Arkansas ADAP To Eliminate Coverage of Two AIDS Drugs Due to Rising Cost of Program

The Arkansas Department of Health will drop two medications covered under its AIDS Drug Assistance Program in order to maintain the program for the 444 patients who are currently enrolled in it, according to committee recommendations announced on Wednesday, the Arkansas Democrat-Gazette reports (Smith, Arkansas Democrat-Gazette, 9/16). ADAPs are federal- and state-funded programs that provide HIV/AIDS-related medications to low-income, uninsured and underinsured HIV-positive individuals. The state health department on Tuesday had warned it was planning to reduce the number of medications offered through its ADAP because of the escalating cost of maintaining the program. The health department said that treatments available through drug manufacturer assistance programs or medications that HIV-positive patients could temporarily stop taking likely would be the first drugs to be temporarily eliminated (Kaiser Daily HIV/AIDS Report, 9/14). Arkansas' ADAP no longer will cover Valcyte, which treats a virus that potentially can cause blindness in the later stages of HIV, and Sporanox, which is used to prevent fungal infections, the Democrat-Gazette reports. Health department officials said that by cutting these "less vital" medications, they hope to avoid eliminating more important medications in the coming months, according to the Democrat-Gazette. According to Dr. Terry Jefferson, less expensive -- but "less convenient" -- medications can be used as substitutes for Valcyte, the Democrat-Gazette reports. Sporanox is available to patients through pharmaceutical companies' assistance programs, according to Dr. Michael Saccente, a member of the committee that recommended the cuts to the health department.

ADAP Finances
The removal of the two medications from ADAP's drug formulary is expected to save the program approximately $10,000 per month, the Democrat-Gazette reports. The program receives about $3.2 million in federal funds annually, and it currently has approximately $1.5 million remaining for the more than six months left in the fiscal year, according to health department spokesperson Bob Alvey. Committee member Eric Camp added that he has discussed with Gov. Mike Huckabee (R) the possibility of supplementing the ADAP budget through his discretionary fund, which totals $500,000 per year. Huckabee has said that he needs more information before making a final decision, according to the Democrat-Gazette.

Only Latest Cut, More Cuts Possible
The decision to cut coverage of Valcyte and Sporanox is the latest in a series of cuts for Arkansas' ADAP, the Democrat-Gazette reports (Arkansas Democrat-Gazette, 9/16). The state in 2002 received $4.4 million in federal ADAP funding to eliminate a waiting list, but the funds ran out and cuts began. The state program in April placed a cap on the number of people the program could serve and a waiting list for the program began soon after (Kaiser Daily HIV/AIDS Report, 9/14). Currently, 11 people are on the state waiting list to be covered under its ADAP, according to the Democrat-Gazette. Committee members said that it is possible they will recommend further cuts to the ADAP in the future, according to the Democrat-Gazette.

Reaction
"These are medications that are really logical to be given up," committee member Dr. Estelita Quimosing said, adding, "We have to prioritize the medications that are really important to patients." Saccente said the decision makes the situation "worse for the patients [and] ... worse for the doctors," adding that recommending the cuts was "a painful decision, but I don't see where we have a choice." However, Camp -- who voted against eliminating the medications from the ADAP formulary -- said that many assistance programs offered through pharmaceutical companies come with "bureaucratic hurdles," and patients may not be able to obtain certain medications at a time when they are "too sick to deal with them," according to the Democrat-Gazette. "This is going to be a hardship for clients," he said, adding, "There's no two ways about that. I'm just so very disturbed that our program is at the point where the only thing we can talk about is removing access to medication, and that still may not solve the problem" (Arkansas Democrat-Gazette, 9/16).