Economy Hurts Government Aid for H.I.V. Drugs
Economy Hurts Government Aid for H.I.V. Drugs
By KEVIN SACK
Published: June 30, 2010
Enlarge This ImageFORT LAUDERDALE, Fla. — The weak economy is crippling the government program that provides life-sustaining antiretroviral drugs to people with H.I.V. or AIDS who cannot afford them. Nearly 1,800 have been relegated to rapidly expanding waiting lists that less than three years ago had dwindled to zero.
Michael McElroy for The New York Times
Tim Sweeney of Fort Lauderdale is now on a waiting list for the medications he has long used.
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As with other safety-net programs, ballooning demand caused by persistent unemployment and loss of health insurance is being met with reductions in government resources. Without reliable access to the medications, which cost patients in the AIDS Drug Assistance Program an average of $12,000 a year, people with H.I.V. are more likely to develop full-blown AIDS, transmit the virus and require expensive hospitalizations.
Eleven states have closed enrollment in the federal program, most recently Florida, which has the nation’s third-largest population of people with H.I.V. Three other states have narrowed eligibility, and two of them — Arkansas and Utah — have dropped scores of people from the program.
Last week, because of swelling numbers here in South Florida, the nationwide waiting list surged past record levels set in 2004, to 1,781 people, according to the National Alliance of State and Territorial AIDS Directors. The growth is expected to continue when Georgia starts deferring enrollment in its drug assistance program on July 1. Illinois may soon follow, and New Jersey plans to cut eligibility on Aug. 1, removing 600 of the 7,700 people on its rolls.
Louisiana capped enrollment on June 1 but decided against keeping a waiting list. “It implies you’re actually waiting on something,” said DeAnn Gruber, the interim director of the state’s H.I.V./AIDS program. “We don’t want to give anyone false hope.”
Ten states’ programs have stopped covering drugs that do not directly combat H.I.V. or opportunistic infections. Unless money is found by Aug. 1, Florida plans to pare 53 of 101 medications from its formulary, including those for conditions that are often related to H.I.V., like diabetes, high blood pressure and anxiety.
In many states, there is a sense of reverting to the 1980s and early 1990s, before the development of protease inhibitors reversed the rise in AIDS deaths.
“The worry then was that there were no medications for AIDS,” said Dr. Wayne A. Duffus, medical director of the drug assistance program in South Carolina. “The worry now is that there are medicines, but you can’t afford them. A lot of patients are certainly old enough to remember what happens if you don’t get your medicines.”
For the moment, pharmaceutical companies have stepped into the breach, negotiating discounts for the state drug plans and accepting needy patients into programs that temporarily provide free medications. Although there is no data to prove it, state AIDS directors said a vast majority of people on waiting lists seemed to be getting medications one way or another.
But they concede that some patients may be going without, and that caseworkers are being diverted from critical tasks while navigating a thicket of cumbersome applications seeking drug companies’ help.
“The drug companies are trying their best to lower prices,” said Carl Schmid, deputy executive director of the AIDS Institute, an advocacy group. “But we cannot rely on them to finance the health care of poor people living with H.I.V. and AIDS.”
Tim Sweeney, 49, a Fort Lauderdale man who has depended on the assistance program for a dozen years, said he was put on Florida’s waiting list because he was four days late to re-enroll, as is required every six months. Mr. Sweeney, who has AIDS, takes six H.I.V. pills twice a day, as well as three other medications. Their total retail cost: $4,500 a month.
Unemployed for 18 months, Mr. Sweeney said he spent three days filling out forms to apply for aid from pharmaceutical companies. While awaiting responses, he is being supplied with drugs, one week at a time, by the AIDS Healthcare Foundation, a social service agency.
The patchwork arrangement gives him little comfort. “My biggest fear,” said Mr. Sweeney, who credits the drugs with vastly improving his immune cell counts, “is that I’ve done all this hard work over 20 years and now I’m going to fall back.”
Scott Miller, 42, a northeast Florida truck driver who lost his health insurance in May along with his job, said he had never before sought assistance during five years with H.I.V. When his caseworker told him there was a waiting list, he asked what he was supposed to do.
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