New coding guidelines for HIV tests
Financial assistance with lipodystrophy
University students fighting the spread of HIV with mobile media
Newly unsealed documents shed light on Norvir price hike
New coding guidelines for HIV tests
From the American Academy of HIV Medicine (AAHIVM): AAHIVM, in partnership with the American Medical Association (AMA), has just released a new CPT coding guide to help health care providers and their billing staffs become familiar with the proper coding for submitting claims forms related to routine HIV Testing. This Guide was developed and published as part of a grant from the U.S. Centers for Disease Control and Prevention (CDC) to help implement the agency’s Revised Recommendations for HIV Testing of Adults, Adolescents and Pregnant Women in Health-Care Settings. CDC released its revised recommendations in 2006, and since that time AAHIVM, AMA and several other national partners have worked to convene several topic-specific, peer-level workgroups to help health care providers understand the importance of routine testing, and to help address any barriers they may have to incorporating routine HIV testing in their respective health-care settings. One of the challenges the workgroup has highlighted is submitting and understanding the proper coding requirements for routine HIV testing, so the Reimbursement Workgroup developed the coding guide to help providers and their staff navigate this often confusing process. The brochure is available as a downloadable PDF from the AAHIVM website. “This brochure is an excellent step forward in helping all health care providers, both HIV-expert and non-experts, submit their medical claim forms for patient consults that include a rapid HIV test,” said Litjen Tan, Ph.D., director of infectious diseases, immunology, and molecular medicine at the AMA. AAHIVM member Sharon Valenti, NP, AAHIVS, who also serves as President of the Association of Nurses in AIDS Care (ANAC) of Southeast Michigan, said, “We are looking forward to a wide distribution of this guide so that health care providers in all settings can more confidently make the choice to screen for HIV disease in all of their patient care activities.”
Financial assistance with lipodystrophy
From a reader and advocate: My name is Gregg Cassin and I’ve been living with HIV for over 25 years. I am the chairperson of the national AIDS service organization AIDS, Medicine and Miracles (please see our websites for more information.) My letter is regarding the thousands of people dealing with the horrible and disabling condition of lipoatrophy and lipodystrophy. A decade ago California State Assembly Bill AB 1621 was amended (in 1998) to give people with HIV who are suffering from facial wasting the same right to insurance-paid reconstructive procedures as a woman having a mastectomy. The goal was mandating that insurance companies see facial wasting, etc. as disfiguring, life-altering conditions that should be treated. As with breast reconstruction, insurance companies had seen facial wasting and other lipoatrophies and lipodystrophies as purely cosmetic. Years later we have come to understand the devastating effects of these conditions causing increased occurrences of depression, anxiety, isolation, and even suicidal thoughts.
My own personal experience living in San Francisco’s Castro district tells me that few people know about it and fewer are benefiting from it. I’ve asked several doctors, case managers, and social workers about insurance coverage of facial restoration treatments and almost all give the same response, “Insurance won’t pay.” It’s troubling that few know about the bill, follow up with any questions, or request more information from me. It seems that it is hard for most people to even believe that there is such a bill. It is troubling to me that this issue continues to not be addressed by doctors, HIV advocates and activists, the HIV/gay media, and “filler” companies. This makes treatment only available to the wealthy few who can afford to pay out-of-pocket. Sadly, I know of only three people who have gotten it covered by insurance—one by Medicare, one by Kaiser, and one by Blue Cross. All three had their procedures done several years ago. I think this is incredibly unfair that there are so many truly suffering from real depression, anxiety, and worse that results from this condition. I’m appealing to you for some assistance in getting this issue addressed so that people can get some real help. Please respond as soon as possible. Thank you very much.”
Positively Aware recommends that people visit www.facialwasting.org for assistance on this topic. See below.
From Program for Wellness Restoration (PoWeR): PoWeR released the results of the largest on-line patient survey performed to date on lipodystrophy options and resources along with a free Spanish translation of their book “Built to Survive.” The survey of 776 individuals summarizes the main therapeutic options used in the HIV community, along with a list and ratings of providers who specialize in reconstructive procedures for HIV-related body changes. The excitement and hope for a longer life that accompanied the arrival of Highly Active Anti-Retroviral Therapy (HAART) has been tempered by accounts of humps, bellies, and facial wasting. … many people living with lipodystrophy have turned to the Internet for advice, treatment, and support in hopes of reversing some of the devastating effects of this stigmatizing syndrome. Visit www.powerusa.org.
From www.hivcruise.com: Last October, a group of 225 HIV-positive men and women went sailing away from the worries of the disease while obtaining key health information and raising funds for HIV non-profit projects. In this 10th year, the retreat raised $6,000 for the non-profit Program for Wellness Restoration (PoWeR) for their project to support the HIV international program of Doctors Without Borders. More than $30,000 has been raised over the past 10 years. “It is great to have people who have been challenged for years with fears of death enjoy life in the company of others who are in the same boat as they are,” said Nelson Vergel, PoWeR founder, AIDS activist, and lecturer on the cruise. Dr. Michael Wohlfieler, a leading South Florida HIV physician and featured speaker on the cruise, said, “As a doctor who treats hundreds of HIV patients, I must say that spending a week with so many people having fun while being helped with medical information is an ideal scenario.” Sam, a long-term survivor from San Francisco, said, “We remember all too well when the virus was considered more or less a signal that it was time to get one’s affairs in order. Thankfully those days are behind us. A week like the one I had on this cruise reminds me that life is rich and full and when the good times roll it can be downright amazing.” This year’s cruise over Halloween will travel from Ft. Lauderdale with stops at Grand Turk (Turks and Caicos), St. Maarten, St. Thomas, and Princess Cays, according to cruise organizer Paul Stalbaum. “We will actually have separate fun activities for gay and straight groups, with some intermingling,” he said. For more information contact Stalbaum at 1-800-735-0401 ext. 241, or e-mail Paul@universal-travel.com. Visit www.hivcruise.com for the gay group and www.positivecruise.com for the heterosexual group.
University students fighting the spread of HIV with mobile media
Click here to read the full press release.
Newly unsealed documents shed light on Norvir price hike
The judge in the ongoing federal class action lawsuit against Abbott Laboratories, Inc., the makers of Norvir and Kaletra, recently ordered the unsealing of documents regarding the pharmaceutical company’s 400% price increase of Norvir in 2003. “We’re appalled by the callous disregard for HIV/AIDS patients that Abbott displayed in the documents they tried to keep secret,” said Steve Abrecht, Executive Director of the SEIU Health and Welfare Fund. The documents show that Abbott executives planned to justify the price increase by suggesting that it was “no longer feasible for Abbott to continue manufacturing Norvir capsules” at their original price. One executive, Jesus Leal, noted that this plan and rationale had a significant weakness—“exposure on price if forced to open books.” Abbott also considered making Norvir available at its original price only in a foul-tasting liquid form that its own executives acknowledged tastes like “someone else’s vomit.” They even considered completely halting the production of Norvir altogether, forcing millions of patients to switch to Kaletra. “These documents show that Abbott put profits ahead of the need of seriously ill HIV/AIDS patients in quintupling Norvir’s price,” said Alex Sugerman-Brozan, director of Prescription Access Litigation. “This information would never have come to light if not for this lawsuit, demonstrating that litigation is sometimes the only means to uncover such schemes and hold drug companies accountable.” When asked to comment a spokesperson from Abbott stated, “The re-pricing of Norvir was legal and captured the value of this important medicine based on its new role in the marketplace.” The Judge’s ruling and copies of the unsealed documents can be found here.—Keith R. Green
Pfizer, Inc., the manufacturer of the HIV protease inhibitor drug Viracept (nelfinavir), issued a Dear Healthcare Professional letter in May. The letter states that the drug meets the new final limits established by the U.S. Food and Drug Administration (FDA) for prescribing to all patient populations, including pediatric patients and pregnant women. Earlier, concerns were raised over the level of an impurity that is a naturally occurring result of manufacture, but the issue was in European supplies, not in the U.S.—Keith R. Green and Enid Vázquez
