The list: Waiting for medicine

October 13, 2008 

South Carolinians who have HIV/AIDS and little or no insurance rely heavily on a public drug assistance program that keeps them alive and healthy enough to work.

Only recently has the state begun to contribute substantial amounts toward the effort.

For 10 years beginning in 1996, South Carolina had provided only $500,000 annually to the AIDS Drug Assistance Program, which is mostly federally funded and has an annual budget of more than $14 million.

The program helps people with little or no insurance get life-saving drugs.

Even as other states increased their contributions in later years — $12 million, $11 million and $5 million in state funds spent by North Carolina, Georgia and Alabama, respectively, in 2006 — South Carolina’s remained low. That year, the state’s allocation amounted to approximately 3.5 percent of the program’s $14.4 million budget.

In mid-2006, federal cuts led to a $3 million shortfall that forced public health officials to put people on a waiting list. In a year, the list grew to 600 names.

Deadra Lawson Smith went on the list when her insurer wouldn’t pay for medicines and a drug company patient assistance program turned her down because she had insurance.

So she went without medication for eight months. Her skin flaked off; she developed pneumonia. She became depressed, which worsened her condition.

When her insurer eventually began to pay her claims, her name came off the waiting list.

Lawson Smith is proud to work for a living, but sometimes, she says, she just needs a little help: “I’m not looking for a handout,” she says. “I’m just looking for a hand up.”

During the crisis, program administrators called in the U.S. Department of Health and Human Services to find ways the program could be made more efficient.

A consultant concluded that the program didn’t spend excessively but still managed to make a variety of drugs available.

“It was good news and bad: We were doing everything right, but there was nothing (more) we could do,” said Noreen O’Donnell, who directs DHEC’s Ryan White program, under which the state’s drug assistance program falls.

Patient-assistance programs offered by pharmaceutical companies could help only so much.

Not everyone who applied for help qualified, and those who did received only 30 days’ worth of medicine before they had to apply again.

That meant a patient’s supply of medicines could start and stop, and start and stop, which can lead to drug resistance and deadly complications.

After intense lobbying by HIV/AIDS advocates and sympathetic lawmakers, the Legislature approved $4 million for the drug program in 2007 and an additional $2.4 million in 2008.

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