Insurance plan cuts waiting list for HIV drugs

Print Friendly and PDF By: Andy Miller Published: Jun 18, 2012

In January, Georgia had the longest waiting list in the nation for people with HIV to receive government drug assistance.

At that time, the state had 1,348 people waiting to join the AIDS Drug Assistance Program (ADAP). Now, less than six months later, it’s only about one-third of that: 490.

ADAP serves HIV-infected people who have low or moderate incomes and no health insurance. HIV is the virus that causes AIDS, and drug treatment is a major factor in preventing infected people from developing the full-scale disease.

The decrease in the waiting list reflects the movement of many Georgians into the Pre-Existing Condition Insurance Plan. That’s a provision of the 2010 health reform law that serves as a safety-net plan for the “uninsurables’’ who can’t get coverage due to medical conditions.

The new June 7 figure still leaves Georgia with the second-highest waiting list, behind Virginia’s 599.

The state Department of Public Health said last week that more than 350 ADAP clients were electronically enrolled into the Pre-Existing Condition Plan at the end of April, and these patients are nearing the final stages of enrollment.

Currently, the 29 individuals fully enrolled in that insurance plan will save the state the state about $46,500 ‘‘while also receiving a higher quality of care,’’ said Ryan Deal, a spokesman for Public Health, in a statement.

Soon, eligibility requirements for ADAP will change to allow greater eligibility, he said.

Most people on the waiting list are getting help through pharmaceutical companies’ assistance programs for low-income patients. But advocacy groups have expressed concern that some people have fallen through the cracks.

Larry Lehman, executive director of the AID Gwinnett/Ric Crawford Clinic, which serves HIV patients in Gwinnett, Newton and Rockdale counties, said, “We are grateful for all the hard work of the state’s ADAP/Pre-Existing Condition Insurance Plan office, along with the network of the enrollment sites around the state.’’

The insurance plan “does take a few weeks to get a patient completely enrolled,’’ said Lehman, who called the plan “an excellent opportunity for so many of our patients, many of whom have gone without health care coverage for years.’’

More than 4,000 Georgians are served by ADAP.

Reasons for Georgia’s long waiting list include the state’s high rate of HIV/AIDS; flat funding by the state; an increase in testing for the disease, which leads to more people being diagnosed; and people losing their jobs and health coverage.

The average cost of an ADAP patient is $10,800 per year.

The Pre-Existing Insurance Plan is scheduled to expire in 2014, to be replaced by state insurance exchanges, if the health reform law is upheld by the Supreme Court. The fully implemented law would eliminate insurance discrimination based on health conditions.

Here are two articles, from the Associated Press and USA Today, breaking down the four “what-if’’ scenarios involved with the reform law, which is more formally called the Affordable Care Act. The law’s constitutionality was argued before the court earlier this year, and the highly anticipated ruling on the case will come this week or next.

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  • John Weiser, MD

    What this press release doesn’t say is that the state sponsored pre-existing insurance plan requires copayments that many patients can’t afford. And as a result of being “insured”, patients no longer qualify for pharmaceutical company patient assistance programs that provide free medications to people with no other means of obtaining them. Some patients are actually losing medication coverage as a result.
    John Weiser, MD

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