June 17, 2011
May, 2011 is the month when the number of lower-income Americans wait-listed for ADAP drug assistance passed 8,000. It is also the month when NIAID Director Anthony Fauci and NIAID Division of AIDS Director Carl Dieffenbach published an article setting out three objectives they believe will have to be part of any effective strategy to stop the spread of HIV:
We couldn't agree more. We've been saying the same things for years.
Behind Fauci and Dieffenbach's first bullet is the HPTN 052 trial's demonstration that diagnosing HIV and starting HAART treatment as early as possible reduces the number of new infections. The public policy implications are major. Early diagnosis and treatment protect the lives and health of people who are already positive and people who are still negative but otherwise might become infected. And the economic incentives are as compelling as the human ones: every new infection prevented is roughly $350,000 or $400,000 of future drug and treatment costs avoided.
But the waiting lists keep growing. Just last week, Elton John publicly called on Florida's governor not to cut ADAP funding even further. What's wrong with this picture?
The states are saying they just can't afford to do what's needed to contain their own future health care costs.
Not true. Massachusetts doesn't have an ADAP funding crisis because its health care system looks a lot like the Affordable Care Act as it will start working in 2014: everyone is required to have health insurance, and insurers cannot refuse coverage or charge higher premiums because of pre-existing conditions like HIV. Massachusetts' ADAP doesn't buy drugs for most of its clients; it pays their insurance premiums, which are no higher than premiums for HIV-negative people. The Massachusetts model works.
And in the year America's HIV epidemic turns 30, Congress is saying it can't afford to do what's needed to bail out the states' ADAPs.
Once again, not true. The federal government's contribution to state ADAPs is infinitesimal in the context of its $3.5 trillion budget. You could eliminate the program entirely or double or triple it and no one would ever notice the impact on the federal deficit. The question is not whether we can afford to fund the ADAPs, but how the return on investment (ROI) on the money spent compares to the ROIs of the many other small programs competing for the same budget dollars. We think everyone who is positive should be identified and brought into treatment, and that funding for state ADAPs to help make that happen will have one of the highest ROIs in the federal government's entire portfolio of programs.
Thank heavens for South Carolina's not-for-profit Welvista Pharmacy and the pharmaceutical companies that partner with it to provide HAART drugs and other medicines to lower-income Americans who are wait-listed or don't qualify for ADAP anymore - Abbot, AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Sqibb, Gilead, GlaxoSmithKline, Johnson & Johnson, Lilly, Merck, Pfizer, Novo Nordisk, Novartis, Sanofi Aventis, Takeda, Tibotec, and ViiV. But the Welvista program's generous and public spirited assistance to Americans denied HAART drugs by ADAP programs for which they are or used to be eligible is no substitute for rational health care budget policy as we enter the epidemic's fourth decade.
From NAPWA's Positive Voice Newsletter: Volume 2 Issue 5.