Ohio AIDS advocates, patients protest against rationing of lifesaving HIV medicines

Apr 6 2012

A group of Ohio AIDS advocates, patients and medical providers hosted a protest in Columbus today in conjunction with a public hearing held by the Ohio Department of Health (ODH) and its Director, Theodore E. Wymyslo, M.D., on proposed rule changes that would restrict access to lifesaving AIDS drugs for low-income Ohioans based on medical criteria. Several members of the group also testified at the hearing in opposition to the proposed changes, which would drastically reduce patient access to HIV/AIDS medicines.

“Changing Ohio's medical-eligibility criteria for its ADAP, such as reducing the qualifying CD4 count from 350 down to 200, as this rule change does, is actually a form of rationing of lifesaving HIV medicines”

Last year, three Ohio AIDS patients successfully sued the state to block implementation of draconian restrictions alleging the state "…failed to follow Ohio's statutory rule-making process…" in rule changes that would, "…arbitrarily deny funding for potentially life-saving medications to Ohioans infected with HIV or suffering from AIDS-related symptoms." That complaint was filed November 2011 in the Court of Common Pleas, Franklin County, Ohio (Case number 11CVH-11-13646) on behalf of Ohioans Eddie Hamilton, William Booth and David Baker by attorneys at Dinsmore & Shohl LLP. The complaint also stated, "Because the Ohio Department of Health and its Director failed to follow Ohio's statutory rule-making process, this Court must find that the proposed rule is unenforceable."

Hamilton, of the ADAP Educational Initiative in Columbus, testified at today's hearing. "The Ohio HIV Drug Assistance Program has kept me alive for the past seven years. With regard to the proposed rule change, HRSA has stated unequivocally that using medical criteria in administering wait lists in HRSA Programs is considered as a discriminatory practice. The new proposed rule also permits the Director of the Ohio Department of Heath to unilaterally lower the program's financial eligibility guidelines to an income as low as 100% of Federal Poverty Level — just $11,000 annually — even though that same individual's lifesaving HIV medications may cost $12,000 or more per year. The proposed rule is not only bad medicine; it violates the Ohio Legislature's intent of 3701.241, the Rehabilitation Act, and the Ryan White Care Act and is contrary to ODH's mission 'to protect and improve the health of all Ohioans.'"

"While we recognize that there is a shortage of funds in the Ohio HIV Drug Assistance Program and the Ohio Department of Health is trying to put in place measures to ensure that those who are the sickest have access to antiretroviral medications, I argue that adding stipulations to ration antiretroviral medications is an act that directly contradicts ODH's mission statement, the core principles on which it operates, and the national and international scientific consensus on the treatment of HIV," said Dr. Thai Nguyen, an AIDS Healthcare Foundation Medical Provider who has managed two Ryan White-funded clinics serving over 4,000 patients and who now personally cares for over 400 HIV/AIDS patients. "I ask that the policy leaders of ODH take into consideration the devastating consequences — continual suffering of the poorest HIV-infected people — that were or are on the ADAP waiting lists of other states including Louisiana, Georgia, and Florida, and the lessons learned from the HIV-related diseases and deaths in resource-limited settings where ARVs are rationed based on CD4-prioritizing eligibility. In addition, based on overwhelming evidence that earlier antiretroviral therapy (ART) reduces morbidity and mortality, in November 2009, World Health Organization, who set HIV treatment guidelines for resource-limited countries, recommended ART initiation for all people with CD4 <350 cells/mm3. In addition, the UNAIDS adopted as its goal a 'test and treat' policy that encourages doctors to start people on treatment as soon as they test positive for HIV. By enacting the Ohio Administrative Code 3701-­44-­03, you will be sending the message that Ohio's HIV healthcare standard is BELOW that of the developing world."

"Changing Ohio's medical-eligibility criteria for its ADAP, such as reducing the qualifying CD4 count from 350 down to 200, as this rule change does, is actually a form of rationing of lifesaving HIV medicines," said David Baker, with the group 'AIDS Awareness Ministry through the Church of Christ in Christian Union' based out of the North Church on the North side of Columbus. "This change does nothing to solve the wait list and will interfere with individuals taking their medications consistently, putting them at risk for building up drug resistance to the medications and possibly getting sick. This is also not a cost-effective strategy for health officials, politicians — or Ohio taxpayers — as it is cheaper to prevent the progression of illness with medications than it is to pay for advanced illnesses that may require emergency room visits or hospital stays that come with far higher costs to the state down the road."

"The medical and financial criteria that are at the heart of these rule changes in Ohio are murder by proxy, plain and simple," said William Booth, one of the plaintiffs in the November legal action and with the group, 'Miami Valley Positives for Positives' of Dayton. "While not every program can be secured with dollars, the cost containment procedures and restricted medical eligibility are forcing Ohio into a system where the state Department of Health will be deciding who lives or dies."

Source AIDS Healthcare Foundation (AHF)