Washington Blade - November 14, 2003
Lou Chibbaro

Council members who opposed the contract said it would create a hardship for the clients it was intended to help by reducing the number of pharmacies available to them for AIDS-related drugs from 68 to about 20.

But the D.C. HIV/AIDS Administration and the D.C. Primary Care Association, which advocates for improved medical care for the poor, said the Council's action jeopardized a five-year effort to implement a federal program that would allow 285 District residents with HIV to enroll in Medicaid.

The federal program waives a longstanding rule that prevents people with HIV from receiving Medicaid benefits unless they have full-blown AIDS.

Ivan Torres, HAA's interim director, stated in a Nov. 4 letter to Council member Sandy Allen (D-Ward 8) that the Council action would result in a "shut down" of the city's AIDS Drug Assistance Program (ADAP) because it was slated to be folded into the same contract.

D.C. Council Chair Linda Cropp (D-At-Large), who supported the contract but had expressed concerns about it, scheduled a special Council session Wednesday morning to consider reversing the action following intense pressure from the mayor's office. But Cropp cancelled the session after a preliminary head count determined there were not enough votes to approve the contract, according to a spokesperson for Council member Jack Evans (D-Ward 2).

"This sky is not going to fall," said gay D.C. Council member Jim Graham (D-Ward 1), who was among the Council members who voted against the contract last week.

"I have assurances from the chief financial officer that our existing contracts can be extended for up to 120 days," Graham said, noting that this would enable the ADAP program to continue uninterrupted.

$6 million in savings

Graham said he and other Council members who voted against the contract were prepared to vote within the next week or two to approve a revised contract.

Graham said he and the other Council members favor the inclusion of two more Dupont Circle area pharmacies, which have long served people with HIV.

Sharon Baskerville, executive director of the Primary Care Association, said the program would save the city nearly $6 million by allowing a limited number of pharmacies to purchase anti-retroviral drugs through a special wholesale pricing arrangement with the Department of Defense. Baskerville said the savings could only be realized through a small network of pharmacies.

The Whitman-Walker Clinic challenged the contract earlier this year when the city rejected the clinic's bid to become part of the pharmacy network. The clinic withdrew its challenge in September after the Arlington-based Care Pharmacies, Inc., the group that won the contract, invited Whitman-Walker to join its network under the contract. The clinic accepted the offer and its in-house pharmacy is now part of the network. Whitman-Walker has supplied AIDS drugs to its clients for more than a decade through in-house pharmacies located in its main clinic and several satellite clinics.

Among the Council members voting against the contract, in addition to Graham, were gay Council member David Catania (R-At-Large) as well as Evans, whose constituents include a large number of people with HIV. The three Council members said their objective was to pressure the city into renegotiating the contract to expand the pharmacy network.

Jeff Coudriet, an Evans staff member, said Evans was concerned that the contract, as currently written, would force many Ward 2 residents to abandon their neighborhood pharmacies and travel greater distances to the pharmacies in the Care Pharmacy network.

No 24-hour access to drugs

Wayne Turner, organizer of the AIDS group ACT UP D.C. who also opposes the current contract, said none of the pharmacies in the proposed network is open 24 hours, a development that could create a hardship for people with HIV who need an emergency prescription.

"This is the most drastic change for D.C.'s HIV care delivery system in a decade, but it is going unnoticed by the press and the public," Turner said.

"The Council did not have a hearing or a roundtable [briefing] on this."

Baskerville said that Turner and the Council members based their arguments largely on incorrect information about the contract and the Medicaid waiver program. She said the Council held a hearing on the program nearly five years ago. At the time, she said, the Department of Health & Human Services selected D.C. to participate in the Medicaid program during the last year of the Clinton administration.

She said the overwhelming number of clients served under the program live in low-income neighborhoods in the city's outer wards, especially Wards 7 and 8.

Baskerville said the program is limited to providing anti-retroviral drugs, which slow the reproduction of HIV within the body.

According to Baskerville, the patients enrolled in Medicaid under the program would be free to go to any pharmacy of their choice to fill prescriptions for all other drugs, including drugs to combat AIDS-related opportunistic infections. She said the Care Pharmacy network would accommodate people who no longer can use their neighborhood pharmacy by offering a free delivery service.

"This contract is for the poorest of the poor," she said. "These are the folks who are left out of the mainstream."

She said the opposition to the contract was driven by a last-minute lobbying campaign by two Dupont Circle area pharmacies that want to become part of the network, even though only a handful of patients eligible for the program live in Dupont Circle.

Baskerville expressed concern that HAA, the city's lead agency on AIDS, had failed to adequately educate the community on the details of the program.

Felicia Lynch, HAA's director of health and support services, said rules that restrict HAA from lobbying activities prevented the agency from doing as much as it would have liked in promoting the current contract and explaining why the pharmacy network had to be limited.

Lynch said HAA does not oppose in principle an expanded pharmacy network. She said rules issued by the federal government prohibit pharmacies participating in the program from marking up the price of expensive anti-retroviral AIDS drugs more than $9 above the price they must pay for them through a federal government wholesale system operated by the DOD.

"The big chain pharmacies like Safeway and CVS may not be willing to do this," she said.

HAA director misled Council?

Turner also criticized HAA's interim director, Ivan Torres, for releasing a letter to the Council claiming the Council's rejection of the contract would lead to the termination of ADAP. ADAP, which is funded by the federal government, pays for AIDS drugs for low-income patients who don't have private health insurance.

Under the proposed contract for the Medicaid waiver program, the Care Pharmacy network would supply anti-retroviral drugs to patients under the ADAP program as well as the drugs under the Medicaid waiver program.

Care Pharmacy has provided ADAP drugs under a sole source contract with the city since the ADAP program began more than 10 years ago.

Catania said the city routinely extends existing contracts while new ones are under negotiation, saying HAA can easily extend the existing ADAP contract while the Council and HAA work out new terms for the Medicaid waiver contract.

Torres did not return a call by press time.

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