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New system changes way HIV patients getting medication

June 17, 2015 MONTGOMERY, ALA. Six months ago, Medical AIDS Outreach's Montgomery clinic needed an entire room to store prescription medications for its hundreds of patients.

Six months ago, Medical AIDS Outreach's Montgomery clinic needed an entire room to store prescription medications for its hundreds of patients.

Now, it needs only a couple of large cabinets.

There's been a significant change in how HIV care and medication are administered in Alabama, and it's giving HIV patients a chance to obtain health insurance.

In January, the state Department of Public Health began purchasing insurance coverage for HIV patients who had none. Public Health is contracting with the United Way of Birmingham to purchase the insurance via Blue Cross Blue Shield.

Previously, the agency was the main conduit for HIV medications, funneling them to patients through the federally funded AIDS Drug Assistance Program. The program provides free HIV medication to uninsured patients, along with free care at designated clinics.

The federal Health Resources and Services Administration allows states to provide health insurance if it is more affordable than supplying just the drugs.

According to state Health Officer Don Williamson, the savings have been significant: Insurance premiums, copays and deductibles run half the cost of purchasing the HIV prescription drugs.

Already, 1,236 HIV/AIDS patients have signed up for the insurance. Another 924 remain on the drug program because they missed the enrollment period.

The insurance covers only outpatient care and prescription drugs; it doesn't cover hospitalization.

Medical AIDS Outreach serves 1,400 patients in 26 counties through four clinics and telemedicine. The clinic treats patients with HIV/AIDS, regardless of their access to insurance, and provides free HIV testing.

Laurie Dill, medical director of Montgomery AIDS Outreach, said that it has seen 105 new patients throughout its network this year.

"(HIV) hasn't gone away in Alabama," Dill said. "Montgomery has some of the highest per-capita rates in the state."

Dill said, "We are seeing it in teenagers. We are seeing it in high school students. We are seeing rural communities where people come in with advanced AIDS. That should not be happening in a developed country."

The Southeast has the highest rates of new infections, but treatment is much better than before, Dill said. People diagnosed in their early 20s will have a near normal life expectancy into their 60s, she said.

Also, those on effective medicines, usually one pill a day, are 96 percent less likely to pass the disease on to someone else, Dill said.

Altogether, an estimated 14,522 people in Alabama have been diagnosed with HIV or AIDS, according to state data.

The Centers for Disease Control recommends everyone from age 16 to 65 be tested at least once in their lives, Dill said. Those having sexual intercourse with multiple partners should be tested more often.

"That's what it is going to take to break the epidemic in Alabama," she said. "Everyone should know their HIV status."

Many of Medical AIDS Outreach's patients are obtaining health insurance for the first time due to health department's new initiative.

There are plenty of benefits, said Alftan Dyson, Medical AIDS Outreach's clinical pharmacist. For example, patients can pick up drugs at pharmacies near their homes, rather than traveling to get them from MAO.

Previously, about 450 patients picked up their medicines at the Montgomery office. Now, that number is down to 150.

Dyson said that she can spend most of her day counseling patients on their medications, stressing the importance of taking them as directed and warning of side-effects.

Dill hopes that the state will take a further step: expanding Medicaid. This would help more poor people obtain quality health care, she said, and get tested for HIV sooner.

Williamson said, however, that the state is struggling to find budget dollars, and trying to cope with a shortage of physicians. Adding 300,000 people to the Medicaid rolls, he said, won't make it easier for patients to receive primary care.

Williamson said that the new insurance initiative for HIV patients is accomplishing good things.

The 2016 General Fund budget vetoed by Gov. Robert Bentley would have cut the state's AIDS Drugs Assistance Program's state funding from $4.5 million to $2 million.

Because of the new insurance initiative, however, the health department would have still been able to provide care for the same number of HIV patients.

The average cost for providing insurance is $400-$500 per patient, compared to $900-$1,000 for the prescription drugs alone.

Williamson said the coverage stretches scarce resources, although he acknowledged that it still leaves gaps.

"It is cheaper," he said. "That means in these budgetary times we are much more likely to continue to be able to serve everybody and not have waiting lists."

About six years ago, he pointed out, Alabama had the longest waiting list in the country for free AIDS medications.

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