Sunday, June 14, 2009

Follow Up - Screw the Poor with HIV/AIDS: State DHS

PHOENIX - The Arizona Republic reported that the state Department of Health Services is slashing the number of free medications it provides to poor and uninsured HIV patients because it didn't receive the level of federal funding it requested for its AIDS Drug Assistance Program.

The program, which has been in place since the mid-1990s, will still cover essential anti-virals that keep patients alive and fight infections.

But beginning July 1, it no longer will pay for more than 130 drugs that help patients manage the side effects of their disease.

Drugs that have been cut from the coverage plan include pain-relievers, antibiotics, medications that control chronic conditions such as diabetes and high cholesterol, and psychotropic drugs that treat anxiety and depression. Most are common ailments in HIV patients.

HIV advocates and health officials worry the cuts could lead to sicker patients, an increase in hospital stays and more deaths.

"The implications of this are very serious," said Jennifer Lewis, director of wellness and life management at the Southwest Center for HIV/AIDS in Phoenix. "The concern is that more people will become suicidal, harm themselves and harm others because their quality of life has diminished so significantly."

The program, which serves 1,100 patients throughout Arizona, including 800 in Maricopa County, costs about $14 million annually.

Roughly $1 million of the program's budget comes from the state. The rest is paid for via a federal grant known as the Ryan White Treatment Modernization Act (Part B).

DHS officials said they had hoped to receive about $13 million in federal funding for their program.

But this year, twice as many states applied for the pot of cash, which ultimately reduced Arizona's share.

Arizona received $2.3 million less than what it needed to fully fund the program, said Judy Norton, chief of the DHS' Office of HIV, STD and Hepatitis C Services. As a result, health officials decided to cut back on the number of non-essential medications they offered patients in order to provide the critical, lifesaving medications to everyone enrolled in the program.

The shortfall has left non-profits and local-government agencies scrambling to help needy clients and patients find other ways to pay for their medication.

"Right now, we're just doing what we can," said Cheri Tomlinson, director of grants for the Maricopa Integrated Health System, which treats hundreds of patients enrolled in the drug-assistance program at its McDowell Healthcare Clinic.

The program cuts, medical experts say, are particularly worrisome because Arizona is known as a "moderate- to high-incidence" state for HIV/AIDS infection, officials said. Roughly 13,000 Arizonans live with the virus; an additional 4,000 may have the disease but not know it, officials estimate.

State vital-statistics reports show that 800 people in Arizona are diagnosed with the illness each year.

As the cost of medications and health services has increased, more people have enrolled in the AIDS Drug Assistance Program. In fact, the number of participants have jumped 34 percent in just two years. Patients enrolled in the drug-assistance program received letters notifying them of the changes this week.

By Friday, case managers at Care Directions, a central Phoenix non-profit that provides assistance to HIV and AIDS patients, were busy fielding calls from concerned clients.

"I think (the impact) is going to be varied from person to person," said Debby Elliott, the agency's director. "What we are most concerned about is the anti-psychotic medications. When that is left untreated, it just affects so many realms of people's lives."

Caseworkers are sharing the program changes with clients and offering options for reduced-cost medications, including $4 generics sold by many retail stores.

For some patients, however, there are no generics for their expensive medications. They will need to enroll in patient-assistance programs offered by individual pharmaceutical companies, Elliott said.

Maricopa Integrated Health System officials, meanwhile, have decided to enroll patients in their Copa Care program, which offers health services and medications at a reduced rate. Some patients are on as many as 18 medications a month that are no longer covered by the AIDS drug program, Tomlinson said.

"People think, oh, they are still going to get their lifesaving medications, so it's OK," Tomlinson said. "But these others are critical, too.

"It's tough."

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