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Thanh Tan, The Texas Tribune: State Won’t Fund Growing Demand for HIV Medicine

Texas Tribune: State Won’t Fund Growing Demand for HIV Medicine
by Thanh Tan, August 27, 2011

Enlargephoto by: UK Department for International Development

31 Days 31 Ways


Throughout the month of August, The Texas Tribune is featuring 31 ways Texans’ lives will change come Sept. 1, the date most bills passed by the Legislature — including the dramatically reduced budget — take effect. Check out our story calendar here

Day 27: Lawmakers didn’t cut spending for the Texas HIV Medication Program, but it remains nearly $20 million short of what’s needed to treat a growing number of low-income patients living with the disease.

As of 2009, health officials reported that more than 66,000 Texans were living with HIV. That number grows by about 6 percent every year, mostly because survivors of the disease are living longer. Since 1987, the Texas HIV Medication Program (THMP) has provided life-saving medications to low-income residents whose annual incomes are below $15,000. It does so through a joint state/federal program called the AIDS Drug Assistance Program (ADAP) and the state-funded State Pharmaceutical Assistance Program (SPAP). In 2010, ADAP served 14,251 Texans; SPAP served 1,541.

Public health officials say providing medications to patients in the early stages of their diagnosis offers a better chance to suppress the spread of the virus. Even short lapses in medication can lead to dire consequences for patients and for public health.

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Though lawmakers kept funding for THMP static for the next biennium, they did not grant the additional $19.2 million needed to address the growing caseload and rising medication cost. Instead, lawmakers added a provision to the state budget that would allow THMP to request a transfer of funds from the Medicaid budget to the HIV medication budget. Providers say it’s unclear whether that money will be granted, considering the Medicaid budget is already underfunded by nearly $5 billion.

“This mechanism allows lawmakers to say that they did not cut the program, but at the same time, the Texas Department of State Health Services can’t guarantee that cuts and restrictions won’t be made to the program over the next two years,” said Randall Ellis, the senior director of government relations for Legacy Community Health Services in Houston, a leading provider of care to the largest community of HIV/AIDS patients in Texas. The Department of State Health Services “is exploring options that will cut eligibility and benefits of the program. With fewer funds available, Legacy and its partners in Texas will have to ration the care and treatment it gives to people living with HIV/AIDS.”

In an interview with the Tribune, Ellis said the lack of guaranteed state funding for the program will have “consequences in both the care of people living with HIV/AIDS and in prevention efforts.” Already, he said, “Texas has one of the strictest eligibility requirements and one of the most restrictive formularies for its HIV medication programs in the country.” Restricting access to HIV medications could increase the cost of care and hospital visits, he said. Though the new fiscal year is just days away, Ellis said providers are still unclear how the budget cuts will be passed down to their patients.

Even if Legacy is able to absorb some of the loss in state support, Ellis said it will likely have to divert funding from other programs to pay for drugs. Access to medical care could be further restricted.

Outside of the budget cuts, lawmakers passed HB 2292 during the session, which authorizes the continuation of an advisory board to oversee the Texas HIV Medication Program. The board is scheduled to meet in October to determine how to move forward with cost-containment measures in the midst of limited resources.

Bottom line: It will take time to know exactly how the budget cuts will affect HIV patients, and whether they will stymie the state’s efforts to treat and stop the spread of the infection.

Web resources:

The Texas Department of State Health Services THMP FAQ page.

The Texas Department of State Health Services HIV/STD Information page, including presentations about THMP’s cost-containment issues.

 

 

 

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