A statewide program that pays for medication needed by people with AIDS recently dropped a drug, ganciclovir, that prevents blindness.

The Assistance for AIDS-Specific Drugs (AASD) program was established in 1989 to give Colorado's AIDS patients quick access to some medicines, eliminating much of the paperwork and many of the delays involved in going through drug companies' patient-assistance programs. Although most of the pharmaceutical companies that manufacture AIDS-specific drugs will fill some prescriptions free of cost, they usually require that private physicians complete numerous forms, and they may take weeks to deliver the drugs--when time is of the essence.

The human immunodeficiency virus that causes AIDS destroys the immune system, leaving an infected person susceptible to a host of opportunistic diseases. Some of the afflictions come and go on their own, slowly wearing down the patient's defenses; others can attack and kill or debilitate within a few days unless checked by treatment. That's when easy access to certain medications can be a literal lifesaver. Under AASD, AIDS patients can get fourteen different drugs, including some of the most necessary, difficult to obtain and expensive ones.

To participate in AASD, which is administered through the University of Colorado's University Hospital, a patient must test positive for the human immunodeficiency virus that causes AIDS and also qualify as medically indigent. If he meets those two requirements, he can have a prescription for one of the program's listed drugs filled immediately at Denver General Hospital's ID/HIV pharmacy or by mail through University Hospital in just a few days.

AASD, which has about 700 clients, runs on a skeleton budget: Every cent goes to pay for drugs, mailings, a toll-free telephone number or the salary of program manager Pam Snyder. When the program's federal funding dropped from $411,000 a year ago to $284,000 this year, there was no fat to cut. (AASD also gets $150,000 directly from the Colorado Legislature.) Facing a shortfall of $42,000, Snyder says, the program's advisory council had only two options: turn away clients or take a drug off the list.

The council decided to remove ganciclovir, a drug that combats CMV retinitis, a viral infection that can cause blindness and even death in AIDS patients. AASD spent about $50,000 a year on ganciclovir for 25 patients.

"Our main goal is to never turn someone away," Snyder says. "So they went with the lesser of two evils, still a difficult decision, and removed the medication, which was expensive and benefited only a few people."

And at least those patients have an option--for now. Roche, the pharmaceutical giant that produces the drug, has a patient-assistance program that supplies ganciclovir relatively quickly. Both University and DGH pharmacies have already tied into the Roche program so that their patients won't have their treatment interrupted.

Still, the fact that AASD cut a drug from its list sets a frightening precedent, according to Jeff Davis, a boardmember on Denver's People With AIDS Coalition. "If they can cut one," he says, "they can cut another." And there's no guarantee that drug companies will continue their patient-assistance programs; there's been some discussion in the past of eliminating them, Davis notes.

AIDS agencies and activists are particularly nervous these days because the Ryan White CARE Act, which authorizes federal AIDS funding, is about to expire. Although President Bill Clinton has asked for a five-year reauthorization, some lawmakers, notably Senator Jesse Helms, argue that the government should spend less on AIDS. Any decrease would certainly be felt at the local level, where agencies already fight over limited funding.

"Priorities change for people with AIDS every day, depending on where they are in their lives," Snyder says. "One day it may be transportation. One day it's food. I'm not saying drugs are the highest priority. I don't know what is...Unfortunately, there's only one pot of money.


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