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AIDS patients might have to wait

A state drug program designed to help poor patients pay for life-saving and life-sustaining HIV/AIDS drugs could again have a waiting list by April, state health officials said Monday.

As the state paused Monday to celebrate the 20th anniversary of World AIDS Day with vigils and other public remembrances, HIV/AIDS clinics in Kentucky and throughout the country are bracing for the return of waiting lists for services because of a drop in federal and state funding.

The Kentucky AIDS Drug Assistance Program, which helps provide HIV/AIDS drugs to 1,300 patients not on Medicaid, Medicare or private insurance, has lost a significant part of its federal and state funding over the past three years.

At the same time, the number of patients who have applied for help to pay for anti-viral drugs — which can cost anywhere between $2,000 and $10,000 a month — has steadily increased, said Sigga Jagne, branch manager for the HIV/AIDS program with the state Cabinet for Health and Family Services. .

"We are seeing 50 new patients a month," Jagne said. That's up from monthly figures of 35 in 2007 and 23 in 2006. But federal funding dropped from $4.6 million in 2005 to $4.3 million in 2008.

In 2005, "Kentucky had the longest waiting list of all states for the drug program," said Deborah Wade, program director for the WINGS Clinic at the University of Louisville. Roughly 30 percent of her 1,100 clients don't have insurance and need the drug assistance program, Wade said.

That waiting list was eliminated in 2006 as the program became more efficient and the state legislature appropriated money to the program, starting in 2004. No money was designated for the program for this budget year.

The program has been able to save the state money by renegotiating pharmaceutical contracts for the drugs and tapping into various rebate programs, said Dr. Kraig Humbaugh, director of the Division of Epidemiology and Health Planning for the Cabinet for Health and Family Services.

Jagne said the state is already preparing for a waiting list. Social workers who work with HIV/AIDS patients are already gearing up to fill out applications for individual drug companies' free or reduced-cost programs until additional money can be found.

Many patients are on multiple medications, which means multiple applications, most of which have to be renewed periodically.

The biggest challenge for HIV/AIDS patients is adherence — taking the drugs as prescribed. If a patient does not take the drugs, the virus can mutate and become even more difficult to treat.

Humbaugh said the cabinet is looking at all options but, with the state facing a deficit of more than $450 million, they have to be realistic.

Kentucky is not alone in its struggle. Two other states already have waiting lists and at least six others have put some type of cap on the number of people served or drugs covered, Humbaugh said.

Advocates say that it's much more cost-effective for states and the federal government to pay for the drugs than to wait until someone becomes seriously ill.

"People who don't get their medicines, get really, really sick," Wade said. "That means that they are admitted to the emergency rooms and eventually moved to intensive care. They stay longer. They can't work ... and taxpayers are going to have to pay for that."

Mortality rates for HIV/AIDS patients nationwide and in Kentucky have dramatically improved, largely because of access to those drugs, advocates say. For example, in 1982, the mortality rate for HIV/AIDS patients was 100 percent. The most recent statistics show Kentucky's mortality rate at 16 percent.

Dr. Alice C. Thornton, project director at Bluegrass Care Clinic at the University of Kentucky's Kentucky Clinic, which treats HIV/AIDS patients in 63 central and eastern counties, said that about 25 percent of the roughly 800 patients at the clinic don't have insurance and need the drug assistance program.

But, with the economy souring, Thornton and Wade are worried that the number of people without insurance — those who need help with paying for prescription drug costs — is only going to climb.

"Just last week, one of my patients got a pink slip," Thornton said. "Now he doesn't have health insurance and will likely need this program."