Associated Press - Friday November 3, 2000
Laura Meckler, Associated Press Writer

Similar problems were found in the AIDS Drug Assistance Program, or ADAP, meant to help low-income, uninsured people infected with HIV or AIDS.

The research, conducted under federal contract by the University of California, San Francisco, measured how many prescriptions are filled by patients in Medicaid and ADAP. The aim was to provide the first reliable measure of how many people get the drugs they need.

The yet unpublished findings remain preliminary, researchers cautioned, but they suggest that state policies are at least partly to blame for the disturbing results.

Health care in Texas has come under particular review as the state's governor, George W. Bush , campaigns for president. Bush has come under fire for the state's high rate of people without health insurance - it ranks last or second-to-last, depending how it is measured. He also has been criticized for proposing rules that would have kept many children out of a new children's health insurance program, although he ultimately agreed with the more generous program approved by the Legislature.

Democrats also pounded Bush after a federal judge ruled that the state has failed to care adequately for the 1.5 million low-income children in its Medicaid program. The state has appealed and vigorously disputes the ruling.

A spokesman for Bush did not return a call seeking comment on the UC San Francisco report.

At issue is how many patients are getting expensive but effective protease inhibitors, drugs that began revolutionizing AIDS care when the first one hit the market in late December 1995.

Taken together with two other types of AIDS medicines, protease-containing drug "cocktails" are credited with helping AIDS deaths drop significantly in the late 1990s and, when taken before full-blown AIDS hits, they can help keep HIV-infected patients healthy for years. But the optimal therapy costs about $12,000 a year.

Researchers examined the programs in Texas, California, Florida and New York, inquiring how many patients with HIV and AIDS had the proper prescriptions filled based on federal treatment guidelines. Among the findings:

-In Medicaid, which serves the poorest Americans, fewer than four out of 10 patients in Texas received proper drugs. The rate was slightly higher in California; in Florida, about half the patients were getting the right drugs. Early findings in New York suggest just over half the patients were getting proper treatment.

-In ADAP, which serves low-income patients with AIDS and HIV who lack adequate health insurance, overall numbers were higher in all states, partly because the program is designed to pay for AIDS drugs, whereas Medicaid is a full health insurance program.

The report found that just over half the Texans in ADAP received proper drugs. In California and Florida, it was about two-thirds, and in New York, early results put the percentage at about three-quarters.

Researchers point to a number of state policies for the low rates.

In Texas and Florida, barriers to treatment included, for Medicaid, limiting patients to three prescriptions per month, when most AIDS patients require more than that. In Texas, there was also trouble getting people in rural areas access to AIDS specialists.

For ADAP, Texas required many patients to pay $5 per prescription and had a limited number of pharmacies willing to fill the prescriptions. The state system also required central processing of prescriptions, meaning there were significant delays in getting the drugs.

"Those are decisions made at the state level. That's how Congress established the program," said Tom Flavin, a spokesman for the Health Resources and Services Administration, a branch of the Department of Health and Human Services (news - web sites), which paid for the report.

The report is being produced by the AIDS Research Institute at the UCSF.

On the Net: Health Resources and Services Administration: http://www.hrsa.gov/ UC San Francisco AIDS Research Institute: http://hivinsite.ucsf.edu/ari/

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