Cutting Costs by Including Cheaper ARVs on the New York State Medicaid Preferred Drug List for treatment, PEP, and potentially PrEP

Archives:

Presentations:

TDF/3TC for PrEP: The Rationale and the Evidence
By Dr. Ioannis Hodges-Mameletzis, World Health Organization

Toward Medicaid Prescription Drug Cost Savings in New York State
By Tim Horn, Director, Medication Access and Pricing, NASTAD

Letter to New York State Medical Drug Utilization Review Board on Symfi and Cimduo

On January 17, 2019, Treatment Action Group and Housing Works presented this webinar discussing current advocacy to cut costs by scaling up the use of Mylan’s Cimduo (TDF/3TC) and Symfi (EFV/TDF/3TC) as part of New York State Medicaid. Tim Horn from NASTAD walked webinar participants through the recent FDA approval of Cimduo, Symfi, and Symfi Lo and the advantages of increasing their usage by Medicaid beneficiaries without compromising safety or efficacy for many people living with HIV. Ionnis Hodges-Mameletzis from the World Health Organization also walked webinar participants through the suitability of Cimduo (TDF/3TC) for PrEP based upon his extensive work on the topic at WHO. The discussion was moderated by TAG’s Jeremiah Johnson.

Following the webinar, TAG and Housing Works sought sign ons from New York State organizations for a letter requesting that Cimduo and Symfi be included on the preferred drug list (PDL) for treatment, that Cimduo be included for PEP, and that Cimduo be considered for inclusion as PrEP.

Below you’ll find the presentations used at the webinar, along with full recording. If you have any questions ahead of time please email Jeremiah at Jeremiah.Johnson@treatmentactiongroup.org.

Correction and Update: On the webinar questions were raised about 340B programs being able to bill Medicaid at standard reimbursement rates and subsequently receive payments for Medicaid patients in order to generate 340B funding. In fact, Medicaid patients do contribute to 340B funding in New York State (NYS); 340B pharmacies are allowed to draw on their stock of discounted 340B medications for Medicaid patients and then bill Medicaid for the full amount. NYS Medicaid then declines to request full rebates from manufacturers in order to avoid double-dipping into the 340B program. Following further discussion regarding this unfortunate link between high drug prices and funding for community programs, recommendations to the NYS Medicaid Drug Utilization Board (DURB) were amended to keep Atripla and Truvada on the preferred drug list (PDL) while also adding Cimduo and Symfi to the PDL. Discussions on how to resolve ongoing tensions between efforts to reduce the burden of ARV pricing and maintaining programs funded by 340B will continue as part of the AIDS Advisory Council EtE Subcommittee’s next meeting on March 13th. Many thanks to those who reached out to TAG with additional information on this important topic.