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Posted on April 20, 2011 by in Features

Florida’s ADAP Seeks Money for HIV/AIDS Patients
by David Volz

The Florida Department of Health is trying to find more money to provide medication for Florida’s HIV/AIDS patients. Florida is among other states struggling to keep up with services, especially providing drugs for its HIV/AIDS population.

The economic downturn has had a negative effect on the department in general and the HIV/AIDS Drug Assistance Program (ADAP) in particular.
“The HIV/AIDS Drug Assistance Program has been around for twenty years,” says Tom Liberti, chief of the Bureau for HIV/AIDS Florida Department of Health. “But until recently, we did not have a waiting list. We started our wait list on June 1, 2010, and for the fourteen years prior to that we had no wait list. We did have a wait list in 1996.”

Florida along with many other states did not have enough money to care for patients requiring HIV/AIDS drugs. The State of Florida is facing a budget crisis. Because of financial and economic problems, the Department of Health had to close its ADAP to new enrollees. Currently the program services 10,000 people suffering from HIV/AIDS. There are 3,200 people on the wait list.

Welvista, a nonprofit pharmacy based in South Carolina, and its partners in the pharmaceutical industry came to an agreement that was brokered by the Fair Pricing Coalition (FPC) that will provide HIV medications to approximately 6,500 AIDS Drug Assistance Program enrollees so these patients will not have to go without medication. On April 1, 2011, the department will receive its federal allocation and so the process will start again. Had this agreement not been reached, ADAP likely would have exhausted all available funds and closed in February.

The money that the department has is not significant enough for the number of patients requiring HIV/AIDS drugs, according to Liberti. “We are using $85 million in federal funding and $9.5 million in general revenue to provide for this medication. We had 100 drugs in the formulary and now, due to the fiscal crisis, [the amount] has been reduced to fifty drugs in the formulary.”

Now, the federal government is debating the 2011 budget. “Until the budget is approved, we don’t know the exact amount of money we will have in the future,” Liberti says. “We have to wait on Congress to approve the federal budget.”

Abbott Laboratories, Bristol-Myers Squibb (BMS), Gilead Sciences, Merck and Co., Tibotec Therapeutics, and ViiV Healthcare already participate with Welvista in its plan to expedite access to HIV medications for ADAP clients on waiting lists, according to Lynda Dee, spokesperson for FPC. Except for Tibotec, which is still in negotiations with the FPC about this particular situation, the pharmaceuticals will provide medications to Welvista for these additional clients in Florida on a one-time, emergency basis.

“None of us are happy with the Florida situation,” says Dee.

“It is a drain on limited funds from drug-company Patient Assistance Programs (PAPs). This inequitable use of industry PAPs could have a very significant, negative impact on the ability of other patients from other states to utilize these PAPs,” Dee adds.

Dee says that one part of the state’s plan is that the legislature will provide additional money or people will not get their medication.
“The state will decide its priorities. If people do not get their medication then they will start dying,” she says.

Dee adds that if a state wants to help people with HIV/AIDS, then it will find a way to do so. “The drug assistance program in Maryland is not in jeopardy,” she says.

“We are nonetheless grateful to the companies and Welvista for their willingness to step in to provide medications for Florida patients,” notes Dee. “We clearly recognize this is a one-time, emergency rescue of a program that cannot be repeated or duplicated by Florida or any other state. We therefore implore the federal government and all state governments, especially Florida, to provide adequate funding to state ADAPs to meet the medication needs of its uninsured and underinsured people living with HIV.”

Nationally, state ADAPs are situated in the eye of a “perfect storm.” Thousands continue to enroll in state ADAPs each year due to the effects from the economic recession, and other factors are contributing additional pressure. These factors include rising drug prices on medications, minimal increases in federal appropriations and significant state budget cuts, and larger client caseloads due to HIV-positive individuals living longer, according to Dee.

The National Alliance of State and Territorial AIDS Directors (NASTAD) reports that as of January 27, 2011, there are 5,779 individuals on ADAP waiting lists in ten states. Twenty states have instituted, or anticipate instituting, cost-containment measures other than ADAP waiting lists before the end of the ADAP fiscal year ending in March 2011.

Florida has the greatest number of individuals on its waiting list with over 3,000. This will continue into the next fiscal year. Those individuals are already receiving medications through other pharmaceutical patient assistance resources and are not affected by this plan.

The FPC remains concerned about the fiscal health of Florida’s and other state ADAPs. Moving forward, the FPC will work with local advocates to push Florida for additional state appropriations and to seek drug rebates that should have already been applied. In addition to working on this stopgap measure to ensure uninterrupted medications for 6,500 Floridians, the FPC will also continue to work with all stakeholders and ADAPs on long-term solutions to the national ADAP crisis, according to Dee.

David Volz has twenty-five years of experience as a journalist. His work has appeared in the South Florida Sun-Sentinel, Miami Herald, and Physician’s Financial News. He also teaches public speaking at Miami-Dade College.

April 2011

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