Patient Costs of HIV in 2012

The standard treatment for HIV or AIDS consists of drugs that need to be taken daily for the remainder of the individual’s life. While these drugs do not cure the disease, they do stop the infected person from becoming ill and prolong their life. The medicines work by keeping the HIV in the body at minimal levels, which in turn prevents the weakening of the immune system and permits the body to repair any damage incurred. The drugs are most commonly referred to as antiretrovirals, or ARVs.

Normally, a minimum of two drugs are prescribed at a time, because with one drug, the HIV becomes resistant quickly and stops working. Taking a combination of two or more drugs is called combination therapy and it increases the chances of success. There are more than twenty approved ARVs belonging to five different classifications available on the market – not every drug is available everywhere and not all are licensed. Each different group of drugs attacks HIV in a diverse way. Initially, an individual is given a combination of drugs known as first line therapy. However, if HIV becomes resistant, then a second line of therapy is started which usually includes a minimum of three new drugs.

For individuals who are tested positive for HIV, the biggest expense will be the drugs they will have to take for the rest of their lives. While effective, they are very expensive, costing $13,000 a year per patient on average. Planning how to pay for them can be a challenge especially for those living on a budget. There are a number of programs available that help to share the cost of treatment, but not everyone may be eligible for every program.

The federally funded AIDS Drug Assistance Program (ADAP) is a type of payer of last option. The program makes available free prescription medicines to patients and in few situations may even pay for health insurance premiums, medical or hospital bills and maintenance for those with HIV/AIDS, if no other source of income is available. However, due to budget constraints the federal funding is being cut, so many people who were previously eligible for this program will no longer be able to benefit from it. The previous eligibility limit was 500% of the federal poverty limit, which as of July 1, 2011 is being lowered to 300%. Those people who no longer meet requirements of the ADAP program will be kept on waiting lists.

Viiv Healthcare is launching a Healthcare Patient Assistance Program raising the maximum household income ceiling so individuals can get lifesaving HIV drugs. It is also running a pilot membership project, the Welvista program for individuals currently on ADAP waiting lists who may become eligible for access to HIV drugs. Additionally, their Patient Savings Card program makes it easier for patients to stick to their medications by cutting their out-of-pocket costs. This is done by filling or refilling prescriptions available at ViiV Healthcare.

For individuals who are HIV positive and have no insurance, getting insurance may become difficult and expensive. The best way around this is to find an employer with fifteen or more employees. Federal law (the Americans with Disabilities Act) gives all employees the same benefits. In such an instance, HIV cannot be pulled out. While it is possible for insurance plans to exclude individuals with serious illness, the large group plans hardly ever do this. Laws differ slightly from state to state, so this needs to be checked.

Many of the large drug manufacturing companies have their individual co-pay programs for HIV medicines they make. While eligibility criteria and amount of savings offered by the various manufacturers differs, it is possible to save up to $400 per prescription. They provide coupons which may be used up to a dozen times before expiry date. Manufacturers are being asked by different associations to provide rebates to further cut the cost of medicines. This will allow more infected people access to the drugs, so the company will not lose financially and more people will be treated.

Treating AIDS is the most efficient tool that prevents further infections. People with successful treatments have fewer HIV viruses in their systems, so they are less likely to infect others. Also, the sooner people find out if they are HIV positive, the better their chances of successful treatment and a longer life. Catching AIDS in time and starting treatment can also lead to a better quality of life instead of just ignoring it.