‘Prescription Gap’ Between Uninsured or Publicly Insured HIV-Positive Patients and Those With Private Insurance Narrowing, Study Says
The "prescription gap" between HIV-positive individuals with private insurance and those who are uninsured or are on Medicaid or Medicare is getting smaller, according to a Johns Hopkins University study published in the May issue of the American Journal of Public Health, Reuters Health reports (Mozes, Reuters Health, 5/27). Lead author Jeanne Keruly of the Johns Hopkins University Medical School and colleagues followed 462 HIV-positive individuals who received treatment at the Johns Hopkins HIV Clinic between April 1, 1996, and March 31, 1997, and followed 497 HIV-positive patients attending the clinic between April 1, 1997, and March 31, 1999. Among the patients, 17% were privately insured, 28% were publicly insured, 26% were uninsured and 29% were partially insured.
During the first time period, those patients with private insurance were "significantly" more likely to have access to highly active antiretroviral therapy than those who were uninsured or had government insurance (Keruly et al., American Journal of Public Health, May 2002). However, during the second study period, subjects were "just as likely" to receive HAART regardless of their insurance status, although those who were partially insured were still somewhat less likely to receive HAART than those were fully insured. According to the authors, the change in HAART prescription patterns may be due to an early belief by doctors that private insurance coverage indicated a "more stable lifestyle" and an increased likelihood that the patient would "reliably" take the drugs. However, this "prescription bias" may have "f[allen] away with time," as doctors gained familiarity with the drugs. In addition, due to state AIDS drug assistance programs and the Ryan White Care Act, 90% of the uninsured study participants qualified for fee reduction. "[T]he fact that we have a public program that provides safety-net care to people living with HIV represents a significant success," co-author Richard Conviser said, adding, "It provides [a] standard of care that is nearly as good as that given to people with private insurance" (Reuters Health, 5/27).