States are tightening their income eligibility requirements. Other states are removing the most expensive drugs from their formularies and using other strategies to contain costs, such as limiting coverage only to the sickest patients. ??
“We are struggling…,” said Penner. “This is in a larger context of our health care system which is a fractured health care system and it really has been a piecemeal approach to getting people with HIV and AIDS the care they need.” ??
Advocacy groups say the pullback is short-sighted: HIV patients who get the antiretroviral drugs are generally able to manage their disease, allowing them to continue working and keeping long-term medical costs down for the state. New research even suggests that people put on medication immediately after being diagnosed are less likely to spread the disease. ????
Most of those people who do not get into ADAP programs find other sources of help, including programs offering drugs donated by pharmaceutical companies. The programs, however, do not guarantee medication since they are dependent on what donations they receive from the pharmaceutical companies and often require patients to reapply frequently for help. ????
Jen Kates, vice president and director of global health and HIV policy at the Kaiser Family Foundation, said these programs are helpful, “but there are gaps all across the country.” (KHN is an editorially independent program of the Kaiser Family Foundation). ????
Florida, one of the states hit hardest by the recession, has 3,938 people on the ADAP waiting list, the highest number in the country. In February, the state ran out of ADAP money and turned to Welvista, a South Carolina-based nonprofit pharmaceutical assistance program that is providing medication to HIV patients on ADAP waiting lists in several states. For six weeks, Welvista supplied medicine to more than half of those in Florida’s ADAP program until new federal funding became available in April. ????
Thomas Decker, a 58-year-old HIV patient in Arlington, Va., was laid off from his job with a local printer in September 2009. He continued to buy his insurance through a COBRA program but when that ran out, he turned to ADAP to pay for his medication. ????
“It’s such a shock when you have insurance and you pay into everything for so many years and then you are just sort of left out into the open — people really don’t get it,” Decker said. He was forced out of the state’s ADAP in January when his T-cell count increased, suggesting his health was improving. “I was kicked off the program basically because of my health. I always kept my health up,” he said. ????
Decker moved to Virginia’s waiting list, along with 684 other individuals. He is also enrolled in a pharmaceutical assistance program that provides his HIV medication. ????
NASTAD’S Penner points to Virginia as an example of how states can deal effectively with the ADAP overflow. While the state did temporarily institute the T-cell criteria to bump healthier individuals off the program so it could allocate ADAP funding to those in most need, “they basically hold the patients’ hand through the process,” he said. ????
Diana Jordan from Virginia’s Department of Health said that in four months the three-person ADAP staff “transitioned” 203 HIV patients off ADAP and worked individually with each person to find another source of funding for their drug treatment. The bumping process has been discontinued, Jordan said, because federal funding grants began again in April. ??”We are sorry we had to do it,” she said, “but … we are glad that they have something.”