Some States May Cut Back AIDS Drug Assistance Programs

Many state AIDS Drug Assistance Programs are "going broke" during a "slumping economy" and the arrival of newer, more costly AIDS medicines, and the lack of funds has forced many states to implement a variety of cost-control measures, the San Francisco Chronicle reports. The federal government has earmarked $1 billion for state ADAPs, but the cost of the program is "outstripping the money budgeted to pay for it." Approximately 80,000 individuals are enrolled in an ADAP, but the programs are enrolling an additional 600 beneficiaries each month (Russell, San Francisco Chronicle, 7/29). The Portland Oregonian reports that some states are facing financial difficulties in their ADAPs because many people with AIDS are living longer and thus staying in the program longer. At the same time, campaigns aimed at increasing the number of individuals who get tested for HIV have contributed to an increase in the number of new applicants (Lawton, Portland Oregonian, 7/26). An estimated $162 million in additional federal funding will be needed to keep the ADAPs solvent through March 2004, and a bill that would add $100 million in federal money to the program has passed a Senate appropriations committee. In the meantime, many states are devising their own responses to tight ADAP budgets. Some states only cover a limited number of drugs, and eight states have implemented waiting lists for the program. Approximately 1,200 people with AIDS in the United States are currently on an ADAP waiting list, and more states are expected to implement waiting lists as budgets grow tighter (San Francisco Chronicle, 7/29).

According to the AIDS Treatment Data Network, nearly every state with an ADAP will begin turning away new applicants by December (Portland Oregonian, 7/26). In addition, tight ADAP budgets mean that states will be less likely to cover new AIDS drugs, such as the "promising" medicine T-20, the Chronicle reports. T-20 is an injectable drug made of fragile, hard-to-manufacture proteins. If the drug receives FDA approval this year, it could cost more than $12,000 per year -- the combined average cost of three to four other antiretroviral drugs. Because the price of T-20 will place it out of reach for most uninsured HIV-positive individuals, there will be "enormous pressure" on state ADAPs to cover the drug. "This is clearly a very expensive drug to make, but the budget is already busted," Bill Arnold, chair of the ADAP Working Group, said.

The ADAP budget problem is "most acute" in North Carolina, where ADAP enrollment has been frozen since last December. Stephen Sherman, director of AIDS policy for the North Carolina Health Department, said that the state's $1.8 billion budget deficit has hurt ADAP and a variety of other programs. "Frankly, I don't see how we are going to get past this barrier in front of us. ... We're looking north, to Washington," he said (San Francisco Chronicle, 7/29). In Oregon, a $1.7 million shortfall in its $3.8 million ADAP budget has led state officials to consider delaying or cutting benefits for ADAP beneficiaries. Oregon has already stopped accepting new applicants for the program, which buys some drugs directly and pays for insurance that covers the cost of drugs and doctor visits (Associated Press, 7/26).