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State AIDS Drug Programs Negotiate with Drug Manufacturers
National Alliance of State and Territorial AIDS Directors
Press Release
3/27/2003
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For further information, Contact:
Murray Penner, (202) 434-8090
"AIDS Drug Assistance Programs (ADAPs) are facing a funding crisis of
unprecedented proportions," stated Julie Scofield, Executive Director of the
National Alliance of State and Territorial AIDS Directors (NASTAD). Funding
shortfalls have already caused thirteen states to create waiting lists or add
restrictions for their ADAPs. Several additional states anticipate limiting
enrollment in the near future. "No American who needs HIV medications should
be denied access. These medications can make a life or death difference to
individuals living with HIV/AIDS," noted scofield. ADAPs are a component of
the federally funded Ryan White CARE Act, administered by states and U.S.
territories, that provide life-saving medications to uninsured or
underinsured people living with HIV and AIDS.
To alleviate the crisis, state AIDS directors and ADAP officials last week
entered into first-of-their-kind negotiations with HIV drug manufacturers.
The meetings, which concluded Friday, have produced mixed results. Although
all eight of the major companies with HIV antiretrovirals on the market
participated in the Washington, DC meetings, only one thus far has reached a
satisfactory agreement with the group while five more continue in serious
negotiations, expected to conclude by late April.
"Roche stepped up to the plate to help us ensure that ADAP patients will have
access to needed HIV therapies, including the newly approved fusion
inhibitor, Fuzeon. Roche has proven to be a critical partner at the most
difficult economic time our programs have faced." Said Michael Montgomery,
AIDS director for the state of California and one of the organizers of the
meetings. Steve Sherman, ADAP coordinator for North Carolina added, "In North
Carolina, even small reductions in the cost of these life-sustaining
medications will allow us to serve more people in need." Even with the lowest
financial eligibility criteria in the nation, North Carolina has had a
waiting list for entry into its ADAP for the better part of the last two
years.
Eight state AIDS directors and ADAP officials met with the pharmaceutical
companies on behalf of the membership of the National Alliance of State and
Territorial AIDS Directors (NASTAD), who hosted the meetings. Representatives
came from California, Florida, Maryland, Massachusetts, New Jersey, New York,
North Carolina and Texas. Collectively these states account for 70% of the
over &850 million in drug expenditures that occur annually through the ADAP
program.
State negotiators were seeking both expanded rebates on the full HIV-related
product lines of the participating companies as well as cost neutrality on
new formulations and new drugs within existing classes of medications.
Reduction requests were targeted to the specific company portfolios and
circumstances. "States have already squeezed out whatever administrative
savings possible. We were hopeful that the pharmaceutical companies would
join federal and state governments to help close the funding gap. We continue
to be hopeful the other manufacturers will follow RocheÕs lead in helping to
alleviate this crisis." Said Montgomery.
Boehringer-Ingelheim, Bristol Myers Squibb, GlaxoSmithKline, Merck, and
Pfizer/Agouron, are in continued negotiations with the ADAP Crisis Task
Force. "These companies represent 75% of our national ADAP market. Their
participation in reducing drug costs in our programs is critical to help
manage the unmet need we are facing," noted Liza Solomon, AIDS Director from
Maryland. Abbott Laboratories and Gilead Sciences had also attended the
negotiation meetings.
The negotiation sessions focused heavily on the restrictions states are
already imposing on the ADAPs. "Beyond the capped enrollments already in
place in 13 jurisdictions, our states are looking at a broad range of efforts
to contain costs in this expanding program. Options include reduced or
preferred drug formularies; restricted regimens; prior authorization; capping
benefits to clients; and premium and co-pay expansions," summarized Dwayne
Haught from Texas. "These are measures we would like too avoid, if
possible." To address the funding crisis, several states have also passed
legislative directives regarding price containment for ADAP programs.
The forces that are driving cost are diverse. "Expanding case loads,
deficient feral funding, possible Medicaid reduction, and expanding and
increasingly costly treatments are all creating a crisis in enrollment.
Florida already has a $2 million deficit projected for next year, and that is
before any other state budget changes are instituted," said David Poole from
Florida.
The series of meetings was the first time state ADAPs have sought to directly
negotiate with the drug companies in their role as purchasers of 20-25% of
HIV-related medications in the U.S. "This is a national effort on behalf of
all the states and territories who are struggling with this challenging
issue. This was a first for us and we remain hopeful that the outcome will
contribute substantially to program cost reductions," Noted Mcguire. "We
look forward to the conclusion of the ongoing negotiations as soon as
possible. We intend to continue to seek national approaches and solutions on
behalf of all ADAPs and hope that the other companies will be more responsive
to the needs of ADAPs and the populations we serve in the very near future."
For further information, contact:
Dwayne Haught, Texas (5122) 490-2505
Jean McGuire, Massachusetts (617) 624-5300
Michael Montgomery, California (916) 323-7415
David Poole, Florida (850) 245-4421
Steve Sherman, North Carolina (919) 715-3111
Liza Solomon, Maryland (410) 767-5013
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