The Wall Street Journal - Wednesday, 11 December 1996.
Pat Beall, Staff Reporter of The Wall Street Journal

In April, the state will begin subsidizing a promising -- but expensive -- new class of drugs known as protease inhibitors for people who have no insurance or whose insurance doesn't cover the drugs, says Paul Arons, medical director for the Florida Department of Health's Office of Disease Intervention.

About 10% of Florida's estimated 56,893 residents with AIDS will qualify for the pricey treatments, which cost as much as $18,000 a year.

The new money more than doubles Florida's current $13 million allowance from the federal AIDS Drug Awareness Program, through which the U.S. funds a variety of state AIDS programs. And the expanded outlay comes at an opportune time: A state panel concluded last month that Florida should subsidize the protease inhibitors, no matter what the cost.

"This is the accepted standard of care for AIDS now," says Dr. Arons.

But even the $27 million may not be enough to cover Florida's AIDS expenses down the road. Some state estimates place the cost of all the state's AIDS programs at $58 million a year, if -- as expected -- the word of funding spreads and more patients come forward.

Florida is among the last states to offer the new drugs to AIDS patients -- despite ranking third among all states in the rate of AIDS cases and second in the rate of AIDS among infants.

Up to now, the best option for AIDS sufferers who couldn't afford protease inhibitors -- also known as drug cocktails -- was to seek donations from drug companies under so-called compassionate-use programs.

The delay in subsidizing the drugs centers on a lack of funds. Florida -- like all states -- receives federal money in part to subsidize AIDS drugs for people who can't afford them.

But the money hasn't been enough even to pay for the 10 far less expensive drugs already on the state list of subsidized AIDS prescriptions.

State dollars for AIDS drugs have taken a back seat to some of Florida's more high-profile budget needs, such as schools and prisons. And, with no major breakthrough in drug treatment since AZT was introduced in the mid-1980s, the drug program was frequently overshadowed by the pressing financial needs of other AIDS programs, such as housing homeless patients.

Says Dr. Arons: "There's definitely not enough money between now and the end of the funding cycle" in April -- when the new federal money kicks in -- to meet the estimated demand for the drugs, which include such items as AZT and potent antibiotics.

The most effective tool yet devised to combat HIV -- the virus that causes AIDS -- protease inhibitors have created dramatic turnarounds, even in desperately ill people.

Patrick Blake, an Orlando man who counsels AIDS patients through the Joy Metropolitan Church and who has also tested positive for the AIDS virus, cites the case of an Orlando man whose T-4 blood cell count -- a key indicator of the immune system's health -- had fallen to three cells per milliliter of blood from the ideal count of 1,500. Further, the man had withered to 1 pounds.

But after beginning a regimen of drug cocktails last December, the man has gained 40 pounds, increased his T-4 blood-cellcount to 400 -- and has gone back to work. "He's never looked better," says Mr. Blake.

Such dramatic results with the cocktails are unleashing a pent-up demand for treatment across the state. "People are coming in now for treatment who were in denial, or who had given up," says Rick Trachsel, AIDS Project Case Manager for the Alachua County Health Department in Gainesville.

"It's the new hope now," agrees Debra Tucci, executive director of Centaur Inc., an Orlando-based AIDS support group.

Currently, an unknown number of Florida AIDS sufferers rely solely upon the generosity of pharmaceutical manufacturers for the drugs. As part of compassionate-use programs, Abbott Labs Inc., Abbott Park, Ill., Switzerland's Roche Holding Ltd. and Merck & Co., Whitehouse Station, N.J., are donating free protease inhibitors to some AIDS sufferers who request them. (The companies don't know yet how much they have donated; they are currently tallying the amount at the state's request.)

Mr. Blake, for instance, has been receiving a three-drug cocktail of protease inhibitors since November through compassionate-use programs. Obtaining the expensive drugs was as simple as filling out a credit-card application, he says.

But Mr. Blake and others warn the program is only a stopgap measure. For one thing, not everyone knows the programs are available. "Health departments are overloaded and overwhelmed," so they sometimes don't dispense information properly, Mr. Blake says.

Further, there's no way of knowing how long the companies' compassionate-use programs -- and thus the supply of drugs -- will last. That makes the decision to take the drugs even trickier, because once a patient misses even a single dose, he or she risks developing another, more virulent form of HIV.

Yet few doubt the need for such drugs is growing in Florida. AIDS is already the leading cause of death among Floridians between the ages of 25 and 44, according to state figures. The only exception in that age group is white females, for whom AIDS is the third-leading cause of death behind cancer and accidents.

Earlier this year, the Centers for Disease Control and Prevention released figures showing that Florida's AIDS cases slipped slightly from 1994 to 1995: to 57 per 100,000 people from 61. But a state Department of Health report on AIDS earlier this year warned that 22 of Florida's 67 counties still aren't tracking the progress of the virus.

That creates "much room for missing cases in the midst of an apparent, increasingly intense statewide epidemic," the report says.

The same report noted that from 1994 to 1995, the rate of AIDS jumped in three major Florida cities -- Orlando, Jacksonville and West Palm Beach.

Says Mr. Trachsel, the Alachua County case manager: "We definitely have an increasing AIDS population, and they're as young as 13 and as old as 70. It's still out there."

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