AIDS Treatment News No. 074 - February 10, 1989
John S. James

Any such person should send a brief note to Paul Boneberg, Mobilization Against AIDS, 1450 Market Street, #60, San Francisco, CA 94102, or call 415/863-4676. These notes will be shown to lawmakers to help them in drafting corrective legislation.

Comment

Medical reimbursement problems go beyond AIDS to affect every man, woman, and child in the country, except those so rich that they do not need health insurance. The rising costs of medicine are increasingly prompting public and private insurers to find excuses to avoid covering care.

For example, cancer chemotherapies are often approved officially only for certain specific tumors, when in practice oncologists use the treatments for other tumors too. But if a tumor does not appear on the FDA's list of approved uses for the drug, insurance companies can refuse to pay, even if the treatment used is in fact the standard of care.

An example in San Francisco shows how such excuses can increase costs and block important research, as well as denying quality care. Physicians at San Francisco General Hospital, one of the world's leading centers for AIDS care, want to try dapsone in the treatment of some cases of pneumocystis. Dapsone costs pennies; lack of reimbursement for it would be no problem. But if dapsone is used, the California office which administers Medi-Cal rules that the physicians used an "experimental" treatment--and refuses to cover the hospitalization also, when it would otherwise be reimbursed. (Dapsone is not "labeled" by the FDA for treatment of pneumocystis--and it never will be, because it is one of the cheapest drugs, so there is no commercial incentive to pay for the clinical trials required to obtain such labeling.)

One of the excuses used in such cases is that Medi-Cal is protecting patients from unscrupulous scientists who would use them as guinea pigs. But the real point is to save money by avoiding payment whenever possible--even if means paying for more expensive drugs, and more hospitalization if the expensive drugs are not as good.

Documenting reimbursement abuses may be difficult, because physicians seldom tell patients that they are using a second- rate treatment for financial reasons; it is easier to give a medical rationale. That is why Mobilization Against AIDS needs support from physicians as well as from patients in its efforts for reform.

It is understandable that insurance companies and public agencies do not want to be billed for some drug company's private research, which they never agreed to pay for. But it is very different to use the FDA lag (typically five to eight years, and often forever) to refuse to pay for appropriate, well-supported treatment. AIDS is especially impacted, because most of the treatments are new; but anyone who becomes seriously ill for any reason could be affected.

Unless these problems can be resolved through legislation, there could be ballot initiatives in California or other states, with the voters deciding directly what Medi-Cal and private health insurance must cover. People may decide to pay a percentage more for insurance that will not run away from them when they need it most. Today you cannot buy that peace of mind at any price.

San Francisco: Quan Yin Herbal Program Deadline March 8

Quan Yin Healing Arts Center (see AIDS TREATMENT NEWS issue # 68, November 4, 1988) is starting its next herbal research and treatment program on March 15; the deadline for application is March 8. This program is part of Quan Yin's ongoing effort to improve HIV treatment using both antiviral and immune enhancing herbs.

The program is subsidized, and acupuncture is no longer required (although it is recommended), so the total cost has been kept low--$200. for three months, about half of the cost of obtaining the same treatment outside of the program. This price includes a consultation every two weeks. A CBC (complete blood count) is required at zero, six, and 12 weeks; these can be done through Quan Yin (at a cost $6. each), or elsewhere. (Other blood work, including T-helper count, P24 antigen, and beta-2 microglobulin, is available through Quan Yin at additional cost.) Participants can continue the herbal program after the three months at the same rate.

For persons who need to commute to San Francisco t participate in this program, only three meetings are mandatory.

For more information, call the Quan Yin Herbal Program at 415/861-4963.

AIDS TREATMENT NEWS : No Issue February 10

AIDS TREATMENT NEWS did not publish on February 10; the issue before this was #73, dated January 27, 1989. Researching the hypericin article proved more difficult than expected. This is the first issue we have ever missed without a prior announcement.
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