Wall Street Journal - Friday, 11 July 1997

Some of the states, such as Alabama, have capped the number of people with AIDS and HIV , the virus that causes AIDS , who can enroll in the programs. Others, such as Florida, have limited the number of people who may receive protease inhibitors, the breakthrough AIDS drugs that have revolutionized care. And states such as South Dakota and Wyoming have set ceilings on the amount spent for each patient's drug costs.

The study, conducted for the Kaiser Family Foundation by the National Alliance of State and Territorial AIDS Directors and the AIDS Treatment Data Network, highlights an increasingly vexing problem in the world of AIDS treatment. Though new drug therapies offer great promise, it isn't clear how to pay for them, given their price tags of $10,000 to $15,000 a year for each patient.

The state drug-assistance programs, which receive federal funding under the Ryan White Care Act, are designed to help uninsured patients; generally these are people who don't have private insurance and don't qualify for Medicaid. The study found that most states cover at least some of the drugs that can be used in the combination-drug therapies, but that only New York and North Carolina cover all the available protease inhibitors and other antivirals. Four states -- Arkansas, Nevada, Oregon and South Dakota -- don't cover any of the protease inhibitors.

The pressure on the AIDS-drug assistance programs is likely to intensify as a result of government guidelines issued last month. The guidelines, which called for much earlier and more aggressive treatment of people with HIV and AIDS, are likely to stoke already rising demand.

The study also showed that 10 states plus Puerto Rico don't have enough money to provide AIDS drugs to their current patients for the entire year, even though some already have taken steps to restrict access to their programs.

The money crunch comes even as the funding for AIDS-drug programs has risen sharply. For 1997, the amount from all sources -- federal and state governments, and company rebates -- is expected to rise 86% to $385 million from $207.5 million.

The Kaiser Family Foundation, based in Menlo Park, Calif., is an independent, nonprofit health-care philanthropy that isn't associated with Kaiser Permanente, a health-maintenance organization. The National Alliance represents the chief HIV and AIDS program managers in state and territorial health departments. The AIDS Treatment Data Network operates the Access Project, a nationwide database of various drug-assistance programs, and provides information about drugs.

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