Medi-Cal to Make New AIDS Drug Available : AZT, Believed to Prolong Lives, Costs $7,000 to $10,000 a Year for Each Patient’s Treatment

State Health Services Director Kenneth W. Kizer has agreed to make the newly approved anti-AIDS drug AZT available through the Medi-Cal program to eligible patients with AIDS or ARC (AIDS-related complex), state health officials said Monday.

Kizer is expected to make his action official today when he formally approves the addition of the drug, marketed under the name Retrovir, to the state Medi-Cal formulary--the list of medications that doctors may prescribe for Medi-Cal patients without first getting approval from a Medi-Cal field office.

The decision is important in part because the retail cost of AZT, which is believed to prolong the life of patients but not cure acquired immune deficiency syndrome, is very high--$7,000 to $10,000 a year for each patient.

State officials are not yet certain how many of those in the state afflicted with AIDS or ARC will qualify for Medi-Cal, the state- and federally-financed health care program for the poor.

However, preliminary calculations indicate that 860 patients will qualify for the drug under Medi-Cal at a cost to the program of $290,000 during the current fiscal year, which ends June 30, said John Rodriguez, deputy director of health services for Medi-Cal.

By next year, those numbers will likely climb to 1,550 patients and $7.5 million, he said. The costs will escalate more dramatically in the second year because many bills incurred in the current fiscal year will not arrive for payment by the state until the next fiscal year. Rodriguez cautioned that the figures are only estimates and do not include added costs of blood tests that accompany AZT treatment.

“When we first did a study 18 months ago, we found that between 12% and 13% of AIDS patients were on Medi-Cal,” Rodriguez said. “New figures indicate that at least 20% become eligible. So the indications are that the numbers are going up.”

Despite these costs, the availability of the drug could result in some savings to the state-run program, because patients taking AZT appear to have fewer life-threatening infections that require hospitalization. The amount of this savings is not yet clear, Rodriguez said.

The U.S. Food and Drug Administration on Friday licensed the manufacturer of AZT, Burroughs Wellcome Co., to begin distributing the drug to certain patients with AIDS and ARC. Patients with the complex suffer from many of the same symptoms as AIDS. ARC often is a precursor to AIDS and can be fatal in its own right.

The effectiveness of the drug was shown in a test of 281 AIDS and ARC patients that was halted in September, after results showed a marked reduction in the death rate among those receiving AZT when compared to those receiving a placebo or dummy drug.

The treatment is not a cure, however, and the drug does have serious side effects. About one-third of patients in the experimental trial showed signs of suppression of bone marrow, the source of the body’s red and white blood cells.

No patient has received the drug for more than 20 months, according to information provided by the company, and its long-term effectiveness is still uncertain.

At first, supplies of the drug will be limited, and the company, working with the FDA, will limit the distribution to those who are most likely to benefit.

Most Not Qualified

Most Californians suffering from AIDS and ARC do not qualify for Medi-Cal. Ironically, that may change as treatment improves, extending the lives of patients.

Frequent hospitalization can exhaust a patient’s insurance coverage and devour a patient’s assets.

To become eligible for Medi-Cal a single patient can have no more than $1,700 in personal property, not counting the value of an automobile and home.

The income limit is $533 per month for full Medi-Cal coverage. That means that patients with more income must spend money from their own pocket down to that limit before Medi-Cal will begin taking over the entire cost of their treatment.

California, like most states, offers prescription drugs to Medi-Cal patients for no cost or with an optional $1 per prescription fee paid directly to the pharmacist.

Doctors are free to prescribe any FDA-approved drug to patients enrolled in the program, but if a drug is not on the state-approved list, the physicians must first obtain permission from a program office.

Placing AZT on that list removes that potential impediment to prescribing the drug for AIDS patients.

First AZT prescriptions may be written next week. Page 21.