States cut back efforts to provide drugs for HIV, AIDS

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States cut back efforts to provide drugs for HIV, AIDS

By Shefali S. Kulkarni, Published: May 22

Cash-strapped states are scaling back efforts to provide life-saving medicines

to HIV patients.

The result: more than 8,300 people — a record number — are on waiting lists in

13 states to get antiretrovirals and other drugs used to treat HIV and AIDS or

the side effects, mental health conditions or opportunistic infections. And that

number probably understates the need, say advocates, who note that many states

have simply eliminated waiting lists or reduced eligibility.

" States that have changed their eligibility programs or don't have a waiting

list, or some states have disenrolled their patients, that's a kind of silent

crisis, I think, " said Jeff Graham, executive director of Georgia Equality, an

advocacy group on gay issues. His state holds the second-highest number of

patients on a waiting list: 1,520.

In recent weeks:

l & #8201;Illinois tightened eligibility for the state program that helps HIV

patients pay for their medications. On July 1, the cutoff for the program will

fall from an annual income of 500 percent of the federal poverty level, or

$54,450, to $32,670.

l & #8201;Georgia cut $100,000 from its program, which serves 4,300 people.

l & #8201;Florida, which already has the nation's longest waiting list for HIV

prescription drug assistance, held public hearings as officials consider cutting

the eligibility threshold in half to $21,780 or less in annual income.

l & #8201;Utah and Alabama are reopening their waiting lists.

AIDS drug assistance programs, or ADAPs, pay for HIV medications for low-income

patients when they cannot afford the drugs and don't have insurance or have

limited coverage that fails to include the cost of the drugs. Nearly 174,000

people are covered by the programs, according to the most recent information

from the National Alliance of State and Territorial AIDS Directors (NASTAD).

Murray Penner, deputy executive director of NASTAD, said the average annual cost

for ADAP drugs is $11,388 per person, but that is significantly less than

individuals trying to buy their own drugs would pay.

The federal government provides the bulk of the ADAP financing through the

White Care Act. This year the budget is $885 million, $25 million more than last

year, according to Macsata, chief executive of the ADAP Advocacy

Association. Many states supplement the funding.

But the number of people seeking help is rising after the recession pushed

millions of people out of work and cut their insurance coverage. And the

downturn in the economy has created budget shortfalls for states and limited

their ability to help those patients.

ADAP is not an entitlement program, so even applicants who are qualified can be

turned away or put on waiting lists if funding is not available.

Advocacy groups say the pullback by states is shortsighted: HIV patients who get

the antiretroviral drugs are generally able to manage their disease, allowing

them to continue working and keeping long-term medical costs down for the state.

New research even suggests that people put on medication immediately after being

diagnosed are less likely to spread the disease.

Most of the people who do not get into ADAP programs find other sources of help,

including programs offering drugs donated by pharmaceutical companies. The

programs, however, are dependent on what donations they receive and often

require patients to reapply frequently for help.

Florida, one of the states hit hardest by the recession, has 3,938 people on the

ADAP waiting list, the highest number in the country. In February, the state ran

out of ADAP money and turned to Welvista, a South Carolina-based nonprofit

pharmaceutical assistance program that is providing medication to HIV patients

on ADAP waiting lists in several states. For six weeks, Welvista supplied

medicine to more than half of those in Florida's ADAP program until new federal

funding became available in April.

Decker, 58, an HIV patient in Arlington, was laid off from his job with a

local printer in September 2009. He continued to buy his insurance through the

COBRA program, but when that ran out, he turned to ADAP.

" It's such a shock when you have insurance and you pay into everything for so

many years and then you are just sort of left out into the open — people really

don't get it, " Decker said. He was forced out of the state's ADAP in January

when his T-cell count increased, suggesting his health was improving. " I was

kicked off the program basically because of my health. I always kept my health

up, " he said.

Decker moved to Virginia's waiting list, along with 684 other individuals. He is

also enrolled in a pharmaceutical assistance program that provides medication.

NASTAD's Penner points to Virginia as an example of how states can deal

effectively with the ADAP overflow. While the state temporarily instituted the

T-cell criteria to bump healthier individuals off the program so it could

allocate ADAP funding to those in most need, " they basically hold the patients'

hand through the process, " he said.

Jordan from Virginia's Department of Health said that in four months the

three-person ADAP staff " transitioned " 203 HIV patients off ADAP and worked

individually with each person to find another source of funding for drug

treatment. The bumping process has been discontinued, Jordan said, because

federal funding grants began again in April.

" We are sorry we had to do it, " she said, " but . & #8201;. & #8201;. we are glad

that they have something. "

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