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States Join Together to Press For Discounts on AIDS Drugs
  Editorial note from Jules Levin: Requests by the ADAP Working Group and community coalitions have in prior years been met with relatively adequate funding from Washington DC lawmakers to meet the growing needs of State ADAPs to provide therapy for patients with HIV. Previous funding always had some shortfalls, but was never so short as now in meeting the needs of patients. The ADAP Working Group and community coalitions have desperately and intensely been advocating during 2002 and early 2003 with the Administration and Congress and with some state lawmakers to provide adequate funding for ADAPs for 2003, but with too little response from government officials. Many States are unwilling or unable to provide funding to fill these large gaps. We knew this time was coming, we expected these large gaps and now it appears they are emerging as States are cutting back on their programs. Criteria to access HIV drugs through these programs are often becoming much more stringent. Here are some changes being considered and implemented by State ADAPs: income requirements to access drugs can be raised, co-payments may be required, the number of clients accepted into programs may be cut. Because the administration in Washington DC and Congress and the State governments have not approved adequate funding for the current needs of ADAPs the State ADAP Directors are going to ask drug companies for additional discounts on HIV antiretroviral drugs they purchase.
WASHINGTON -- Worried about the escalating costs of AIDS treatments, state health officials are joining forces to press for price concessions.
The strategy will come to the fore the week of March 17, when the six states with the biggest AIDS-drug programs plan to meet here with drug makers. The state officials plan to push the manufacturers for additional rebates for all 56 AIDS drug-assistance programs, or ADAPs, in the U.S. and its territories.
In the past, each state ADAP has, for the most part, fended for itself in talks with drug companies. But now the programs want to bring unity and clout to the discussions, hoping that manufacturers will cut prices if several states say they can't afford a drug. The new initiative also is focused on all AIDS drugs, not just new ones, which had been the focus of existing efforts.
"We feel it's important that we talk to the drug companies directly," said Michael Montgomery, chief of the California Office of AIDS. Officials from New York, Texas, Florida, Illinois and New Jersey also are expected to attend.
The AIDS programs are federally funded, state-run efforts that provide drugs to low-income people who lack insurance. Money has always been a problem, but the programs face added pressures following Roche Holding AG's recent decision to charge $20,000 a year for its new AIDS drug, Fuzeon, in Europe more than double the price of the next-costliest AIDS treatments. The U.S. price for the drug, intended for patients who don't respond to other therapies, hasn't been set.
Patient advocates worry that if the U.S. price is too high, state programs might not offer Fuzeon to all who need it, or might drop other AIDS drugs to make room for it.
Companies invited to the meeting include Roche, GlaxoSmithKline PLC, Merck & Co., Pfizer Inc., Abbott Laboratories Inc. and Bristol-Myers Squibb Co.
State officials plan to meet with companies individually to avoid antitrust issues.
States have become increasingly aggressive in trying to control drug costs. Some demand steep Medicaid drug discounts in exchange for putting medicines on their Medicaid programs' preferred-drug lists. Michigan and Vermont recently announced the first joint effort to extract discounts on Medicaid drugs. But states face legal challenges from drug makers, who argue that some cost-containment strategies are illegal.
Several drug manufacturers last year agreed to freeze prices charged to ADAPs, but the programs are still beset by budget woes and are taking other steps, including restricting eligibility. Nearly 700 people in a dozen states are on waiting lists to enroll in the programs.
Roche said it is involved in separate discussions with state officials and AIDS groups over Fuzeon, which is expected to get Food and Drug Administration approval in mid-March. "We'll be working to put together the best package [of prices] for all payers," a Roche spokeswoman said.
Part of the ADAPs' problem is the success of the drugs: The treatments are prolonging lives, meaning more people are on the programs longer. The programs serve about 80,000 clients, about 30% of the U.S. market for AIDS drugs.
-- Vanessa Fuhrmans contributed to this article.
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