When the Illinois legislature failed to provide appropriate funding to cover the cost of adding saquinavir and lamivudine to the AIDS Drug Reimbursement Program (ADRP), the Illinois Department of Public Health eliminated 82 of the 112 drugs from the ADRP formulary to finance the addition of these two antivirals. Gone from the formulary are all antibiotics, all drugs for the management of Kaposi's sarcoma and other malignancies, all drugs for the prophylaxis and treatment of mycobacterial infections, drugs for the treatment of toxoplasmosis and cryptosporidiosis, and agents for the management of HIV-wasting syndrome, including antidiarrheal medications.
It would appear that the net impact of these changes will be a decrease, rather than an increase, in the life expectancy of the 3000 Illinois ADRP beneficiaries with HIV/AIDS. The State of Illinois has failed to realize that many of the advances in extending the lives of people with HIV disease have been made possible through more effective prophylaxis and treatment of opportunistic infections, such as Mycobacterium avium complex. The elimination of some of these drugs may also destroy the quality of life of many people with late-stage HIV disease and will result in unnecessary hospitalization and suffering.
Other states are now concerned that there will be an exodus of Illinois residents with AIDS to surrounding states due to patients' attempts to qualify for the drugs taken away from them by the State of Illinois. So to hedge against such a perceived threat, legislators in Missouri, Michigan, Minnesota, Iowa, and Indiana have started to consider whether to follow Illinois's lead and eliminate the same drugs from their formularies.
If other states follow Illinois's Draconian measures, some pharmaceutical companies may cut back on their drug assistance programs, since the pharmaceutical industry does not want to position itself as the pis aller for governmental agencies that refuse to pay for critical drugs for those with life-threatening illnesses.
If this nation needed an example of the potential risk of having welfare responsibilities turned over to the states, the failure of the Illinois legislature to provide funding to support the continued survival of people with life-threatening illness and maintain their quality of life should signal what the future will be like in a society where the ethicists are beancounters.
The City of Chicago earmarked nearly four million dollars to beef up security during the final basketball playoffs between the Bulls and the SuperSonics to prevent loss of life and property resulting from possible riots surrounding the anticipated Bulls victory. This money was made available because public order is a priority of the Daley administration. It would take 6.7 million dollars for the State of Illinois to restore the 82 drugs in the ADRP formulary, maintain saquinavir and lamivudine, and add indinavir and ritonavir. That, however, would mean giving priority to the lives of 3000 Illinois residents with HIV/AIDS. But their lives aren't a priority. After all, these people are going to die anyway. Why not give them a helping hand and take away their drugs?
This article was provided by International Association of Physicians in AIDS Care. It is a part of the publication Journal of the International Association of Physicians in AIDS Care.