Implementation of the medicare part D prescription drug benefit is associated with antiretroviral therapy interruptions

Moupali Das-Douglas, Elise D. Riley, Kathleen Ragland, David Guzman, Richard Clark, Margot B. Kushel, David R. Bangsberg

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Antiretroviral (ARV) treatment interruptions are associated with virologic rebound, drug resistance, and increased morbidity and mortality. The Medicare Part D prescription drug benefit, implemented on January 1st, 2006, increased consumer cost-sharing. Consumer cost-sharing is associated with decreased access to medications and adverse clinical outcomes. We assessed the association of Part D implementation with treatment interruptions by studying 125 HIV-infected homeless and marginally housed individuals with drug coverage receiving ARV therapy. Thirty-five percent of respondents reported Medicare coverage and 11% reported ARV interruptions. The odds of ARV interruptions were six times higher among those with Part D coverage and remained significant after adjustment. The majority of Part D-covered respondents reporting ARV interruptions cited increased cost as their primary barrier. Directed interventions to monitor the long-term effects of increased cost burden on interruptions and clinical outcomes and to reduce cost burden are necessary to avoid preventable increases in morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalAIDS and Behavior
Issue number1
StatePublished - Feb 2009
Externally publishedYes


  • Adherence
  • Cost-related medication nonadherence
  • Cost-sharing
  • Medicare
  • Treatment interruption

ASJC Scopus subject areas

  • Social Psychology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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