[Ip-health] 2011 proposal from CHAI for expanding access to HIV drugs in USA

Jamie Love james.love at keionline.org
Fri Oct 14 11:01:01 PDT 2016


I found this interesting, from the wikileaks leaks of Podesta emails:

Ira Magaziner,

"If President Clinton wishes, CHAI could build on the Welvisita model to
expand this program to reach all people living with HIV living at or below
500% of the FPL.   CHAI would not attempt to run this program directly but
would work with a group like Welvista to build their capacity to support
such a program, to raise the funds needed to sustain such a program, and to
negotiate with the pharmaceutical companies to participate."

"We think that PhRMA could be an appropriate organization to fund and/or
house a central application clearinghouse but would also engage Welvista
and NASTAD, who have been the major players in this space to date."

https://www.wikileaks.org/podesta-emails/emailid/7739

---------- Forwarded message ----------
From: Amitabh Desai <adesai at clintonfoundation.org>
Date: Mon, Dec 19, 2011 at 10:06 PM
Subject: For WJC: memo from Ira on Domestic HIV
To: Hannah Richert <hrichert at clintonfoundation.org> Cc: Bruce Lindsey <
blindsey at clintonfoundation.org>, Laura Graham <lgraham at clintonfoundation.org>,
Doug Band - PC <doug at presidentclinton.com>, Justin Cooper - PC <
justin at presidentclinton.com>, "john.podesta at gmail.com" <
john.podesta at gmail.com>

------------------------------------
From: Ira Magaziner
To: Amitabh Desai
Sent: Mon Dec 19 19:46:29 2011
Subject: FW: Domestic HIV - Memo for President Clinton

Ami:

Attached is a proposal for a program that CHAI could implement in the first
quarter of 2012 that would help expand coverage for people with AIDS in the
US who are now unable to access affordable drugs. We have done enough
research to feel that we have a decent chance of success Please forward to
President Clinton to see if he wishes us to proceed.

Thanks  Ira

December 19, 2011 Memo, from CHAI.


​As a follow-up to President Clinton’s request that CHAI consider how we
might engage to help close the treatment gap in the United States, we have
evaluated a number of different options.  These options were evaluated
based on an expected probability of success and potential risk to CHAI’s
primary mission.  We focused our evaluation on various drug related
interventions that one could make to get treatment to more patients.  We
did not evaluate non-drug interventions beyond what we presented in our
last memo on the subject.

Based on this analysis, we would recommend that President Clinton and CHAI
focus on supporting pharmaceutical companies to expand the reach of their
existing drug donation programs.   This would involve creating and
publicizing a central clearinghouse organization that would act as a
“one-stop shop” for patients who do not have adequate insurance coverage
and who cannot otherwise afford the required medication.  This organization
would work with  drug companies to evaluate patient’s eligibility for
Pharmaceutical Assistance Programs (PAPs) and would streamline the process
for patients to apply for assistance under these programs.

 Background and Rationale

Antiretroviral treatment in the United States is extremely expensive with
patients in the US paying an average of $15,000 for a year of medication
and patients that access drugs in the private market paying significantly
above this average cost.  While 17% of PLWHA have some level of private and
53% have government supported health insurance, 30% are completely
uninsured.  Furthermore, eligibility criteria and other insurance policy
restrictions limit the extent to which ARVs are covered under existing
plans.  The 2010 Affordable Care Act closed many of these insurance
loopholes and many more patients will have their drug costs covered by
Medicaid and other programs when the bill is fully implemented in 2014.
Until then the AIDS Drug Assistance Program (ADAP) acts as the primary
safety net for people in need.  ADAP is a federally designed, state
administered program that pays for drugs and diagnostic products for
patients who otherwise cannot afford them.  Since ADAP is a discretionary
program that is co-financed by the federal and state government, it has
been hit hard by the financial crisis both through budget cuts and
increasing enrollment rates.   This has resulted in two problems;

Waiting list for ADAP programs- Over the past several years, many states
have had to cap their programs at a set enrollment level and to put people
on waiting lists until patients in the program die or gain the means
Clinton Health Access Initiative
383 Dorchester Ave, Suite 400, Boston, MA 02127
Tel: 617-774-0110 · Fax: 617-774-0220

to pay for drugs through another funding source.  As of December 15th,
2011date, there were 4,333thousand people on waiting lists for the ADAP
programs in 12 states.

2. State by state cost containment measures limiting the # of people
eligible for ADAP- When the economy was strong anyone living at 500% of the
FPL was eligible for the ADAP program in most states (as of the  2011
guidelines, this  translates to an annual income of $111,750 for a family
of four).   Over the past number of years, many states have responded to
ADAP budget cuts by reducing the income eligibility threshold for this
program based income availability rather than need.  The National Alliance
of State and Territorial AIDS Directors (NASTAD), which represents the
State Health Agency staff responsible for administering HIV related
programming, believes that the number of people impacted by this change is
significant but there is not good data available to help quantify the
impact of this change.

Pharmaceutical companies have helped to address this problem by donating
their drugs to patients who cannot otherwise afford them through
Pharmaceutical Assistance Programs (PAPs). In most cases these programs
have more generous eligibility criteria than many ADAP programs (500% of
the poverty level in all but one company’s case). However, in order to get
drugs, each patient has to individually apply to each company’s PAP
program, up to three per regimen, which can be complex and time consuming.
The programs are also reportedly not well understood by patients.  As a
result they have been relatively limited in scope.  For example Gilead,
which has one of the largest donation programs, currently serves only
13,000 people.

In response to the recent highly publicized ADAP waiting list crisis, the
pharmaceutical companies have come together in partnership with Welvista, a
non-profit organization that has provided ARVs to PLWHA in South Carolina
for fifteen years, to create a simplified central ordering system for their
drugs.  Welvista effectively acts as mail-order pharmacy for uninsured
patients and provides a single place for them to go to access drug company
donation programs for all of the ARV drugs they need in one place.  If this
program was effectively marketed, it would therefore solve the ADAP waiting
list problem from an ARV drug perspective.  However, this program is only
available to people on ADAP waiting lists and does not solve the access
problem for people living in states where the ADAP program itself has
limited reach (there are currently only six states that have maintained an
eligibility standard at 500% of the FPL) and it does not include all drugs
or diagnostic products required by PLWHA to maintain their health.


Recommendation

 If President Clinton wishes, CHAI could build on the Welvisita model to
expand this program to reach all people living with HIV living at or below
500% of the FPL.   CHAI would not attempt to run this program directly but
would work with a group like Welvista to build their capacity to support
such a program, to raise the funds needed to sustain such a program, and to
negotiate with the pharmaceutical companies to participate.

Pharmaceutical companies are likely to be receptive to this concept, and it
has even been proposed by Gilead.  We think that PhRMA could be an
appropriate organization to fund and/or house a central application
clearinghouse but would also engage Welvista and NASTAD, who have been the
major players in this space to date.  If we wanted to pursue this option we
think we could do so quickly and have something done on this in the 1Q12.

We believe that we can accomplish this work without requiring extra budget.

Beyond this, we could consider more expansive activities of the sort
detailed in the memo we sent to President Clinton two weeks ago. But that
would require a significant budget and a major departure from current CHAI
work. We can consider that at a future time.

​

-- 
James Love.  Knowledge Ecology International
http://www.keionline.org/donate.html
KEI DC tel: +1.202.332.2670, US Mobile: +1.202.361.3040, Geneva Mobile:
+41.76.413.6584, twitter.com/jamie_love



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