A Bitter Pill : AIDS Drug Treatment Funds Running Out

Janice Barrett sighed and repeated the mantra her doctor gave her in 1994 when she was found to have AIDS: “Avoid stress.”

“Stress is the worst thing for our immune systems,” said the 43-year-old grandmother of two. But, she asked, “how can I avoid stress when I will soon no longer be able to receive the medication that keeps me alive?”

The same concern has troubled about 600 people in Orange County with AIDS or HIV, the virus that causes AIDS, since they learned last week that a crucial state subsidy for their costly medications might run out next month.

According to officials with the county branch of the AIDS Drug Assistance Program, an annual allocation of about $990,000 for AIDS medication such as AZT might run dry by mid-March, more than three months before the fiscal year ends June 30.

Unless an additional $550,000 is infused into the county program before then, officials say they will begin turning people like Barrett away until new money arrives from the state in July. The news is especially unwelcome after recent announcements, made with much fanfare, that two additional medications, saquinavir and epivir, are now available to people with AIDS.

“We need our medication in order to stay healthy,” said a frustrated Barrett, her voice still vibrant despite recent spells of listlessness that forced her to quit her bookkeeping job. “They have to understand that people are going to die from this.”

In a county whose financial hands have been tied for months, such frustration resonates strongly.

“The county simply does not have the money,” Supervisor Marian Bergeson said. “We are still straining with programs that are mandated by the state. Those [other] types of programs are slipping through the cracks.”

Currently, the program provides full or partial monetary assistance to anyone with AIDS or the HIV infection who earns less than $50,000 per year but is unable to receive Medi-Cal assistance. Many patients can spend $11,000 or more on AIDS medication annually.

Bergeson said she might make a formal request for emergency assistance to the state on behalf of the local program.

“This is an emergency,” she said. “We can’t afford to reduce AIDS assistance.”

But even if the state can help Orange County out with this year’s AIDS Drug Assistance Program budget--a move officials say is already being considered--larger problems must still be addressed. According to the state Department of Health Services’ Office of AIDS, several other counties, including Los Angeles and San Francisco, have projected budget shortfalls this fiscal year of as much as $3 million.

Unless the entire program is restructured, said Office of AIDS administrator Michael Montgomery, a similar shortfall will occur again next year.

Ironically, the 9-year-old program’s budget has been sapped by its own success, Montgomery said. A recent increase in the variety of drugs available to AIDS patients through the program, and increased use of its money in general, have drained the fund at a much faster clip than was projected when the program was set up in 1987.

Back then, AZT and aerosolized pentamidine were the only forms of AIDS medication subsidized by the program, Montgomery said. Now, there are 145 medications available to the 8,500 California recipients of the subsidy.

The growing popularity of therapies that involve taking a number of drugs together has resulted in a higher cost per patient.

Studies show that the cost of providing AZT in combination with two other forms of AIDS medication may exceed $11,000 per year for recipients of the subsidy.

Ron Taylor, who oversees the Orange County program, said its costs have escalated from $104,000 per month budgeted for this fiscal year to $180,000 in December.

“Clearly, we need to take a look at how this program is structured,” said Montgomery, “and we are trying to determine to what extent there is a problem right now.”

Among the reform options the state is considering are tightening eligibility requirements and reducing the variety of drugs available. Another alternative would be to force recipients to use their health insurance first, though some have been reluctant to do so out of fear of becoming identified as HIV carriers, Taylor said.

But those alternatives and a suggestion that more than $3 million in federal funds used for other AIDS programs be redirected into the AIDS Drug Assistance Program budget are irrelevant at this point to recipients in Orange County.

“The bottom line is we need $555,000 now or some people are going to die,” said Taylor, head of the Orange County program.

Said Brian Sadler, who was informally appointed by recipients to speak on their behalf: “It’s a horrible thing to look at your own mortality and realize it depends on the stroke of someone else’s pen.

“We need the money now and the state has to help us,” added Sadler, who, received assistance from the program after his condition was diagnosed as AIDS in 1989. He has since qualified for Medi-Cal.

But Montgomery said that, as of now, no promises could be made to Orange County or any other county seeking emergency help for its AIDS assistance program.

“It’s a hot topic at the highest levels of the [state Department of Health Services],” he said. “We are looking for additional funds.”

But, if additional funds are not identified before the county department runs out of money, he added, “we will no longer be able to reimburse them.”