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Kaiser to reclassify 45 HIV drugs to specialty tier in 2026; SFHSS told 86 members will be affected
Summary
Kaiser Permanente told the San Francisco Health Service System board that, effective Jan. 1, 2026, 45 high-cost HIV drugs will move to a specialty tier under the Medicare Part D formulary, changing member cost-sharing to 20% coinsurance (capped at $100 per prescription); SFHSS staff said 86 members will be affected and Kaiser described assistance options.
Kaiser Permanente representatives told the San Francisco Health Service System board on Dec. 11 that 45 high-cost HIV medications will move to a specialty tier on Jan. 1, 2026, a change that will shift cost-sharing for affected Medicare Advantage members.
"Effective 01/01/2026, 45 high cost specialty drug, HIV drugs, are gonna move" from their prior brand-name tier to a specialty tier, Ramiro Salas, director for Kaisers California group Medicare, said during the presentation. Salas said memberscost share will change "from $15 per prescription to a 20% coinsurance with a maximum of $100 per…
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