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Costly New Drugs, Sudden Surge in Patients Straining State AIDS Programs

August 4, 1996

WASHINGTON (AP) _ State after state is running low on money to buy the newest, most potent AIDS drugs for thousands of low-income Americans, leaving many patients facing a possible rationing of medicine.

Washington last month became the latest state, following Illinois and Kansas, to dramatically cut its AIDS Drug Assistance Program as it tried to avert almost certain bankruptcy.

More cutbacks are pending as states scramble to cover unexpected bills for today’s patients, not counting the thousands suddenly demanding treatment because of headlines promising unprecedented new hope for AIDS.

And as many as 20 states haven’t begun offering the newest drugs as they grapple with the costs.

``For all the folks drowning in the sea of HIV disease, all of a sudden there’s a lifeboat ... and when they swim to it it’s full,″ said Washington AIDS Director Mariella Cummings, who temporarily shut that state’s AIDS drug program after a 76 percent jump in AIDS patients between January and June pushed her bills from $53,000 a month to $144,000.

``That’s the image I wake up with and go to sleep with,″ she said. ``How we are going to get some more lifeboats in the water?.″

At issue are state AIDS Drug Assistance Programs, or ADAPs, that buy medicine for uninsured HIV-infected people who don’t qualify for Medicaid because they’re not quite poor enough or sick enough.

This fiscal year, ADAPs will spend $145 million buying drugs for 65,000 Americans. That includes an extra $52 million in emergency funds President Clinton allotted this spring in anticipation of the crisis, money many states say is all that’s keeping them afloat.

ADAPs are in trouble mainly because of new drugs called protease inhibitors that, when combined with two older drugs, are so potent that AIDS patients have their first hope of truly longer and healthier lives.

But these three-drug cocktails cost $10,000 to $15,000 per person per year. That doesn’t count the myriad other drugs taken to fight pneumonia and other deadly illnesses that stalk AIDS patients.

And proteases have a unique problem: Stopping taking them for even a month because the ADAP temporarily ran out of money can allow HIV to rapidly mutate into a virtually untreatable strain.

When protease inhibitors began selling in December, ADAPs faced a triple threat: How to afford at least one and give it to only the patients as they could guarantee a constant supply _ even as patients who had shunned treatment until the proteases made headlines this spring suddenly started lining at their doors.

Already, several ADAPs have made deep cuts:

_Washington partially reopened last month, but restricts proteases to patients who were taking them before the crisis and gives new enrollees only antibiotics and certain other medicines for AIDS symptoms, not any drugs that directly attack HIV.

_Illinois now offers one protease, but cut 82 of the 112 other drugs that patients had been able to take, including almost every antibiotic. The ADAP is anxiously awaiting an $800,000 grant from Chicago to help.

_Kansans can no longer enroll in ADAP unless other patients leave the program.

Twenty-nine states now offer at least one protease, and 21 offer all three, according to the National Alliance of State and Territorial AIDS Directors. This month, Virginia will begin offering one and Texas hopes to offer all three.

But most of the states told a NASTAD meeting last week they fear their money won’t last until April 1, when they’re due to receive federal funding for fiscal 1997. Clinton has asked Congress to appropriate $195 million for ADAPs next year, and the states would be required to add $65 million then.

Washington alone has $980,000 to last until April 1 _ but at $144,000 a month, won’t make it, said Cummings, who is searching for a solution.

``A lot of people ... were gasping″ at the financial reports, said NASTAD Deputy Director Joseph Kelly.

The irony is that protease treatment is expected to save millions of dollars in the long run as very sick patients bounce back. One preliminary study found protease treatment saved $6,000 in other medical bills, said Richard Jefferys of the ADAP Working Group, an AIDS activist coalition.

``Someone’s got to pay,″ said Mike Shriver of the National Association of People With AIDS. The message to government is ``you have underfunded our ability to stay alive.″

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