Decline of Nonrecommended HIV Care in Medicare

TOPLINE:

Among Medicare beneficiaries with HIV, the proportion receiving at least one nonrecommended antiviral prescription decreased substantially from 5.1% in 2013 to 0.1% in 2021.

METHODOLOGY:

• Clinical guidelines in 2017 recommended discontinuing older, more toxic antivirals in people with HIV. However, some people continue to take them due to several barriers to switching.
• This cross-sectional study used a 20% random sample of traditional Medicare beneficiaries with Part-D coverage from 2013 to 2021 and categorized prescribed antivirals as nonrecommended — based on drug toxicity and the availability of more effective alternatives — the remaining being classified as preferred.
• The analysis examined the proportion of beneficiaries with HIV who received at least one nonrecommended antiviral vs those who received only preferred antivirals.

TAKEAWAY:

• Of the total Medicare beneficiaries with HIV, 1052 (74.1% aged < 65 years; 74.9% men) received at least one nonrecommended antiviral prescription, and 28,019 (75.9% aged < 65 years; 74.4% men) received only preferred antivirals.
• Compared with beneficiaries who received only preferred antivirals, those who received nonrecommended antivirals were more likely to be from the South (45.6% vs 50.5%; standardized mean difference, 0.10).
• Didanosine and nelfinavir emerged as the most frequently prescribed nonrecommended antivirals, accounting for 27.5% and 25.3% of prescriptions, respectively.
• The proportion of beneficiaries receiving nonrecommended antivirals substantially declined from 5.1% in 2013 to 0.1% in 2021.

IN PRACTICE:

“Further research should assess how many beneficiaries switched to less toxic antivirals over time (rather than being censored), characteristics associated with switching to safer alternatives, alternative antivirals prescribed instead, and how more recent ART [antiretroviral therapy] guideline recommendations may influence future prescription patterns,” the authors wrote.

SOURCE:

This study was led by Jose F. Figueroa, MD, Harvard T.H. Chan School of Public Health, Boston. It was published online on May 1, 2025, in JAMA Network Open.

LIMITATIONS:

The study focused exclusively on traditional Medicare beneficiaries living with HIV, possibly limiting the generalizability of the findings to individuals with HIV covered by commercial insurance, Medicaid, or Medicare Advantage plans. HIV diagnoses relied on claims data.

DISCLOSURES:

This study was supported by grants from the National Institute on Aging, the Harvard Center for AIDS Research, and the Advancing Clinical Therapeutics Globally program. Some authors reported having financial ties with multiple foundations and pharmaceutical organizations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.