The New York Times - January 14, 1996
Michael Cooper

Most of his prescriptions, which would cost more than $2,500 a month, were covered by the AIDS Drug Assistance Program, a federally financed program administered by the state. But with demand for drugs outpacing available government money, the state cut back the list of drugs it covers, to 66 from 195. The changes, which went into effect on Jan. 1, mean that Mr. Noble will have to find other means to pay for drugs to help fight infection, stave off diarrhea and sleep at night.

The drug program, for the uninsured and people like Mr. Noble whose insurance does not cover prescriptions, receives $44 million from the Federal Government. But with drug costs rising and more than 10,000 people eligible, ADAP faced a $3.25 million shortfall this year. The State Health Department decided to reduce the number of drugs covered rather than the number of people enrolled. People with incomes of up to $44,000 qualify if they meet other criteria.

"A group of clinicians went over the list and left on the most essential and most expensive drugs," said Claudia Hutton, a department spokeswoman. "We still have one of the most generous programs in the country."

But all across the city -- at clinics, hospitals, drug stores and social service centers -- people with AIDS are struggling to cope with the new policy.

"It's a disaster," said Dr. Gabriel Torres, director of the AIDS Center at St. Vincent's Hospital in Greenwich Village. "Our social workers are scrambling to figure out what they can do to get drugs for people." He said some patients ask to remain hospitalized so they can get free medication.

George Manos, owner of the Village Apothecary on Bleecker Street, is charging ADAP customers 10 percent less than the wholesale cost for drugs taken off the list. The Health Department suggests that people apply to drug manufacturers' programs for indigent patients to receive drugs no longer paid for by the Government. It also advises them to get rid of their assets to qualify for Medicaid, which pays for all drugs and medical services. That infuriates State Senator Catherine M. Abate of Manhattan, who failed to get the state to cover the $3.25 million shortfall. Medicaid, she said, costs far more per person than ADAP.

Mr. Noble, 28, who lives in Park Slope, Brooklyn and recently sold his share in a legal services support business, is going the Medicaid route. Until he qualifies, he will use his supply of canceled drugs. Sometimes, he said, the struggle to get the care he needs can seem almost as daunting as his illness. "Somebody who does not have the wherewithal, or is too sick, or does not have a support net -- I don't know how those people survive," he said. "I would imagine that they don't." MICHAEL COOPER

PRESCRIPTIONS One Man's Medicine Chest

These are the drugs that Conrad Noble takes each day and their monthly cost, including those no longer covered under the AIDS Drug Assistance Program (ADAP).

Actigall (for gallbladder parasites) 1 pill 3 times/day Cost: $250 /month (never covered by ADAP; supplied free by drug company program for indigent patients, which reconsider's patient's eligibility every 3 months.)

Ceftin antibiotic for meningitis-like condition, 1 pill 2 times/day Cost: $435 (no longer covered by ADAP.)

Diphenoxelate antidiarrheal, 3 times/day Cost: $11 (no longer covered by ADAP.) Epivir (3TC) AZT-like reverse transciptase inhibitor, 150 milligrams 2 times/day Cost: $250 (still covered by ADAP.)

Humatin antibiotic, 500-milligrams 3 times/day Cost: $355 (never covered by ADAP.)

Mepron to prevent Pneumocystis carinii pneumonia, 1 teaspoon 2 times/day. Cost: $600 (covered by ADAP.)

Prednisone anti-inflammatory, 5 milligrams/day Cost: $6 (covered by ADAP.)

Trazodone antidepressant, 150 milligrams at bedtime COST: $45 (no longer covered by ADAP.)

Tylenol with Codeine 3 times/day for diarrhea Cost: $45 (no longer covered by ADAP.)

Zithromax antibiotic to prevent infections, 500 milligrams once a day Cost: $420 (still covered by ADAP.) Zovirax antiviral for throat herpes, 800 milligrams 3 times/day; an Cost: $400 (still covered by ADAP.)Source: Conrad Noble, Village Apothecary, (State Health Department.)
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