CHAMP Act Could Provide Stability For HIV, Cancer Patients

A bill to expand health care benefits for children could also create more stable policies for providing medicines to children and adults with chronic diseases.

The House version of the State Children’s Health Insurance Program bill would guarantee that patients have access to six classes of drugs that now are protected under federal Medicare policy but not under law. The drugs are used to treat HIV/AIDS, cancer, mental illnesses, autoimmune diseases, epilepsy and organ transplants.

Medical experts and organizations said the provision will help their patients, even though most of them have no idea that the wave of a federal official’s wand could leave them without low-cost access to life-saving drugs.

The Medicare policy is reviewed annually by the Centers for Medicare and Medicaid Services, which has not proposed any changes to the policy.

Michelle Billups, director of client services at Philadelphia Fight, an AIDS service organization that provides care and education to patients, said just as with any policy, the impact won’t be felt until it is gone.

“I don’t think many people know that it could change,” Billups said. “When a policy has been on the books for years and it suddenly changes, then people are shocked.”

Two Versions

The House and Senate passed separate versions of the SCHIP bill earlier this month. The Senate version does not include the drug guarantee, called the Children’s Health and Medicare Protection Act.

A conference committee will reconcile the SCHIP bills after the congressional recess, said an aide to Sen. John Kerry, D-Mass., who is on the committee that dealt with the issue. President Bush has threatened to veto both versions of SCHIP because both would cost more than his proposal.

While the government supports the drug guarantee policy, some medical organizations said they fear the policy could be threatened if the government becomes more involved in negotiating prices with drug companies without establishing a formulary, a specific set of drugs that should be covered.

Medicare officials are prohibited from negotiating drug prices or setting formularies.

Democrats wanted to allow CMS to negotiate drug prices, arguing it would save patients money.

But CMS said that could backfire if manufacturers aren’t offered more business in return for lower prices. That could mean fewer options for patients and doom the future for negotiated discounts.

Options Necessary

Andrea Weddle, associate director of the HIV Medicine Association, an organization of medical professionals, said security is vital.

“The government is supportive of the guidance. But that could change,” Weddle said. “Regardless, clinicians are still going to need options so they can prescribe what is specifically needed for patients.”

Weddle said CHAMP would also make it harder for health care plans to require patients to go through prior authorization for drugs they are already taking.

Weddle’s group surveyed 561 medical providers specializing in treating AIDS and found 83 percent reported that their patients had experienced problems getting their medications.

Of that group, 80 percent said one or more of some patients’ drugs were subject to prior authorization by a health care provider.

“Some patients usually don’t find out they are authorized until they get to the pharmacy,” Billups said.”Prior authorization is what most people fear when they depend on medications for continued treatment.”

Chad Shearer, who until last week was legislative director for Rep. Fortney “Pete” Stark, D-Calif., said the bills would prohibit health plans from requiring prior authorization without government consent.

Shearer said creating that extra step may be “to say maybe they should not be doing all this authorization.”

Shearer said that if President Bush vetoes the SCHIP bill, CMS can still enforce the current policy.

No Health and Human Services secretary is likely to get rid of a policy that helps sick patients because it would be “political suicide,” Shearer said.