the start of the new Medicare prescription drug program, which is one of the biggest changes in health care entitlement benefits in over 40 years. Staff members at the San Francisco AIDS Foundation have been working for months to help prepare clients for significant changes in their benefits.

"The way that many individuals receive their medications changed substantially when this program went into effect," explains Sue Gallego, director of client services for the San Francisco AIDS Foundation. "Many people needed assistance understanding how Part D interacts with other programs, such as Medicaid and the AIDS Drug Assistance Program (ADAP)." In particular, individuals who are "dually eligible" for both Medicare and Medicaid (known as Medi-Cal in California) are no longer able to receive drugs through Medi-Cal and are now required to obtain drug coverage through Medicare Part D. It is estimated that over 13,000 Californians living with HIV/AIDS fall into this category.

During most of 2005, the San Francisco AIDS Foundation worked alongside Project Inform to educate community members and clients about the new program. Together, the two agencies developed several brochures to help Medicare clients understand how Part D would affect them. The agencies jointly sponsored public forums for both providers and the community. The AIDS Foundation's Client Services Department also held individual and group counseling sessions to help clients take steps to prepare for Part D.

The AIDS Foundation and Project Inform were also actively advocating for people with AIDS at both the federal and state levels as policymakers developed and implemented Part D. In particular, advocates secured an agreement from Governor Schwarzenegger to allow ADAP to pay the deductibles and co-payments required of most Part D beneficiaries.

"Even with these improvements, some individuals are faced with a new set of out-of-pocket expenses," states Fred Dillon, the AIDS Foundation's public policy director. "In the coming months, we will work to secure funding to permit ADAP to pay monthly premiums for those Part D beneficiaries whose incomes require them to share in the cost of their medications."

Unfortunately, when Part D began on January 1, advocates' worst fears were realized--many Part D beneficiaries went to pharmacies only to leave without their medications, either because the government's database did not indicate that they were fully signed up or because they were asked to pay incorrect and extremely costly co-payments. The federal government was inadequately prepared for the implementation and people were falling through the cracks as a result. Thankfully, Governor Schwarzenegger and the Legislature passed an emergency law permitting the state to pay for medications for individuals experiencing problems with Part D during the initial weeks of the program.

The AIDS Foundation is continuing to help Part D clients resolve any problems that threaten their ability to access HIV medications. We encourage anyone having problems to email policy@sfaf.org with a description of the issue and their contact information. In addition, the AIDS Foundation's benefits counselors continue to be available for those who need assistance by calling 415-487-8000.