SEPTEMBER 1998

NUMBER ONE

ADAP Under Siege
Federal Programs don't meet need

The cost of HIV antiretroviral drugs remains astronomical, tipping the scale an estimated $14,000 a year for a three-drug regimen, which doesn't include doctor's visits, expensive laboratory tests, nutritional counseling, day care, and other procedures that are a critical aspect of HIV care. That's the main reason HIV drugs are out of reach for many HIV-positive people, especially the urban poor and homeless. Today, fewer than one in five people with HIV are covered by health insurance, and most rely on cash-strapped public-assistance programs like Medicaid and the AIDS Drug Assistance Program (ADAP). Despite funding increases for state ADAP programs, the growing demand for HIV treatment has created long waiting lists and strict limits on drug coverage for many programs.

The statistics show a clear, troubling picture. Today, a small percentage of HIV-positive individuals in the U.S. out of almost 1 million are taking HAART, but who are they? Surveys show they are more likely to be white, have higher incomes, and have insurance.

A report presented at the recent World AIDS Conference in Geneva found that only 8 percent of San Francisco's HIV positive poor and homeless population were taking antiretroviral drugs, while 75 percent of them received no AIDS care at all. The study also found that about 28 percent of the urban poor who are HIV positive received antiretroviral therapy, compared with almost 90 percent of middle-class HIV-positive people.

In another informal survey of 1,000 Philadelphia people with HIV, almost 40 percent were not on protease regimens. Other surveys show that African-Americans and Latinos are getting less access to HIV drugs, while women are slower to seek care than men. Those left furthest behind are IV drug users, prisoners, and the homeless, who are often denied drugs by physicians who fear poor adherence to HIV drug regimens.

On a positive note, HAART is proving very cost effective, greatly reducing hospital admissions and inpatient and outpatient care costs across the country.

Listed below are programs to help pay for HIV drugs and care. New research presented at Geneva showed that it is cost effective to provide early access to HIV treatment for the poor and uninsured. (See also Get Organized!)

Private Insurance and Health Maintenance Organizations (HMOs)
If you're HIV positive and work for a company with 15 or more employees, the Americans With Disabilities Act gives you the same right to insurance coverage as other employees. Insurance plans vary by state and some exclude people with serious illnesses. Many employers offer medical plans through HMOs, whose coverage varies widely when it comes to paying for prescription drugs, special tests, visits to doctors outside the HMO network, or home health care. Read the fine print. Statewide health insurance programs also exist for low-income people with HIV and part-time or periodic employees.

Federal Programs
Social Security programs are administered by the state Department of Social Services (DSS) and offer benefits based on a person's employment history; eligibility is based on a diagnosis of disability. SSI, or supplemental security income, is for people who are considered permanently disabled, with few assets and low income. SSD, social security disability, helps those who are temporarily disabled but plan to go back to work. If you worked on the books and paid FICA taxes, you qualify for SSD.

If you receive SSI, you are automatically enrolled in the Medicaid program. It generally pays a predetermined amount for medical bills, prescription drugs, hospital and home health care. Medicaid will cover 100 percent of medical expenses at clinics, hospitals, drugstores, and laboratories that accept Medicaid.

Tip: Apply for Medicaid as soon as you qualify because the application process may take weeks. To get food stamps, you'll have to prove (in writing) that you're self-sufficient (buy your own groceries, pay rent, etc.).

ADAP
ADAP is administered by the states to provide free HIV drugs to those who don't qualify for Medicaid and can't afford them. Eligibility is based on medical need and financial status; the income ceiling is above the poverty line. The ADAP program is confidential; with an ADAP card you can get drugs directly from a pharmacy. To apply, you'll need documents: driver's license, rent receipts, etc. When applying, fill in all the spaces on the form to avoid delays; your doctor fills in the medical portion. For help, contact the AIDS Treatment Data Network (see "Vital Resources").

Drug Company Patient-Assistance Programs
Several pharmaceutical companies that make HIV drugs have created patient assistance programs for those who fail to qualify for other forms of assistance or are on ADAP waiting lists. Eligibility varies and it usually requires help from your doctor to apply.

ADAP policy and access information can be found on these sites:

• The Access Project
• The ADAP Working Group
• The ADAP Monitoring Project