California: AIDS Drug Assistance Program, New Drugs Proposed; Title II Public Input Sought

California's AIDS Drug Assistance Program (ADAP) pays for
certain drugs required by AIDS/HIV patients, for those with
annual gross income under $50,000. For those with under 400
percent of the Federal poverty level, the drugs are provided
free; for those with incomes over that amount, but under
$50,000, a copayment may be required.

To qualify, you must also have a prescription signed by a
physician licensed in California, and not have the drugs
covered by your health insurance program. (If your health
insurance requires a copayment which creates a financial
hardship, the program may help with the copayment.)

For more information about qualifying for the program,
California residents can contact their county's health
department. Also, a brochure published by California lists
the following hotline numbers: Northern California, 800/367-
2432; Southern California, 800-922-2437; Spanish hotline
(Southern California only), 800/400-7432. However, the people
who answer the phone are sometimes not informed about the
program.

The drugs currently covered are: acyclovir, amphotericin B,
atovaquone, azithromycin, AZT, clarithromycin, clindamycin,
clofazimine, clotrimazole, dapsone, ddC, ddI, ethambutol,
fluconazole, flucytosine, foscarnet, ganciclovir,
ketoconazole, nystatin, paromomycin, pentamidine (aerosol),
pentamidine (intravenous), pyrimethamine, rifabutin,
sulfadiazine, and trimethoprim-sulfamethoxazole.

In addition, the physician advisors to the program have
recommended adding the following drugs: d4T, trimethoprim,
all chemotherapies, megace, itraconazole, G-CSF (Neupogen),
EPO Procrit), alpha interferon, marinol, trimetrexate. Their
highest priority recommendation is d4T. Whether these drugs
are added will depend on their estimated cost to the program,
and whether the money is available.

This year there has been an unexpected decrease in ADAP
expenditures, due to a fall-off in demand for AZT. Exact
figures are not available, apparently due to lack of
statistical staff at the California State Office of AIDS. If
the figures are not provided by December 6 and 7, $1,000,000
held in reserve for ADAP is likely to be transferred to home
and community-based care for persons with AIDS or HIV. [As of
today, the preliminary recommendations for the different
programs are: $15,158,881 for health care and support
services administered through local HIV CARE consortia -- the
50 percent, required by law; $7,449,105 for ADAP; $1,500,000
for CARE/Health Insurance Premium Payment Program; $2,178,000
for Home and Community-Based Care to expand statewide;
$1,515,888 for planning and evaluation, $1,515,888 for
administration, and $1,000,000 in reserve for ADAP.]

These programs are Federally funded by Title II of the Ryan
White Comprehensive AIDS Resources Emergency (CARE) Act of
1990. (Title II pays for state AIDS programs; Title I funds
heavily-impacted cities.) This act authorized funding for
five years, and will expire after 1995 unless it is
reauthorized by Congress. Reauthorization of Ryan White is
perhaps the highest Federal priority of AIDS service
organizations today. [Note: AUTHORIZATION does not by itself
make the money available. Congress must also APPROPRIATE the
funding each year, in competition with other priorities; in
fact, the Ryan White Care Act has never been fully funded (up
to its authorized level). Without reauthorization of Ryan
White, Congress could still authorize and appropriate money
annually for the same purpose, but there would be an
additional fight for AIDS funding every year, and probably
less money would be available.]

Title II Funding Distribution -- Public Comments Sought by
November 15, and on December 6 and 7

Recommendations for distributing Title II money will be
finalized by the HIV Comprehensive Care Working Group, at its
meeting at the Waterfront Hilton Beach Resort, 21100 Pacific
Coast Highway, Huntington Beach, California, on December 6
and 7. A public comment period is scheduled for 9 a.m. on
December 6.

In addition, public comment will be taken on November 15,
from 4 to 6:30 p.m., at hearings in six cities: Fresno, Long
Beach, Oakland, Redding, San Diego, and Ukiah -- or can be
mailed to the CARE Section of the Office of AIDS until
November ll. These comments, unfortunately, will not be
transcribed until after the decisions have been made; instead
they may be summarized for the working group. Public comment
may be more influential at the meeting of the Working Group
itself.

The major decision on the table is how to allocate the money
among three programs: ADAP, AIDS Case Management Program
(CMP), also referred to as Home and Community-Based Care
(HCBC), and CARE/Health Insurance Premium Payment Program
(CARE/HIPP). All of these programs serve people with AIDS or
HIV, and all three are important. The Working Group needs to
hear from those with personal experience with these programs.

For more information about how to have input into the Title
II process, including ADAP funding, contact David Lewis,
Project Inform, 415/558-8669, ext. 225; he is in the office
on Monday, Wednesday, and Friday. Or contact the California
Office of AIDS, 916/327-6804, and ask for time and place of
the Title II hearings on November 15, in one of the six
cities listed above.

Note: Project Inform, ACT UP, and other activists have spent
hundreds of hours improving the California AIDS Drug
Assistance Program. They secured funding increases, and
demanded the establishment of a medical advisory panel,
making possible the addition of 13 of the drugs listed above,
as of April 1994. They also decentralized the program, in San
Francisco at least, and insisted that its existence be
advertised to potential clients.