San Francisco Chronicle - The Voice of the West, 901 Mission Street, San Francisco, CA 94119 - 20 March 1996, p.A1
Sabin Russell, Susan Sward, Chronicle Staff Writers

As activists gather in San Francisco this week for the city's eighth annual conference on the epidemic, the question overshadows genuine enthusiasm about progress on the AIDS drug front.

"It would be a cruel hoax to develop all these promising treatment options and then not pay attention to how people can obtain them," said Timothy Rodriques, spokesman for the San Francisco AIDS Foundation.

Called protease inhibitors, the three new drugs are widely considered the most powerful weapons against the disease since it first appeared. But the catch is that any of these new medications has to be taken in combination with previously approved anti-viral drugs. The retail cost of this three-drug cocktail ranges from roughly $12,500 to $16,700 per year.

Federally funded programs that help uninsured patients pay for AIDS drugs are tapped beyond their limits. California's AIDS Drug Assistance Program, for example, is projected to outspend its $17.5 million budget by $6 million by the end of the fiscal year in June.

Nationwide, 20 states, including California, are reporting severe budget shortages in their AIDS drug programs. Three out of four states operating AIDS drug programs have been forced to delay or cancel expansion of their list of covered drugs, and eight states actually pulled drugs from coverage because of financial concerns.

While private health insurance should cover the new prescriptions, some policies do not include coverage for drugs or place a ceiling on the amount they will pay each year. Most at risk are low-income working people who have no insurance but make too much money to qualify for Medi-Cal or Medicaid, the state and federal health plans for the poor.

AIDS activists are particularly concerned about access to protease drugs because early test results have been so encouraging. When combined with the anti-viral drugs AZT and 3TC, the protease inhibitors made by Merck and Abbott cleared most free-floating AIDS viruses from the bloodstream, in some cases below the level that instruments could detect. The drugs attack the enzyme protease, a chemical used by the virus in the latter stages of its efforts to make copies of itself.

In San Francisco, public health officials are determined that no one will be denied the new protease drugs. Medications not yet covered by the AIDS Drug Assistance Program will be provided this year to city patients through $1.8 million in leftover federal money originally allocated to various community AIDS programs, said Dr. Mitch Katz, director of the city Office of AIDS.

Meanwhile, efforts are under way in Sacramento and Washington, D.C., to address the funding shortage. A coalition of AIDS advocacy organizations and major drug companies is heavily lobbying Congress to add at least $75 million to funding for AIDS drug programs, and the Republican-controlled House and Senate have tentatively agreed to add $52 million.

To those who have watched the AIDS epidemic unfold over the past 15 years, today's concerns echo those raised when the first useful anti-HIV drug, AZT, was released in 1987 at a wholesale price of more than $10,000 a year.

"This crisis will just continue to get worse because as more drugs become available, the price tag will increase per patient," said Bill Thorn of ACT UP San Francisco, an AIDS patient advocacy organization.

In contrast to the uproar accompanying the pricing of AZT, AIDS activists are allied with the drug companies this time in seeking ways to pay for the new medicines. "These new drugs are obviously going to be expensive," said William Arnold, co-chairman of the AIDS Drug Assistance Program Working Group, which is lobbying on behalf of drug manufacturers and AIDS activists for more money to buy the new drugs. "If they were not expensive, the drug companies that are developing them would not have developed them."

Arnold said $150 million may be needed from Congress to pay for the new therapies.

Because of its cash shortage, California has yet to add any of the protease drugs to its AIDS Drug Assistance Program list. Unlike 30 other states, it does not even include 3TC, which was approved by the Food and Drug Administration in November.

Wayne Sauseda, chief of the California Office of AIDS, said a proposal to place 3TC and the three new protease drugs on the state list is being reviewed by the Wilson administration's Department of Finance. Details of the proposal will not be released until next week.

"The people who have trouble are those who are caught in between those with the best insurance and those with no insurance," said Ian Wallach, who works for Dr. Mary Romeyn, a San Francisco AIDS doctor. Wallach said he spends much of his time struggling with insurance companies to get coverage for AIDS drugs.

Ironically, those who qualify for Medi-Cal may enjoy richer benefits than those on private health plans. For example, the genetically engineered human growth hormone taken by many AIDS patients to combat catastrophic weight loss is covered by Medi-Cal but not by health plans such as Kaiser Permanente. Last month, an FDA advisory panel declined to recommend the drug, which can cost $50,000 a year, saying there is insufficient evidence that it really helps AIDS patients survive.

Nick Moss, a retired health maintenance organization manager who lives in Los Angeles, said he shops health plans and looks for the best benefits he can find to cover his AIDS condition now that he is on disability.

"You have to be aware of your costs and what the different HMOs offer in the way of benefits," said Moss. He added that because of his HMO background, he knows what he is doing. But he said most people do not know how to go about it. "You have to be willing to roll up your sleeves and get in a fight," he said.

The Eighth National AIDS Update Conference runs through Friday at Civic Auditorium.
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