Medicine Chest: Some Thoughts on Troubled ADAPs and Medicaid
There are 56 AIDS Drug Assistance Programs (ADAPs) and another 50-plus Medicaid programs in the United States and its territories. ADAPs are funded by the Ryan White CARE Act (federal money). ADAPs and Medicaid receive some money from the state governments, and it is up to each state to determine how to use the money to help provide drug services to those needing assistance.
Many of my patients who relocate from another state ask why they are not able to get the same drugs that were covered by their previous program. That's because it is up to each state to define the benefits of each program for the residents of their own state; programs and benefits differ from state to state. A person receiving ADAP drugs in California may, in addition to the antiretroviral drugs, get medication for treating side effects like lipodystrophy, while in Illinois the same drugs may not covered.
In general, many states' budgets are in trouble. After September 11, 2001, states are finding that they do not have as much money in their accounts as in the past. Citizens of many states are being warned of tax increases and budget cuts across the board. Included in these cuts are plans to limit or reduce some programs that people living with HIV/AIDS depend on. Nine states now have a waiting list for access to drugs. There are many reasons why the state governments are pressured.
In many ways, the drugs themselves are to blame. People are living longer! I personally don't understand why we did not foresee this coming. As a result of providing "life saving" drugs, people are not dying! More people are in need of drugs -- because they are alive! For this reason alone, more money should be allocated each year to programs to support patients. Newer drugs tend to be pushing the monthly price tag up.
Also, as drugs are added to a regimen, other drugs to control side effects plus new unique therapies are prescribed, and price tags soar as these can all contribute to a higher drug bill. Some patients are now taking more than three antiretroviral drugs. Boosted protease inhibitors or "salvage" therapy may include up to six or seven drugs. An example of new therapy being added to existing HIV regimens is the new drug by Roche called Fuzeon (T-20). The price is about $2,000 per month. Certainly, it will take time before states can find funding to supply this drug to patients on either the ADAP formularies or Medicaid. Other new drugs are coming as well.
Because of the economic situation that we are all living with these days, more people are losing their jobs and insurance coverage. We are also seeing new HIV infections increase nationwide, which will eventually increase the number of people requesting assistance for obtaining drugs to treat HIV.
Although drug prices are not going down, the good news is that many of the pharmaceutical companies have agreed to freeze prices of the HIV drugs. Glaxo and Pfizer have promised not to raise prices on any of the antiretroviral products that they market for a period of two years. The hope is that a long-term solution to find funding for these programs will be found. Generic equivalents of branded products used in other countries could reduce our drug bill, but they are still years away from use in the United States because of patent protection that these companies enforce.
At this time, each state can negotiate prices independently with each drug company with different degrees of success. States are now banding together to negotiate with drug companies to lower prices. This strategy should be successful because with larger buying power, the drug cost should come down.
There are some things we can do as individuals to help the states serve more people. While one is protected temporarily with support by an ADAP program or Medicaid, we should continue to look for more permanent solutions to finding employment, disability, or insurance. Even companies like Starbucks offer health and prescription benefits for their employees. It might even be fun to get paid to hang out at a coffee shop!
Another point that we cannot overlook is that we are a powerful political force. Let's get together and pressure our politicians and lobby for more funding and show them how important this is to the state and country. One only needs to look to countries like China and the African continent to understand that ignoring the need to provide lifesaving drugs to people living with AIDS will be disastrous to governments.
Finally, let's play safe! We all have in our control the ability to help others stay negative. Keeping people negative will allow more of the money we are able to secure for helping those already in need.
Editor's note: Many in the AIDS community have been critical of the pharmaceutical industry's domestic pricing practices and its overall impact on ADAP and the health care system. The ADAP Crisis Task Force is a group that is currently negotiating with antiretroviral manufacturers for additional ADAP rebates for all states' ADAPs. The central premise for the work of the task force is to have each company make one agreement that would cover all state ADAPs to ensure equity and access. By joining forces all ADAPs will benefit; creating better prices in the short term and impacting pharmaceutical pricing practices in the long term. For more information on the ADAP Crisis Task Force contact Murray Penner (202) 434-8099. -- Charles E. Clifton
Glen Pietrandoni is director of Clinical Pharmacy Services for the Walgreens Specialty Pharmacy, focusing on HIV, located in the Howard Brown Health Center of Chicago. Contact: Glen.Pietrandoni@walgreens.com.
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