icon star paper   Articles  
Back grey_arrow_rt.gif
State AIDS Drug Programs Negotiate with Drug Manufacturers
National Alliance of State and Territorial AIDS Directors
Press Release 3/27/2003
  For further information, Contact: Murray Penner, (202) 434-8090
"AIDS Drug Assistance Programs (ADAPs) are facing a funding crisis of unprecedented proportions," stated Julie Scofield, Executive Director of the National Alliance of State and Territorial AIDS Directors (NASTAD). Funding shortfalls have already caused thirteen states to create waiting lists or add restrictions for their ADAPs. Several additional states anticipate limiting enrollment in the near future. "No American who needs HIV medications should be denied access. These medications can make a life or death difference to individuals living with HIV/AIDS," noted scofield. ADAPs are a component of the federally funded Ryan White CARE Act, administered by states and U.S. territories, that provide life-saving medications to uninsured or underinsured people living with HIV and AIDS.
To alleviate the crisis, state AIDS directors and ADAP officials last week entered into first-of-their-kind negotiations with HIV drug manufacturers. The meetings, which concluded Friday, have produced mixed results. Although all eight of the major companies with HIV antiretrovirals on the market participated in the Washington, DC meetings, only one thus far has reached a satisfactory agreement with the group while five more continue in serious negotiations, expected to conclude by late April.
"Roche stepped up to the plate to help us ensure that ADAP patients will have access to needed HIV therapies, including the newly approved fusion inhibitor, Fuzeon. Roche has proven to be a critical partner at the most difficult economic time our programs have faced." Said Michael Montgomery, AIDS director for the state of California and one of the organizers of the meetings. Steve Sherman, ADAP coordinator for North Carolina added, "In North Carolina, even small reductions in the cost of these life-sustaining medications will allow us to serve more people in need." Even with the lowest financial eligibility criteria in the nation, North Carolina has had a waiting list for entry into its ADAP for the better part of the last two years.
Eight state AIDS directors and ADAP officials met with the pharmaceutical companies on behalf of the membership of the National Alliance of State and Territorial AIDS Directors (NASTAD), who hosted the meetings. Representatives came from California, Florida, Maryland, Massachusetts, New Jersey, New York, North Carolina and Texas. Collectively these states account for 70% of the over &850 million in drug expenditures that occur annually through the ADAP program.
State negotiators were seeking both expanded rebates on the full HIV-related product lines of the participating companies as well as cost neutrality on new formulations and new drugs within existing classes of medications. Reduction requests were targeted to the specific company portfolios and circumstances. "States have already squeezed out whatever administrative savings possible. We were hopeful that the pharmaceutical companies would join federal and state governments to help close the funding gap. We continue to be hopeful the other manufacturers will follow Roche’s lead in helping to alleviate this crisis." Said Montgomery.
Boehringer-Ingelheim, Bristol Myers Squibb, GlaxoSmithKline, Merck, and Pfizer/Agouron, are in continued negotiations with the ADAP Crisis Task Force. "These companies represent 75% of our national ADAP market. Their participation in reducing drug costs in our programs is critical to help manage the unmet need we are facing," noted Liza Solomon, AIDS Director from Maryland. Abbott Laboratories and Gilead Sciences had also attended the negotiation meetings.
The negotiation sessions focused heavily on the restrictions states are already imposing on the ADAPs. "Beyond the capped enrollments already in place in 13 jurisdictions, our states are looking at a broad range of efforts to contain costs in this expanding program. Options include reduced or preferred drug formularies; restricted regimens; prior authorization; capping benefits to clients; and premium and co-pay expansions," summarized Dwayne Haught from Texas. "These are measures we would like too avoid, if possible." To address the funding crisis, several states have also passed legislative directives regarding price containment for ADAP programs.
The forces that are driving cost are diverse. "Expanding case loads, deficient feral funding, possible Medicaid reduction, and expanding and increasingly costly treatments are all creating a crisis in enrollment. Florida already has a $2 million deficit projected for next year, and that is before any other state budget changes are instituted," said David Poole from Florida.
The series of meetings was the first time state ADAPs have sought to directly negotiate with the drug companies in their role as purchasers of 20-25% of HIV-related medications in the U.S. "This is a national effort on behalf of all the states and territories who are struggling with this challenging issue. This was a first for us and we remain hopeful that the outcome will contribute substantially to program cost reductions," Noted Mcguire. "We look forward to the conclusion of the ongoing negotiations as soon as possible. We intend to continue to seek national approaches and solutions on behalf of all ADAPs and hope that the other companies will be more responsive to the needs of ADAPs and the populations we serve in the very near future."
For further information, contact:
Dwayne Haught, Texas (5122) 490-2505
Jean McGuire, Massachusetts (617) 624-5300
Michael Montgomery, California (916) 323-7415
David Poole, Florida (850) 245-4421
Steve Sherman, North Carolina (919) 715-3111
Liza Solomon, Maryland (410) 767-5013
  icon paper stack View Older Articles   Back to Top   www.natap.org