Medicaid Blues
Having trouble getting your HIV meds? You're not alone. as more and more people seek access to the lastest medications, fewer are able to get them (see main story). While the AIDS Drug Assistance Programs (ADAPs) do their best to catch those who fall through the cracks, the gap keeps widening.
The overburdened ADAPs provide new drug prescriptions for those who can't afford private insurance but don't qualify for Medicaid. And because Medicare doesn't cover prescriptions at all, the ADAPs also carry the weight of those locked out of the pharmacy by such limited government programs. Medicaid remains one of the most important AIDS care programs, providing care for over 50 percent of all people with HIV and AIDS who receive treatment in the United States. But in some states Medicaid recipients are facing difficulties in obtaining prescriptions to the new drugs because of a cap on prescription plans that limit the number of prescriptions allowed per month. Despite the fact that Medicaid is required by federal law to add new FDA-approved drugs to their formularies, the price of one drug can directly affect the availability of other drugs. The high drug prices also affect people with private insurance now, with higher premiums that some can't meet.
"As combination regimens become even more elaborate, people with HIV as well as their third-party payers will likely face medical costs over the course of a lifetime rising into the stratosphere," states the recently-formed Fair Pricing Group. Looking to the future, Susan Dooha of New York's Gay Men's Health Crisis says, "We really need to fight to universal coverage. This would allow for the broadest cost subsidy for high-maintenance people and would also give leverage to combat the high drug costs."
The federal budget crisis also affects coverage of important HIV tests. As of January, the following state Medicaid programs weren't covering viral-load testing: New Jersey, Indiana, New Mexico, Oklahoma, Alabama, and Texas. A proposal for new Medicare regulations would limit coverage of viral-load testing to the less-sensitive Roche polymerase chain reaction, (PCR) test that only measures down to 500 HIV RNA copies per milliliter of blood plasma. Newer viral load tests can measure down to 40 copies. But according to HIV advocate Brenda Lein of Project Inform, money isn't the deciding factor at play. "This is a cost-neutral issue," says Lein. "The more sensitive tests do not cost more than the less sensitive tests." Keep your eye out for updates.
-S K
