Medicare spending on clinical care for people aging with HIV projected to rise steeply over next decade

As more Americans with HIV live into older age, Medicare spending on their care is projected to rise dramatically from $10.9 billion in 2026 to $27.3 billion in 2035, with HIV medications accounting for nearly two-thirds of total costs.

Emily P. Hyle, MD, and Kenneth A. Freedberg, MD, of the Medical Practice Evaluation Center within the Department of Medicine at Mass General Brigham, are the lead and senior authors of a paper published in JAMA Network Open, “Ten-Year Cost Projections for Medicare Beneficiaries 65 Years or Older With HIV.”

What challenges or unmet needs make this study important?

Survival among people with HIV in the United States continues to improve due to highly effective antiretroviral therapy (ART), a lifelong treatment. As a result, costs to Medicare are expected to rise substantially as more adults with HIV live long enough to age into the program. However, it has been largely unknown how much the number of Medicare beneficiaries may increase over the next decade and how much the program’s spending could rise.

What central questions were you investigating?

Our team used simulation modeling to answer these three main questions:

• Over the next decade, how many people with HIV (who are receiving HIV care) age 65 and older are likely to be enrolled in Medicare?
• How much is Medicare estimated to spend on this population over this time period?
• How might policies or strategies to reduce the cost of ART affect these projections?

What methods or approach did you use?

We developed and populated a new model called CHARMED with projections from the previously validated CEPAC model, Medicare claims data and publicly available data. Our aim was to simulate a population of Medicare beneficiaries with HIV, age 65 and older, who are being treated with ART, and their associated costs.

To address uncertainty in model estimates and trends, we examined scenarios in which the size and associated costs of this group varied—for example, by assessing the potential impact of policies to reduce the cost of ART. Such policies included the Inflation Reduction Act (IRA), which allows Medicare to negotiate the cost of Biktarvy, the most commonly prescribed ART regimen in the United States, with lower prices to take effect in 2028. Additionally, generic dolutegravir is expected to become available in 2031, thereby enabling a highly effective, well-tolerated, fully generic ART regimen.

What did you find?

Our projections show that nearly 122,000 older adults receiving HIV care may be enrolled in Medicare by the end of 2026—a number that may increase to about 193,600 by the end of 2035. We also estimated that annual Medicare spending for this population may increase from $10.9 billion in 2026 to $27.3 billion in 2035.

Cumulative 10-year costs may reach $187.2 billion, with 63% attributable to ART costs alone. If ART costs were reduced by 60%, Medicare could potentially save $70.3 billion over the next decade. Moreover, if current prescribing patterns remain unchanged, policies such as the IRA and the availability of generic HIV medications could save Medicare approximately $19 billion between 2026 and 2035.

What are the real-world implications, particularly for patients?

Our findings demonstrate that the number of older adults living with HIV is likely to increase substantially over the next decade, driving up Medicare enrollment. Clinicians and health care systems must be prepared to address the medical needs of this growing population through comprehensive, person-centered care—especially given these individuals’ increased risk of comorbidities and polypharmacy (taking several medications regularly).

We also conclude that policymakers for Medicare and other public programs will likely seek ways to reduce the cost of HIV care. While recent proposals have included higher Medicare premiums, drug coverage reductions and stricter eligibility for drug assistance programs, our paper points to other promising strategies to reduce ART costs without increasing patient costs or limiting access.

Who’s behind this story?

Gaby Clark

MA in English, copy editor since 2021 with experience in higher education and health content. Dedicated to trustworthy science news.

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Robert Egan

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