This past World AIDS Day, on Dec. 1, Gov. Hochul joined advocates in celebrating the significant progress we’ve made to end the epidemic and acknowledged the need to recommit to the effort to eradicate HIV and AIDS once and for all.
New York has long led the way in the push to end the epidemic. But the coronavirus pandemic has jeopardized its efforts, due to disruptions to the safety net system that made it difficult for individuals to access testing and care. The result has been a 14% rise in new HIV infections statewide in 2021 — the first increase in years.
To get back on track, the governor must support the safety net system by canceling the proposed Medicaid pharmacy benefit carve-out. Failing to do so will further curtail HIV/AIDS clinics’ operations and force up to three dozen community facilities to shut down entirely. This ill-conceived plan would disproportionately impact lower income New Yorkers of color and members of LGBT communities, making it more difficult — if not impossible — for them to access life-saving healthcare.
Under this proposal, safety net clinics serving 2.3 million New Yorkers will lose more than $250 million in annual funding. This funding helps vulnerable New Yorkers receive care and services not covered by Medicaid — including nutrition, housing, transportation and more — at no additional cost to the taxpayers. It would also dramatically change how millions of New Yorkers on Medicaid, including those living with chronic conditions like HIV, access their medications by disintegrating the pharmacy benefit from Medicaid Managed Care.
It is puzzling to hear that the state Department of Health will persist with the Medicaid pharmacy carve-out, a policy change that will completely upend how New Yorkers on Medicaid access their pharmacy benefit. This is an incredibly complex and challenging undertaking that will require adept management to ensure continuity of care for millions of New Yorkers.
Ending the HIV epidemic requires sustained action to address persistent disparity and health care inequity. The rate of diagnoses among Black individuals, for example, was 8.1 times higher than that of whites. And AIDS remains a leading cause of death in the Black community — especially among young Black women, who were 14 times more likely to be diagnosed with HIV in 2018 than their white counterparts.
In addition, despite comprising just 18% of the state’s population, Latinos account for 35% of new HIV diagnoses. Gay and bisexual men, as well as New Yorkers of transgender experience, are also disproportionately impacted by the virus.
These are the same groups who were disproportionately impacted by the COVID-19 crisis. The carve-out would transition the pharmacy benefit from Medicaid Managed Care to a fee-for-service model. This will eliminate the mechanism that gives covered entities that make up the safety net system to the savings realized from the 340B program, created by Congress in 1992 to improve care for marginalized populations.
The 340B program provides discounts on prescription drugs as a condition of participation in Medicaid, and enables safety net providers to re-invest the resulting savings into care and services not covered by Medicaid — all at no additional cost to taxpayers.
In addition to making it harder for grassroots organizations to operate, the carve-out will dramatically change how patients access pharmacy care. Removing the pharmacy benefit from Medicaid Managed Care would mean more than 15,000 New Yorkers who are members of HIV Special Needs Plans will lose access to a tailored formulary that uses data in real time to resolve problems, and specialty pharmacists with experience dealing with HIV, mental health, and gender-affirming issues.
It is difficult, if not impossible, to reconcile the governor’s commitment to health equity with a policy that will undermine the safety net providers, who are the frontline soldiers in that battle. The Department of Health, which is in turmoil due to the abrupt resignation announcement of its commissioner, Dr. Mary Bassett, has not suggested a workable solution that will maintain the funding levels safety net providers need to ensure that Medicaid recipients do not see a disruption in care.
Over the past few years, we have seen multiple public health crises that have laid bare startling inequities in our healthcare system and underlined the need for a strong safety net. Gov. Hochul has a unique opportunity as she prepares to make history as the first woman elected to serve as New York’s governor to prove she indeed plans to prioritize protecting vulnerable New Yorkers and advance health equity. She can show us she is serious about ending the AIDS epidemic and advancing health equity by repealing the carve-out today.
Fields is the president of the National Black Leadership Commission on Health and Chacon is the president of the Latino Commission on AIDS.
