Background
As people with HIV (PWH) in the US continue to age, costs to Medicare are expected to rise substantially. We projected the number of 65y+ Medicare beneficiaries with HIV in the US from 2023 to 2033 and the potential budget impact on Medicare.
Methods
We used the CEPAC microsimulation model of HIV disease and treatment with CDC population estimates and simulated Medicare beneficiaries with HIV aged 65y+ and on ART from 2023-2033. We accounted for PWH already in care turning 65y and new HIV diagnoses in people 65y+. Annual, age-stratified costs were derived from 2014-2018 Traditional Medicare (TM) claims data for people filling ART prescriptions for ≥10 months per year: ART ($31,000-34,400), direct HIV-related care ($2,200-2,800), and other clinical care costs ($19,300-20,100). For people dying during the simulation period, we incorporated age-stratified TM claims in the 12m prior to death: ART ($29,400-31,600), direct HIV-related care ($9,900-17,200), and other care costs ($51,100-66,400). We performed sensitivity analyses on key parameters and assumptions, including a 40-90% reduction in ART prices given the possibility of generic ART regimens or price negotiation under the Inflation Reduction Act. Model outcomes included numbers of PWH aged 65y+ in Medicare and undiscounted dollars spent by Medicare from 2023-2033.
Results
We projected that 130,750 PWH would meet age-eligibility criteria for Medicare in 2023 (65-69y: 66,110; 70-74y: 39,320; 75-79y: 17,490; 80y+: 7,830) (Figure, Panel A). By 2033, this number would nearly double to 252,350 (65-69y: 99,950; 70-74y: 80,560; 75-79y: 44,320; 80y+: 27,520). Costs to Medicare for PWH 65y+ would rise substantially, from $7.9 billion in 2023 to $15.2 billion in 2033, with over 50% contributed by ART costs (Figure, Panel B). If ART prices are reduced by 50%, Medicare would save $33.7 billion over the 10y period, lowering ART costs to 33% of overall expenditures.
Conclusions
The number of 65y+ Medicare beneficiaries with HIV is likely to double over the next decade, reaching $15.2 billion in annual costs to Medicare by 2033; these projected costs do not include additional costs of Medicare-eligible PWH under age 65 or variation in costs among PWH on Medicare Advantage instead of TM. Reductions in ART prices could lead to substantial decreases in overall Medicare spending for older beneficiaries with HIV.