Rush on Free AIDS Drug Program Feared : Prescription Recipients Must Be Enrolled Before Sept. 30 Fund Cutoff

Health officials in San Diego and elsewhere in the state are bracing for what could be a flood of infected Californians seeking prescriptions for an expensive anti-AIDS drug before federal funding to provide it free runs out Sept. 30.

The state will have money left over to continue the free AZT program for several months after that date, but it has said the funds cannot be used for patients who aren’t already enrolled in the free medication program by then.

The prospect of a two-tier system that allows some people to die while others receive a drug to live longer has county health officials “absolutely dismayed,” said Dr. Donald Ramras, chief public health officer for San Diego County.

Wants More Patients

Thomas Peters, associate director of health for San Francisco, said he had asked the state Department of Health Services to allow new patients to be added to the program after Sept. 30.

“It certainly would be good to have a fully functioning program rather than a partially functioning one,” Peters said.

But the cutoff rule is important to equitably distributing the remaining AZT funds throughout the state, said Thelma Fraziear, chief of the state Office of AIDS.

“I do have some counties that are running out of money. To let some counties run out of money while others think they have a big pile sitting there--I don’t think that is an equitable distribution,” Fraziear said.

In June, the last month for which figures are available, the program provided AZT for 689 Californians who otherwise wouldn’t be able to afford the cost of the drug, which amounts to about $8,000 a year, Fraziear said.

AZT has been shown to prolong the lives of people with AIDS or AIDS-related complex (ARC), a condition that often precedes the full-blown disease symptoms. It also recently has been suggested for use as preventive therapy in people infected with the AIDS virus who have not yet developed symptoms.

Even though this latter therapy is controversial and potentially dangerous, these pre-AIDS patients may be tempted to get onto AZT treatment before the cutoff occurs, county health officials said.

“All of us have to keep in mind that someone who is infected with what is a uniformly fatal disease has every reason in the world to think long and hard about some of these decisions,” Peters said. “And they may want to take the risk in that direction.”

State rules specify that patients must have ARC or AIDS and have an income of no more than $40,000 a year before they qualify for free AZT. However, asymptomatic people infected with the AIDS virus probably could get into the program undetected if they found a doctor willing to write the prescription, health officials said.

That is because the federal emergency allocation that gave California $7.6 million this fiscal year for AZT also set strict limits on administrative costs, Peters said.

“Quite frankly, we don’t go back to the doctor and check out whether he has appropriately prescribed the drug. We simply require the prescription and the proof of income,” said John Schunhoff, assistant administrator of the AIDS program for the Los Angeles County Department of Health Services.

Extension Granted

When it became apparent early this summer that a slow start of the program would prevent California from spending the full $7.6 million by the end of the federal fiscal year, Sept. 30, the state received permission to keep the extra money and extend the program beyond that date, Fraziear said.

San Diego’s original allocation of $458,000, plus an additional $100,000 the state is adding from unexpended funds elsewhere, has served 112 people, 78 of whom are still in the program, Ramras said. If the total number does not change drastically, the carry-over will last until about next March, he said.

Los Angeles expects to have spent $1.2 million out of $2.2 million by Sept. 30, serving 150 patients. San Francisco expects to have spent $700,000 out of a $2.7-million allocation serving 150 to 160 patients.

Likely to Lose Surplus

Fraziear said both Los Angeles and San Francisco are likely to lose some of their surplus to other counties, notably Riverside, San Bernardino, Alameda, Sacramento and San Diego.

But after the money is reallocated and spent, the federal Health Resources Service Administration has said, there will be no more.

“When the money came down from the federal government it was clear that it was for a one-year period of time. There never should have been the expectation that it would be a continuous program,” Fraziear said.

She said her agency has no plans to lobby the federal government or California legislators for new funding until the leftover funds dry up. “I’m not comfortable going back and saying we need more money when we haven’t spent what we had,” she said.

Planning Strategies

But county officials, AIDS advocacy groups and individual patients are already planning their strategies to press for further funding.

“This is terrible. We think the feds should come up with the money,” Ramras said. “This drug, even at the government price, is still in the range of $8,000 a year. Who else has got the money?”

The San Diego Regional Task Force on AIDS voted Wednesday to urge county supervisors to lobby Congress, and San Francisco’s officials have contacted congressmen already.

Peters labeled as “haughty” the federal government’s contention that states knew the funding would only last one year.

“We certainly have no option to set artificial time limits on this epidemic,” he said. “To set artificial time lines and say ‘We told you so,’ is just inappropriate. Who do we say that to? Should we say to patients the same thing?”

Funding Effort

Richard Stone, an Encinitas resident who has been receiving free AZT since last fall, said he will put his energy into trying to ensure further public funding for the drug.

A part-time actor, he makes too much money to qualify for Medi-Cal--which does provide AZT to its indigent clients--but has no medical insurance to cover the cost of the drug to treat his ARC symptoms. So far he has tolerated the powerful drug well and it has helped keep his immune system from declining further, he said.

“It just literally is pulling the rug out from someone when the thing that is prolonging their life is going to stop. It’s a frightening proposition,” Stone said.

“But if I have to throw some energy into fighting for this, I will. I’m not going to sit back and die.”