Research Spotlight: Antiretroviral Therapy Use and Disparities Among Medicare Beneficiaries with HIV

Emily P. Hyle, MD, MSc, a physician investigator at the Medical Practice Evaluation Center at Massachusetts General Hospital and an associate professor of Medicine at Harvard Medical School, is the senior author of a recent paper in the Journal of General Internal Medicine, Antiretroviral Therapy Use and Disparities Among Medicare Beneficiaries with HIV.  

Jose Figueroa, MD, MPH, of Brigham and Women’s Hospital, is first author of the study.

What Question Were You Investigating with This Study?

People with HIV live near normal life expectancies with consistent antiretroviral therapy (ART) use, which also prevents transmission of HIV to others. National and global guidelines have recommended lifelong, continuous ART use for all people with HIV for more than a decade.

With more than 70,000 people with HIV now insured by Medicare, what are the trends in antiretroviral therapy (ART) use from 2013-2019 among Medicare beneficiaries with HIV and what racial disparities exist in ART use?

What Did You Find?

From 2013-2019, the percentage of Medicare beneficiaries with HIV who did not fill any ART prescriptions in a year declined from 6.2% (2013) to 4.1% (2019).

Medicare beneficiaries with HIV who never filled an ART prescription in 2019 were more likely to be older, female, and with complex medical comorbidities and were less likely to have dual eligibility for Medicaid status and Part D low-income status.

Although a greater proportion of Medicare beneficiaries with HIV filled ART prescriptions in 2019, more than a quarter of Medicare beneficiaries did not fill 10+ months/year of ART despite having insurance coverage and national guidelines that endorse continuous ART use.

In 2013, only 65.8% of Black beneficiaries filled 10+ months/year of ART, which improved to 70.3% in 2019; in contrast, 74.8% of White beneficiaries filled 10+ months/year of ART in 2013, improving to 77.4% in 2019.

Although disparities in consistent ART use between Black and White Medicare beneficiaries have narrowed since 2013, the percentage of beneficiaries who filled ART prescriptions for 10+ months/year remained significantly lower among Black beneficiaries relative to White beneficiaries in 2019.

What are the Clinical Implications and Next Steps?

Our findings have important implications for clinicians and policymakers focused on improving the quality and equity of clinical care for people aging with HIV.

Medicare beneficiaries who were female, older, and with complex comorbidities were less likely to fill any ART prescriptions in a year, which could be due to physician prescribing practices or structural barriers to filling ART prescriptions, including trust in the health care system or health literacy.

We also found that beneficiaries who were dual-eligible for Medicaid status or with Part D low-income subsidy were more likely to fill at least one ART prescription, suggesting that financial stressors such as copays could also play a role when eligible beneficiaries are not filling ART prescriptions.

Despite improvements in ART use among Medicare beneficiaries from 2013 to 2019, more than a quarter of Medicare beneficiaries did not consistently fill ART prescriptions despite insurance coverage and national guidelines that support consistent ART use (10+ months/year).

Additionally, important disparities remain in consistent ART use, with Black beneficiaries less likely to fill 10+ months of ART in 2019 compared with White beneficiaries.

Improving consistent ART use and addressing persistent disparities will be essential to improve health outcomes for people living with HIV in the Medicare program.

Paper Cited:

Figueroa, J. F., Duggan, C., Phelan, J., Ang, L., Ebem, F., Chu, J., Orav, E. J., & Hyle, E. P. (2024). Antiretroviral Therapy Use and Disparities Among Medicare Beneficiaries with HIV. Journal of General Internal Medicine, 10.1007/s11606-024-08847-y. Advance online publication. https://doi.org/10.1007/s11606-024-08847-y