California AIDS Program May Cut Services

The California AIDS Drug Assistance Program may have to reduce the number of covered drugs and start a waiting list for new enrollees due to rising drug costs and the $34.6 billion state budget deficit. About 26,000 Californians rely on ADAP for their costly life-saving medicine. The program has been hit by cost overruns because of increasing cases, the weak economy and introduction of expensive new drugs. For the fiscal year beginning in July, California advocates say the program will cost about $24 million more than was budgeted.

"We're going to have to look at a waiting list, as well as removing some drugs from the formulary," said Michael Montgomery, the state AIDS program chief. AIDS activists, who take pains to praise Gov. Gray Davis for his past support for ADAP, have known for months that restrictions were possible. They acknowledged that Montgomery's public airing of the prospect now made it more likely.

Each year, about 2,000 more residents enroll in ADAP. The program provides free AIDS drugs to those with incomes of less than $34,000, while those making up to roughly $50,000 make co-payments. Participants take four to 10 medications daily, which would otherwise cost them more than $15,000 a year for their antiviral drugs alone.

Total California ADAP spending had been growing at $20 million a year, but Davis proposed an ADAP budget increase of only $2 million. As a result, state health officials and AIDS advocates have been scrambling for ways to close the gap. ADAP lobbyists in Washington had hoped to boost the $714 million annual federal spending by $162 million. They won a $75 million increase -- of which California can expect about $3 million.

"People are piling up on waiting lists, while Medicaid is dumping people who used to get coverage, and private insurers, in their quiet way, are getting rid of high-cost patients," said Bill Arnold, director of the Washington-based ADAP Working Group, a coalition of advocates, care providers and drug companies.

California advocates are also battling a state proposal of $30 co-payments per month per prescription [summarized in Prevention News Update on April 17, 2003]. Montgomery said he hoped a solution can be found, but he warned that some cutbacks might be inevitable.

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