A program to
provide financial help for those seeking expensive treatment for AIDS
and HIV has recently seen its income eligibility threshold slashed by
more than half, leaving many of those who depend on the program
scrambling for other options.

The Arkansas Drug Assistance Program,
or ADAP, was started in 1990 by the Arkansas Department of Health to
assist AIDS and HIV patients in paying for their medications, which can
routinely top $1,000 a month. ADAP is a partner of the state’s Ryan
White Comprehensive AIDS Resource Emergency (CARE) program, which
provides AIDS/HIV patients help with insurance co-pays, oral health,
transportation to and from medical appointments and other expenses.
Approved by Congress in 1990 after the death of Indiana teen-ager Ryan
White, who contracted the disease while being treated for hemophilia,
the programs are funded by a federal grant.

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Since 2007, the ADAP and CARE programs
have offered help to accepted applicants whose yearly income was up to
500 percent of the federal poverty level — $51,050 or less. Beginning
on May 22, however, the Health Department reduced the eligibility
threshold to 200 percent of the poverty level — $21,660.

Health Department officials said they
had to reduce the threshold to make room for the increasing number of
people in the most desperate financial situations. As more Arkansans
with AIDS/HIV have lost their jobs and health insurance, ADAP and CARE
have seen a spike in patients seeking assistance. Because the federal
grant for CARE and ADAP is fixed and the programs must admit applicants
who meet medical and economic eligibility requirements, officials
feared the programs would have eventually been overwhelmed financially
if the threshold had not been lowered.

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Under the new guidelines, 203 patients
currently enrolled in the CARE program will be removed from the rolls,
as will 49 people currently served by ADAP.

Kevin Dedner, the Health Department’s
section chief for AIDS, STDs and Hepatitis C, said that there are 698
patients enrolled in ADAP now. “Our earmark is around $4.1 million for
ADAP,” Dedner said, “which means we can comfortably support about 402
persons on the drug assistance program. You can see the stark
difference between 402 and 698.”

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The ADAP grant has also shrunk, by around $600,000 from the previous fiscal year.

The income eligibility threshold wasn’t
always 500 percent. Prior to 2005, eligibility was limited to those
making 300 percent of the federal poverty level. That changed when
federal law reauthorizing the program in 2006 provided a significant
bump in funding.

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“In May of 2007,” said Gail Gannaway,
associate branch chief for infectious diseases, “we increased our
eligibility level because we had significantly more money to spend.”

James Phillips, infectious disease
chief said that in fiscal year 2006, “We had a 2 percent increase [in
ADAP enrollment]. 2007 to 2008, there was a 22 percent increase in
enrollment, and 2008 to 2009 there was a 54 percent increase in
enrollment. So you can see where the problem arises.”

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Dr. Michael Cannon, executive director
of the non-profit Arkansas AIDS Foundation, said that his organization
sent out letters two weeks ago reminding their clients about the
change. “There are other alternative methods, but [patients are] going
to have to be a little more industrious at this point,” Cannon said.
“It’s not like we won’t assist them, but there’s just no more money for
a handout.”

Gannaway said that patients who are
already enrolled in the ADAP and CARE programs but exceed the income
threshold have been “grandfathered in” and given until Dec. 31 to make
other arrangements for their care. In that time, patients are being
encouraged to apply for patient assistance programs set up by
pharmaceutical companies to provide help in purchasing drugs. “You
might imagine that at the price they’re getting for these [drugs],
there would be a lot of protest,” Phillips said. “That why the
pharmaceutical companies are somewhat eager to assist in these patient
assistance programs, so there won’t be a major uproar.”

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Dedner said the Health Department is
working to help people complete the paperwork for the pharmaceutical
company programs — a process which can take up to six weeks. His
department has also started a list for those seeking financial help
with their drugs, something that is crucial if the programs are to
receive emergency funding. “Having the waiting list puts us in a
position that we can go after supplemental funding in January,” Dedner
said. “However, the supplemental funding is a competitive process. It’s
not something that’s guaranteed for the state, but we will make every
effort to try to bring in more dollars.”

Phillips said he’s concerned that the
difficulty of the paperwork required for applying for help from
pharmaceutical companies will discourage patients from filing and they
will end up going without medication. Once a patient strays from the
treatment regimen for HIV/AIDS, restarting treatment can be complicated
and even more expensive. “Continuity is very important in decreasing
the development of resistance,” Phillips said. “Once an individual
develops a resistance to the first set of drugs that they are started
on, then you try to recoup and progress onto a different regimen. It
almost always is a more expensive regimen.”

Behind the scenes, Dedner said, the
department is working to cut costs, and doing all it can to help
patients cope with the change. “We’ve been working on cost containment
measures for a few weeks,” he said. “We took a hard look at our
formulary and actually removed some drugs from our formulary to reduce
costs … so we’ve done a lot of things to try and avoid this point.”

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