Medicare HIV cases are projected to double by 2035, with cumulative costs reaching $195.6 billion and creating critical challenges for federal funding.
The number of Medicare beneficiaries living with
The effect of the rising cost of ART is not known when it comes to Medicare costs for people living with HIV (PWH). The Inflation Reduction Act has offered the opportunity to negotiate the price of bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy; Gilead Sciences), which may help in lowering overall costs for the care of those living with HIV who utilize Medicare. This study aimed to project the total costs of care for Medicare beneficiaries living with HIV and to estimate the total number of PWH who will be covered by Medicare in the future.
This study used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC-US) model to project numbers and age distribution of all PWH in the US from 2026 through 2035. These projections assumed that all current trends would be maintained through the next decade. The Cardiovascular, HIV, Aging, Hearing Loss, Mental Health, and Dementia (CHARMED) model was developed and fed with the CEPAC projections for age distribution and population size to project the population size, age distribution, and total costs.
The CEPAC model was populated with surveillance data from the CDC from 2014 and calibrated with CDC incidence data from 2014 to 2022. The CHARMED model simulated clinical care for people aged 65 years or older who were taking ART, with simulated individuals assumed to continue their use of ART. The number of PWH enrolled in Medicare was estimated through combining 3 cohorts of those on Medicare in 2026, PWH who turn 65 years each month after 2026 and are enrolled in Medicare, and those who were enrolled in Medicare and initiating ART after being newly diagnosed with HIV. The researchers estimated that 74% of those with HIV and aged 65 years or older were enrolled in Traditional Medicare or Medicare Advantage.
Traditional Medicare claims data from 2023 were used to estimate the annual clinical care costs for beneficiaries. Data were gathered from PWH enrolled in Part D who filled at least 10 months’ worth of prescriptions for ART.
The researchers estimated that the number of individuals using Medicare who have HIV, are using ART, and are aged 65 years or older would increase from 111,600 in 2026 to 193,560 in 2035, with increases in all age groups. The increase in Medicare beneficiaries with HIV is projected to increase by 1.3-fold in those aged 65 to 69 years compared with 3.3-fold in those aged 80 years or older.
The researchers estimated that the total number of deaths would increase from 5500 in 2026 to 9640 in 2035. The total health care spending for Medicare would increase from $11.4 billion in 2026 to $28.6 billion in 2035, which includes projected increases to the cost of ART, HIV-related care, and other costs not related to HIV. The total projected costs equal $195.6 billion over the next decade.
There were some limitations to this study. This study was limited to those aged 65 years and older and did not account for those on Medicare younger than this age group. Mortality may be lower than the estimates when accounting for those at older ages and in care. Costs for patients who are disengaged from care could be higher than these estimates. Costs to Medicaid, commercial insurance, or the uninsured were not accounted for in this study. In addition, this study is appearing as a preprint and has not been peer-reviewed yet.
The researchers concluded that the number of Medicare beneficiaries with HIV will nearly double in the next decade, which could put strain on both the costs of care and mortality. “Reductions in ART costs, based on recent legislation and near-term generic availability, could lead to substantial decreases in overall Medicare spending for older beneficiaries with HIV,” they wrote.
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