In anticipation of an additional round of cuts to the AIDS Drug Assistance Program (ADAP) to be implemented in the next few months, AIDS Healthcare Foundation (AHF) today proposed three possible funding solutions to the current ADAP crisis—which has left more than 5,000 people on waiting lists to receive lifesaving medications and thousands more scheduled to be disenrolled from the program altogether. Currently, ADAP waiting lists are growing at a rate of 550 people per month.
“AIDS treatment is one of the most effective tools we have to prevent new infections”
Due to a perfect storm of AIDS budget cuts, increased demand and rising drug prices, the federally-funded, state-operated ADAPs—which currently provide lifesaving AIDS drugs for 165,000 low-income Americans—can no longer provide treatment to all of the people who need it. As of January 2011, more than 5,300 people are on ADAP waiting lists, with an additional 2,500 at risk of being dropped from the program altogether. This crisis is quickly worsening as many larger ADAP programs are being forced to stop providing treatment to new patients. For example, Florida, which has the third highest HIV population in the country, instituted a waiting list in June 2010 that now has 2,816 people on it. California (with 40,000 ADAP patients) has proposed cuts intended to force many patients off the program.
In 2011, ADAPs will need to serve an additional 25,000 people who cannot afford their treatment. Given the high cost of AIDS drugs, upwards of $12,000 per year for a single drug, at least $260 million is needed to ensure that ADAPs can provide assistance to all those who need it.
According to AHF, there are several available offsets that would provide these funds without adding to the deficit. The three proposals are below:
1. Reallocate a portion of the $48 billion in unobligated funding within the Department of Health and Human Services (HHS) budget. Secretary Sebelius has the authority to transfer portions of these funds to other HHS accounts (such as ADAP). A transfer of roughly 0.5% of these funds would be enough to restore ADAP.
2. Apply a 10% cut to the administrative overhead of Health Resources and Services Administration (HRSA), the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). These agencies, which are tasked with implementing ADAP and other AIDS programs, spend a combined $2.3 billion on administration and overhead.
3. Secure an additional 20% discount/rebate for ADAP drugs from AIDS drug manufacturers. Drug price increases are one of the main causes of this crisis and additional discounts would mean ADAPs could serve everyone who needs it without new funding. Moreover, given the unique nature of ADAP, i.e., it operates independently from other Federal/State programs and the budget for drugs is fixed, these discounts would not impact price calculations for other drug programs or reduce drug company revenues.
"Whether it is through allocation of unobligated funds, trimming the fat from federal administration or the procurement of additional drug rebates, intervention is needed now to end this crisis," said Michael Weinstein, President of AIDS Healthcare Foundation.
Added Weinstein: "Skyrocketing drug prices are a key factor in this crisis. Since 1996, drug spending by state ADAPs has increased by more than 617%--that's more than twice the rate of patient growth over the same time period. In earlier negotiations, the efforts of AIDS advocates have resulted in additional discounts from drug companies. If federal funding does not come through and soon, we must return to the negotiating table. AHF hopes that all of those working in the HIV health care field—including the National Alliance of State & Territorial AIDS Directors—would support this reasonable and common-sense approach."
The AIDS Drug Assistance Program is vital to combating the nation's epidemic. Lack of access to AIDS treatment significantly impedes the community's ability to address the epidemic. When not properly treated with antiretroviral medication, AIDS patients quickly become increasingly sicker and more expensive to care for. The opportunistic infections that develop in patients due to their weakened immune system are more costly than treating AIDS correctly, and typically lead to more expensive inpatient care. Moreover, advanced antiretroviral treatment for those patients experiencing treatment failure—because they can't obtain their medication—is not only more toxic and intolerable, but costs thousands of dollars more than standard therapy.
"AIDS treatment is one of the most effective tools we have to prevent new infections," said Tom Myers, AHF's Chief of Public Affairs and General Counsel. "People who are successful on treatment have less HIV virus in their bodies, which means they are less infectious and less able to infect others."
Added Myers: "The crisis has already caused a decline in testing. The best medical model to combat the spread of the virus is to test as many people as possible and treat those who test positive. People at risk for HIV are less likely to get tested if they cannot receive treatment after their diagnosis. They would just rather not know."
GLP-1 drugs, like semaglutide, lower risk of hospitalizations for alcohol use disorder