California: Advocates Say ADAP Is in Crisis

The nation's AIDS Drug Assistance Program, which provides medications for about 150,000 low-income patients, is in crisis, AIDS advocates and government officials warn. With patients living longer, state and federal budgets have been strained with higher monthly drug costs incurred over longer periods of time. At the same time, various organizations criticize the ADAP Working Group (AWG), a national coalition of community AIDS groups and pharmaceutical companies, as no longer effective in lobbying for ADAP funding.

The AIDS Healthcare Foundation, San Francisco AIDS Foundation and Project Inform have all pulled from the working group: AHF most recently, SFAF in December and PI last May. AHF's chief complaint with AWG is that it fails to address the artificially high and ever-rising drug costs, a "fatal weakness." Of the $60 million in additional federal ADAP money for medications in 2002, AHF stated, half covered just price increases. AHF specifically targeted AWG member GlaxoSmithKline, saying it used technicalities involving rebate calculations to avoid honoring its two-year price freeze. AWG Co-chair William Arnold said he respectfully disagrees with AHF and is nonplussed by its criticisms.

Unlike AHF, the other organizations did not withdraw from AWG solely because of concerns regarding Glaxo or drug company influence. "We have joined a number of organizations to look for another community-driven process in D.C. to carry out our ADAP advocacy," said Ernest Hopkins, SFAF's director of federal affairs. AHF official Clint Trout said his group would also "use other venues to formulate an effective plan of action" in securing patients' access to AIDS drugs. Deputy Director Michael Montgomery of California's Office of AIDS stressed it is imperative all groups find a way to work together advocating for federal resources.

Already, Arnold said, ADAP will start fiscal 2003 with a more than $100 million deficit. In fiscal 2004, ADAP needs an estimated $200 million, though President Bush is asking for $100 million. While California has not instituted an ADAP waiting list, it is on the precipice of having to do so. Gov. Gray Davis has also floated a co-payment idea, where patients would pay $25-$50 per prescription. On average, that could mean $120-$200 monthly -- a sum advocates contend would be financially crippling to low-income HIV patients. It is estimated the California program needs $20 million more each year to keep pace with enrollment and costs. Once Roche's new drug Fuzeon -- priced at more than $20,000 annually in Europe -- is added to the drug mix, it is assumed another $5 million will be needed.

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