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No-meds land . . . HELP!
Sep 12, 2007

You know that proverbial "no man's land" that exist between two realities? . . Well, I'm in a similar situation that I'll call "no-meds land" and I really need some good advice on what to do. I've chosen this forum to post to because I've seen you, Dr. Frascino, give such wonderful advice in the past to people in all kinds of situatons.

My situation is: I'm an American citizen who was living in Asia for many years, doing pretty well teaching at universities. When I became infected two years ago and had to go on meds soon after, I started making regular trips to Thailand for labs and meds ( to keep my status hidden in the country I was working ). I decided to come back to the U.S. earlier this year and seek employment here with a university - - and benefit from its group health plan. That was April 3, 2007. I brought with me a six-month supply of old formula Kaletra and Combivir ( bought with my own money; at Thai prices, about $3,200).

My job hunt didn't go as well as I had hoped and I have only now been offered a position. It starts in mid-October, just when the meds I brought from Thailand run out.

My worries are not over though because the university's group health plan has a 90-day waiting period; i.e., new employees are not covered until they have been with the university for 90 days.

I really can't afford to go it alone and pay for the labs and three more months of meds here in the U.S. at U.S. prices. I have been living on my savings for the past seven months and this includes a lot of traveling around the country for interviews and such. I'm nearly drained.

I've checked into ADAP. The state I'm in says there is no sense in starting the paperwork here if I am about to move in a week or so to the other state of the university I will be teaching at. At the same time, the state where I am going says that I would likely not qualify for ADAP because my income from my job at the university will be well over the maximum allowed, . . .never mind I have had no income since February of this year.

I'm stuck. I have considered flying all the way back to Thailand, using mileage points, and doing labs and buying a 3-month supply before arriving at the job at the university here stateside in October. But even that would cost me dearly, given my drained financial situation.

I've thought about Mexico; Canada; Brazil ! In the end though, I know that any of these options would have me importing meds once again, not exactly in keeping with good U.S. Customs practices.

Dr. Frascino . . I could use some good advice here. Is there a way you know of that I have missed that would allow me access to the labs and meds I need, quickly and within my limited ability to pay?

Again, I have a one-month supply left of my meds. And by the way, while I know it is not wise, maybe even reckless, I haven't had labs done since March of this year ( nearly seven months ago ). I kept seeing a job opportunity on the horizon and thinking I would do them once I was hired.

Thank you, Doctor.

Sign me,

Nowhere Man in No-Meds Land

Response from Dr. Frascino

Hello Nowhere Man in No-Meds Land,

You present a very challenging conundrum. Your situation also points out the complete insanity of our current national health care insurance fiasco! Living with HIV/AIDS is challenging enough without having to negotiate our inane health care system (or lack thereof). What you need is an advocate, a competent and compassionate HIV/AIDS specialist physician who will go to bat for you. He may well be able to intercede on your behalf to get you the 90-day supply of meds you need until your health insurance kicks in. We have done this successfully at the Frascino Medical Group on several occasions. Abbott, the company that makes Kaletra, has begun providing samples to HIV specialist's offices. Your specialist may well be able to get enough to hold you over. Alternatively he could contact Abbott and GlaxoSmithKline (makers of Combivir) directly and ask for a 90-day supply based on compassionate need, due to your rather unique situation. Another avenue to pursue would be the local AIDS service organizations. Some organizations have begun collecting unused or unwanted HIV meds and redistributing them to those in need. A fair number of HIVers are switching off Combivir, because it contains AZT, which has been linked to increased risk of lipoatrophy. Consequently you may be able to snag an unwanted supply for the next three months. I certainly hope you won't need to travel outside the U.S. just to obtain cheaper generic HIV meds!

Good luck!

Dr. Bob



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