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The HIV Medicine Association (HIVMA) says it is pleased to see a key Senate committee putting medical care first in a new bill to reauthorize the Ryan White CARE Act, the federal government's largest program for uninsured or underinsured people living with HIV/AIDS. However, the bill the Senate Health, Education, Labor and Pensions Committee approved earlier this week could lead to rationing of medications unless it is funded appropriately. And it does nothing to reverse the growing shortage of qualified HIV care providers.
"Unlike 16 years ago, when the CARE Act was first written, people can live for decades with HIVbut only with the right medical care," said HIVMA chair Daniel R. Kuritzkes, MD. "But currently the CARE Act does not give medical care the priority it deserves. This new reauthorizing bill helps to fix that problem by focusing on providing access to vital care to those in this country who, even today, aren't getting it."
Last April, HIVMA and the AmericanAcademy of HIV Medicine (AAHIVM) released joint recommendations designed to bring the CARE Act in line with today's HIV/AIDS epidemic, where fewer people are dying of AIDS but growing numbers are living with HIV and needing lifesaving medications and medical care.
HIVMA says it is pleased to see lawmakers have incorporated these recommendations into the bill. The bill, S. 2823, would require organizations receiving CARE Act funds to spend at least 75 percent on core medical services including physician's visits, medications, laboratory tests, and othersa list which very closely matches HIVMA and AAHIVM's priorities.
"Access to core medical services is one of the most important issues for patients," said Anita Vaughn, MD, an HIV physician in Newark, N.J., and chair of HIVMA's Ryan White CARE Act reauthorization work group. "But it's practically impossible to expect patients to stick to their drug therapy without managing other important issues as well, such as substance abuse and mental health concerns," Vaughn said. "We're extremely happy lawmakers recognized this and included substance abuse and mental health treatment as core medical services."
The bill includes another provision topping HIVMA's priority list: establishing a minimum set of anti-AIDS drugs for state AIDS Drug Assistance Programs (ADAPs) to offer. However, HIVMA is very concerned that there will be unintended consequences if the federal government fails to provide the additional funds needed.
"If the ADAPs are required to expand their medicine chests without getting any more money to do so," Kuritzkes said, "they may end up offering a wider variety of drugs but able to offer them to fewer patients." Chronic underfunding has already left some ADAPs with patients on waiting lists for drugs. More could find themselves in this situation, or having to cap the amount of medication a patient could receive. "ADAPs need much more funding to avoid worsening a situation HIVMA has called on lawmakers to end," Kuritzkes added.
Furthermore, the focus on care that legislators wrote into the reauthorization bill will be wasted if there aren't enough qualified HIV care providers to prescribe drugs, monitor resistance, deal with adverse reactions, watch vital organ function, and otherwise manage this extremely complex disease. HIV practices are closing as physicians burn out, retire, or close their practices due to under-funding and budget cuts. And very few physicians are stepping in to take their places.
"In many areas, it's becoming a crisis situation to find qualified medical providers to care for people with HIV/AIDS," Vaughn said. "New training programs are badly needed to entice young talent into the field." The bill misses an opportunity to address the shortage of qualified HIV care providers that is just around the corner.
The bill was drafted by leaders in both the Senate and the House of Representatives and has bipartisan support, which suggests it will move quickly. HIVMA calls on lawmakers to add provisions to fund training programs in HIV medicine and loan forgiveness programs in exchange for service in underserved areas and to guarantee that ADAPs have the federal support that they need to provide lifesaving medications to everyone with HIV in the United States who needs it.