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Companies Lower HIV Drug Prices for ADAP, but Many Patients Still Waiting

Four pharmaceutical companies recently agreed to discount their prices on antiretroviral drugs for AIDS Drug Assistance Programs (ADAPs), which are under increasing pressure due to the ongoing financial crisis. More than 4000 people with HIV are currently on ADAP waiting lists, most of them in the Southeast U.S.

According to the latest issue of ADAP Watch, produced by the National Alliance of State and Territorial AIDS Directors (NASTAD), there were 4387 people in 12 states on waiting lists as of December 21, 2011. Florida had the largest number of waiting patients (1163), followed by Virginia (1112), Georgia (1104), Louisiana (596), South Carolina (153), North Carolina (118), and Alabama (83). Some states outside the south also have waiting lists, ranging from 8 people in Montana to 27 in Utah.

Thanks to emergency ADAP funding for fiscal year 2011, these states were able to reduce the number of people on their lists, with Ohio eliminating its shortfall. This has helped decrease the total number of wait-listed patients in the U.S. from more than 9000 -- the highest level ever -- this past August.

Several of these states, as well as others currently without waiting lists, have implemented other cost-containment strategies -- such as raising financial eligibility criteria and reducing formularies (list of drugs approved for coverage) -- or have indicated that they plan to do so, according to ADAP Watch.

The Centers for Disease Control and Prevention (CDC) recently revealed that just 20% of the estimated 1.2 million people living with HIV in the U.S. know their status, and within this group only half were receiving ongoing medical care including antiretroviral therapy in 2010. Financial hardship was cited as one of several factors keeping people away from treatment.

"The current federal-state funding partnership is not viable when the states are struggling with rising ADAP enrollments and dropping tax revenues," argued an article in the National Association of People with AIDS (NAPWA) newsletter Positive Voices. "It may be time for the federal government to recognize the concentration of HIV in the same lower-income Americans who enroll in ADAPs as a national problem, make ADAP assistance available nationwide without waiting lists or unreasonable income eligibility ceilings, and assume the full cost of the program."

"That's going to be a very tough sell in today's economic and political climate," the article continued. "Consensus is growing that we have the tools to end the epidemic. Getting the ADAPs funded at levels that meet the real need may tell us whether what is scientifically possible is also politically possible."

Pharma Agrees to Lower Prices

Over the past month 4 pharmaceutical companies that collectively produce a majority of widely used modern antiretroviral drugs -- Gilead Sciences, Janssen/Tibotec, Bristol-Myers Squibb (BMS), and Merck -- reached agreements with NASTAD's ADAP Crisis Task Force to make their HIV medications available to ADAPs at reduced prices.

Gilead, which already offered ADAP discounts, agreed on the eve or World AIDS Day (December 1) to "extend additional voluntary discounts and rebates for most Gilead products," according to a Task Force press release. The agreement also continues an ADAP price freeze through 2013. Gilead's cooperation is critical as the company produces the best selling coformulations Truvada (tenofovir/emtricitabine) and -- in cooperation with BMS -- Atripla (efavirenz/tenofovir/emtricitabine).

The following week Janssen Therapeutics also agreed to additional voluntary discounts and rebates for all of its products purchased by ADAPs, which includes antiretrovirals formerly marketed by Tibotec. This enhanced agreement also continues a price freeze through 2013. 

BMS and the Task Force announced an enhanced agreement on December 19.

"Bristol-Myers Squibb has a longstanding commitment to people living with HIV, and we have worked with the [ADAP Crisis Task Force] since its inception in 2002 to help ensure patient access to our HIV medications,” Raymond Sacchetti, BMS senior vice president, U.S. Virology, said in a press release. “We are proud to continue our support of the ADAP Crisis Task Force, and we applaud its ongoing efforts in working with state and federal officials to secure the necessary funding to appropriately meet this critical public health challenge.”

Finally, on December 21, Merck also announced a new agreement with the Task Force to improve ADAP access, including lowering and freezing the price of the sole approved HIV integrase inhibitor, raltegravir (Isentress).

"With our company's legacy in HIV over the last 25 years, we consider it our obligation to continue to work with the ADAPs on solutions that provide crucial support for uninsured and underserved people living with HIV," Chirfi Guindo, vice president and general manager of Merck's HIV Franchise, stated in a press release. "It is imperative to act now, given the ongoing ADAP funding crisis."

The ADAP Crisis Task Force had previously secured multi-year, voluntary discounts and rebates from all 8 manufacturers of antiretroviral drugs. The 4 recent enhanced agreements provide deeper discounts and longer price freezes. Earlier this year the Task Force also reached an enhanced agreement with Boehringer Ingelheim for additional voluntary discounts and rebates.

12/27/11

Sources

National Alliance of State and Territorial AIDS Directors (NASTAD). ADAP Watch. December 22, 2011.

National Association of People with AIDS (NAPWA). ADAP Waiting Lists in an AIDS-Free America. Positive VoiceNo. 42. December 5, 2011.

National Alliance of State and Territorial AIDS Directors (NASTAD). ADAP Crisis Task Force Announces Enhanced Support from Gilead Sciences for ADAPs in the United States; Additional Federal and State Funding Critical. Press release. November 30, 2011.

National Alliance of State and Territorial AIDS Directors (NASTAD). ADAP Crisis Task Force Announces Enhanced Support from Janssen Therapeutics for ADAPs in the United States. Press release. December 8, 2011.

Bristol-Myers Squibb and NASTAD. Bristol-Myers Squibb and ADAP Crisis Task Force Announce Enhanced Multi-year Support for AIDS Drug Assistance Programs (ADAPs) and People Living with HIV/AIDS. Press release. December 19, 2011.

Merck and NASTAD. Merck and the ADAP Crisis Task Force Announce New Agreement to Improve Access and Care for People with HIV. December 21, 2011.