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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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