Future Medicare Costs for Older HIV Patients: Implications of ART and Policy Changes

Emily P. Hyle, MD, and Kenneth A. Freedberg, MD, from the Medical Practice Evaluation Center at Mass General Brigham, conducted a pivotal study, published in JAMA Network Open, focusing on future cost implications for Medicare beneficiaries aged 65 and older living with HIV. Their research highlights a projected increase in Medicare costs, driven by improved survival rates among HIV patients due to effective antiretroviral therapy (ART).

Utilizing the CHARMED model, which incorporates data from the CEPAC model, Medicare claims, and public databases, the study estimates the expected costs for this demographic. It examines the potential financial impact of policy changes aimed at reducing ART expenses, including the Inflation Reduction Act (IRA), facilitating drug price negotiations for medications like Biktarvy starting in 2028, and the introduction of generic dolutegravir in 2031.

The research forecasts a surge in Medicare enrollment for older HIV patients, potentially reaching 193,600 by 2035, with annual spending escalating from $10.9 billion in 2026 to $27.3 billion in 2035. Cumulative costs over a decade may hit $187.2 billion, with ART expenses accounting for 63% of this total. Potential savings of up to $70.3 billion could result from a 60% reduction in ART costs, while measures like the IRA and generic drug availability might save approximately $19 billion from 2026 through 2035.

The authors underscore the necessity for healthcare systems to cater to this population's unique needs, who are at increased risk for comorbidities due to aging with HIV. They advocate for cost-reduction strategies that avert higher premiums or decreased drug coverage. This research received backing from the National Institutes of Health and the Massachusetts General Hospital Jerome and Celia Reich HIV Scholar Award, with disclosures revealing various NIH grants awarded to the authors.