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ADAP Crunch in Virginia: HIV/AIDS patients scrambling to cover cost of medications
  By Amy Jeter
The Virginian-Pilot
December 19, 2010
For the first time in two decades, a sharp increase in enrollment has forced Virginia's medication assistance program for low-income, uninsured HIV and AIDS patients to limit who it serves.
Like several states, Virginia is struggling to accommodate increased need, which has been driven by a lagging economy, more HIV testing and diagnosed cases, and patients living longer on available treatments.
An estimated 760 of the patients with more stable immune systems will transition from Virginia's AIDS Drug
Assistance Program to a waiting list in the next few months because they don't meet the scaled-back eligibility requirements. An additional 400 new clients a year who would have qualified also will be placed on the waiting list, according to estimates.
It is likely Virginia's eastern region, which includes South Hampton Roads, will feel the pinch, as it represents about a third of the program's patients and the state's new HIV diagnoses.
However, officials with the Virginia Department of Health predicted that all patients who are no longer eligible for the program will find help through either Medicaid or drug companies' assistance programs.
State health workers are helping them find alternative sources for their medication.
"The focus is to make sure that they get their treatment for their HIV," said Maureen Dempsey, the state's chief deputy for public health.
Workers with an HIV/AIDS support program in Norfolk are worried about the logistics of applying for drug company charity and that those resources would eventually run dry.
"I can imagine that at some point, the patient assistance programs are going to get maxed out," said Stacie Walls-Beegle, executive director of Access AIDS Care.
Though anti-HIV medications don't cure an HIV infection, they can control the reproduction of the virus and slow the progression of related disease. In patients who miss dosages, the virus can replicate more rapidly and may develop a resistance to drugs.
The federal Ryan White program pays for almost 90 percent of the $20 million budget for Virginia's AIDS Drug Assistance Program. The state contributes the remainder.
Funding has been constant in recent years, state health officials said. As recently as 2006, the program was losing clients, according to a recent George Mason University report.
However, between spring 2007 and spring 2010, the total number of patients served per year grew 21 percent to 3,952, according to state health department statistics.
Between spring 2008 and spring 2009, the program paid an average of $1,254 a month for 1,649 patients, according to the George Mason report. From April to October of this year, though, the average monthly cost per patient rose to $1,283, with the program serving an average of 2,019 patients per month, according to the health department.
Also adding to the expense: Over the past few years, individual patient treatments have required more different drugs, said Kathy Hafford, director of the state health department's division of disease prevention.
Federal funding didn't keep pace because it's based on less recent data, Dempsey said. Money for the 12 months beginning in April 2010 was determined using the number of people living with HIV/AIDS in 2008.
Programs across the nation saw enrollment spikes in 2009.
As of Dec. 9, Virginia and eight other states had waiting lists totaling more than 4,500 patients, and 17 other states had taken steps similar to Virginia's to limit program costs, according to the National Alliance of State and Territorial AIDS Directors. At that time, Virginia reported 24 patients on its new waiting list.
To help contain costs, pharmaceutical companies earlier this year agreed to reduce medicine charges for AIDS Drug Assistance Programs. The federal government also awarded some extra money; Virginia received $400,000 of it.
"It was very helpful," Hafford said. "But it wasn't enough."
To stay within budget, state officials last month closed enrollment for new patients to everyone except pregnant women, children ages 18 or younger, and other patients receiving treatment for an active opportunistic infection.
They also decided to limit the drugs in the program to antiretrovirals, medications to prevent and treat opportunistic infections, and vaccines not available from another source.
The income criteria remains at 400 percent or below federal poverty levels, which amounts to $43,320 for one person.
Though both federal and state lawmakers have taken steps to provide the program more money in future budgets, Dempsey said Virginia's new rules likely would be in place until at least April 2012.
"If the ADAP funding stays flat and the demand stays as high as it is, we're going to have to continue our enrollment restrictions and assist people into other programs," she said.
Walls-Beegle said it's unfortunate that the drug program's cutbacks come at a time when many groups are diagnosing more HIV/AIDS patients and trying to get them into treatment.
"It's still a good thing that they're being identified, and they're knowing their status," she said. "It's another thing that we have to say, 'Oh, we want to help you, but then there's not that help that has been traditionally available by the government.' "
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