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Issue #174: April 26, 1998
fastfax is available by fax in the 215 and 610 area codes at no cost, or by mail anywhere for $20.00 per year, by calling 215-545-6868, and by E-mail by contacting and type the message SUBSCRIBE in the message section. Sources for some information in this issue include the Los Angeles Times.Rite Aid pledges access to AIDS drugs; reimbursement crisis continues
Advocates decry Clinton stand on needle exchange
Action AIDS "Wellness" schedule announced
Rite Aid pledges access to AIDS drugs; reimbursement crisis continues
Responding to a demand from the Working Group on HealthChoices and HIV, a regional manager for Rite Aid, the area's largest pharmacy chain, has agreed to fully stock its stores with drugs used by people living with HIV/AIDS and expedite access to the drugs for their customers.The controversy arose after reports by PWAs that some Rite Aid stores were telling them that they did not have AIDS medications in stock, or requiring them to wait from six hours to many days before filling prescriptions. Other complaints involved refusal by pharmacists to contact the state's Special Pharmaceuticals Benefits Program (SPBP), which covers the cost of AIDS drugs for the uninsured, and reducing payment rates for some drugs so as to make it almost impossible for pharmacies to carry the drugs.
Other advocacy groups, including those representing the American Association of Retired Persons, have also complained that Rite Aid pharmacies are making it unnecessarily difficult for consumers to obtain drugs they have been prescribed by a doctor.
Robin Canada, coordinator of the region's Community AIDS Hotline, said that "consumers call the hotline in distress because they are unable to obtain protease inhibitors, Biaxin or fluconazole. These are life-saving medications for persons living with HIV/AIDS. Consumers are scared. While doctors talk about advances in the treatment of HIV and AIDS, people are getting sick because they cannot access routine medications. Therefore, these advances are of little consequence for the poor and those on public assistance."
The city estimates that over 70% of people with HIV/AIDS in the region are low-income and rely on Medical Assistance for their primary care.
:Accessibility of HIV drugs is crucial to people living with HIV/AIDS," said a statement issued by the Working Group. "HIV medications, especially anti-viral drugs which combat HIV, must be taken on an extremely strict regimen. These drugs are taken at least three times a day with rigid dietary guidelines. Missing even one of these dosages can contribute to viral resistance as medication-resistant viral strains will replicate. Consequently, when a person begins taking the drug again, the drug will be ineffective against these new, resistant viral particles. In sum, inability to access HIV medications threatens the overall health and survival of people living with HIV/AIDS."
Joan Curran, associate executive director of ActionAIDS, reported to the Working Group that an ActionAIDS client was forced to wait three days by a Rite Aid pharmacy in West Philadelphia in order to get a prescription for 3TC. Another West Philadelphia Rite Aid refused to fill a prescription for Procardia, a heart medication, and refused the customer's request that the pharmacist contact the patient's doctor for confirmation of the prescription. Still another was given a generic drug in place of a prescribed medication, which the consumer was afraid to take because he was given no explanation for the replacement and wasn't confident it was the right drug.
In a related matter, a company called Eagle Managed Care, a Rite Aid subsidiary, has announced that it will significantly lower reimbursement rates for some Rite Aid pharmacies who serve members of Keystone Mercy Health Plan, the largest of the HealthChoices Medicaid managed care companies. Eagle manages Keystone Mercy's prescription plan. Many pharmacies have said that they cannot accept the lower reimbursement rates because they lose too much money on the drugs, with the result that they will not be able to provide AIDS medications to Keystone Mercy subscribers once the new reimbursement plan goes into effect on May 1st.
Marc Garber, owner of Haussmann's Pharmacy, said that he often receives referrals from Rite Aid pharmacies when a patient presents a prescription for AIDS-related medications. He said that the referrals indicate that while Rite Aid is reducing reimbursement rates through Eagle Managed Care, they are then referring patients elsewhere so that their own pharmacies won't lose money on the new policy.
Because of the new reimbursement rates, "many pharmacists cannot, and will not, fill prescriptions for people with HIV or AIDS," Garber said. "Access will be limited and patients will suffer and die." Haussmann's serves about 100 people with HIV/AIDS, Garber said.
"A lot of my patients are upset and nervous about the new reimbursement rates, and many are too sick to understand," he said. "Their HMO is giving up on them."
In a letter to the Philadelphia Inquirer, Sam Brog, director of the Philadelphia Association of Retail Druggists, said that "managed health care's inadequate reimbursement rates to pharmacy providers...cause many pharmacists to sell to the chains and close down in communities where they are most needed."
At a meeting with the Working Group and the AIDS Law Project of Pennsylvania on April 9th, Rite Aid regional manager Edward Huschen said that Rite Aid had looked into some of the problems and would now guarantee that all Delaware Valley Rite Aid pharmacies are now "overstocked" with HIV/AIDS medications and will continue to assure that they are fully stocked to meet future demand.
Huschen said that if a medication is not available at a particular pharmacy when a customer requests it, it will take "at most" five or six hours for the pharmacy to obtain it. He said that he has instructed pharmacies to contact his office directly if they do not have a drug in stock, and that his office will be responsible for making it available within that time frame.
Huschen also said that if coverage of a protease inhibitor, the major component of the three-drug combination that has proven effective for most people with HIV/AIDS, is denied for a Medicaid recipient when a pharmacist enters it into the computer, pharmacists will now be instructed to fill the prescription through the state's Access program, rather than attempting to fill it through the Medicaid HMO. Pharmacists will be able to confirm the customer's Access eligibility by using the Access card or contacting the Clinical Sentinel Hotline, which has been established by the state Dept. Of Public Welfare to address clinical emergencies resulting from HealthChoices.
The Rite Aid manager said he would also instruct all Rite Aid pharmacies on how to use the SPBP to pay for prescriptions and where to go to get assistance if they have problems utilizing the program.
Huschen said that Rite Aid pharmacists have also been authorized to provide an emergency 72-hour supply of prescribed AIDS medications while billing disputes are being resolved. The 72-hour supply is guaranteed under HealthChoices regulations, but many Rite Aid pharmacies were either unaware of the provision or refused to follow it. He agreed that pharmacists will contact the prescribing physician when these incidents occur to assure that the doctor is part of resolving the problem.
Rite Aid will be establishing a 24-hour hotline for pharmacists to offer assistance in resolving coverage problems with HealthChoices prescriptions, Huschen said. The hotline, which will be functional by May 1st, will only apply to the Philadelphia region, although Huschen said he would recommend to Rite Aid's corporate headquarters in Harrisburg that it be extended statewide. He also said that special training for pharmacists at Rite Aid pharmacies on HIV/AIDS will be provided, and agreed to accept a proposal from the Working Group on how the training can be conducted.
Huschen said he would transmit his agreements to the regional manager for Rite Aid in Montgomery County in order to assure that residents of that area were entitled to the same protections.
Huschen announced that Rite Aid pharmacists had been instructed not to sign a pledge that had been sent by the Working Group to all Rite Aid pharmacies which called for them to commit to assuring that they would make AIDS drugs available on demand to covered Medicaid recipients. He said that his company objected to some of the language of the pledge, but would propose an alternate version that the pharmacies would be authorized to sign.
Advocates decry Clinton stand on needle exchange
Paul Akio Kawata, Executive Director of the National Minority AIDS Council, while noting that the Clinton Administration has taken a step forward by formally recognizing that needle exchange programs reduce HIV infections among injection drug users and do not encourage the use of illegal drugs, says that "tens of thousands of additional lives may now be lost because President Clinton and Secretary Shalala have abdicated their leadership role by not allowing Federal funding of these critical needle exchange programs.""By leaving states and localities to fund these programs on their own, the federal government is effectively denying this lifesaving intervention to thousands of Americans at risk for HIV/AIDS."
The Clinton administration declared this week that needle exchange programs reduce the spread of AIDS and do not encourage illegal drug use -- but it will continue to oppose federal funding for this approach, a decision that provoked anger on both sides of the long-raging debate.
"It is long past time for the President and Secretary Shalala to let public health, and not politics, determine our national agenda to fight AIDS, and to put the weight of the federal government behind these lifesaving programs," Kawata said.
Health and Human Services Secretary Donna Shalala said that, although the administration has concluded that it is best to leave the funding of such programs to state and local sources, she encouraged communities to include needle exchanges as part of their AIDS prevention strategies.
"This is like acknowledging the world is not flat, then refusing to fund Columbus' voyage," said Daniel Zingale, executive director of AIDS Action Council, a Washington-based lobbying group.
Congressional conservatives, meanwhile, expressed chagrin over the administration's ringing endorsement of needle exchange programs. Sen. John Ashcroft (R-Mo.) said that the administration's expression of support "accepts and encourages drug use as a way of life." He also expressed concern that "it opens the door" to future federal funding of needle exchange programs.
Numerous studies have shown the efficacy of such programs but the subject of government-backed needle exchanges has remained a politically volatile one. Not only have conservatives adamantly opposed such programs but President Clinton's own advisors have
argued heatedly over whether to support them. Barry R. McCaffrey, director of the White House office of drug control policy, for example, has insisted that such programs send the wrong message about drug use.
The administration's announcement was reminiscent of Clinton's past approaches to some hot-button issues -- gays in the military, for example -- where he has attempted to strike a middle ground that pleased few.
Federal funding of needle exchange programs was banned by Congress in 1988 but the secretary of Health and Human Services has the authority to remove the ban. Many public health officials, AIDS activists and others -- including Clinton's own AIDS advisory panel -- have called on her repeatedly to do so.
Armed with new scientific findings by high-ranking administration health officials showing that the programs help reduce HIV transmission, Shalala was willing to defend funding the programs before lawmakers on Capitol Hill, sources said.
But White House officials said they doubted they could win such a fight with the GOP-controlled Congress and were afraid that the battle would dampen state and local efforts to establish or sustain the programs.
Funding efforts "would have been voted down immediately and you would have scared off the local people," White House advisor Rahm Emanuel said.
Ultimately, Clinton decided that it was not worth the fight with Congress, sources said. Referring to the politics surrounding the issue, Emanuel said, "You've got to see three, four or five moves down the checkerboard." And Clinton, by endorsing the concept that needle exchanges help reduce HIV transmission, hopes to boost local efforts to fund needle exchanges, he said.
But AIDS activists predicted that it would have the opposite effect, saying they feared local programs now will founder without federal help.
Clinton's decision "has the potential to do damage to the funding that exists today," said James Loyce Jr., chief executive officer of AIDS Project/Los Angeles. "The funding is barely there now. The local governments, such as Los Angeles, that have taken [needle exchanges] on have already taken a big risk -- this will only undermine the advocacy that's already been done on the local level."
Shalala noted that the use of needle exchange programs has increased throughout the AIDS epidemic. Citing figures from the CDC, she said communities in 28 states and one U.S. territory operate needle exchange programs supported by state, local or private funds. In Philadelphia, only one needle exchange program -- Prevention Point Philadelphia -- operates with public funds, a small grant awarded by the city Health Department. That grant has come under heavy fire by members of Philadelphia City Council, including Republican Frank Rizzo, Jr., who is rumored to be contemplating running for Mayor next year.
Shalala said the administration decided "that the best course at this time" is to leave the creation and funding of needle exchange programs to communities and "to communicate what has been learned from the science so that communities can construct the most successful programs possible to reduce the transmission of HIV."
She said the programs should be part of a comprehensive HIV prevention strategy that includes referring participants to drug treatment and counseling and that needles must be made available only on a replacement basis.
Rep. Nancy Pelosi (D-San Francisco), a longtime advocate of needle exchange programs, said the administration's stance "shows a lack of political will in the midst of a public health emergency." And Rep. Henry A. Waxman (D-Los Angeles) said "it is unfortunate that fear of congressional backlash sustains the funding freeze."
But Rep. Gerald B. H. Solomon (R-N.Y.) condemned the administration's "seemingly continued support for such programs" and urged administration support "in pursuing a permanent ban on the use of federal tax dollars for needle exchange programs."
Kawata said that the National Minority AIDS Council (NMAC), a national coalition of organizations combating AIDS in communities of color, believes the federal government must go much further in developing a proactive public policy response to the devastation wreaked on communities of color by the twin epidemics of HIV and substance abuse. "NMAC believes that needle exchange programs are a key component of a comprehensive strategy to reduce HIV infections that must, to be widespread and effective, be funded by the federal government. Failure to provide these funds is an abdication of responsibility by the federal government."
Approximately half of all new HIV infections are occurring among injection drug users in the United States. As of June 1997, the Centers for Disease and Prevention (CDC) reported that people of color account for 72% of the male and 78% of the female cumulative AIDS cases directly and indirectly related to injection drug use. The African American community is most severely impacted by injection drug use, which contributes directly to 38% of all adult/adolescent cases of AIDS in this community. An additional 10% of all AIDS cases among African Americans are attributed to having a sexual partner who is an injection drug user. AIDS is the leading cause of death among African Americans between the ages of 25-44 years.
There is now broad based support across the United States for needle exchange programs. Legislative leaders, including Representative Maxine Waters, Chair of the Congressional Black Caucus, Representative Xavier Becerra, Chair of the Hispanic Congressional Caucus, and the National Black Caucus of State Legislators favor needle exchange programs and have called on Clinton to make available federal funds for these programs.
Leading national organizations, including the American Medical Association, the American Public Health Association, the American Psychological Association, the Association of State and Territorial Health Officials, the American Nurses Association, the National Academy of Science, the Presidential Advisory Council on HIV/AIDS and the American Bar Association also support needle exchange programs.
Action AIDS "Wellness" schedule announced
April workshops in the "Maintaining Wellness Series" sponsored by ActionAIDS' ACT Program have been announced by series coordinator Kevin D. Greene. All workshops are participatory with pre-registration required, Greene said.This month's offerings include:
April 8, 13, 15, 20, 22, 27, 29 @ 3:00 p.m. - 5:00 p.m.
Qi Gong Series
"Qi Gong is the art of developing vital energy for health, vitality, mind expansion and spiritual cultivation." How can you have more energy, shake off depression, and decrease some of those aches and pains? Qi Gong! This class is powerful! Daily Practice gives best results.
Mondays April, 6, 13, 20, 27* @ 6:00 -- 7:30 P.M.
Reiki Sharing: Come experience a Reiki Treatment!
Reiki is a form of healing energy used to promote wellness. This "laying on of hands" technique will cause deep relaxation, decrease anxiety, pain, and stress.
Thursday, April 16 @ 6:00 p.m.- 7:30 p.m.
What Does Research Say about Prayer and Healing?
Discusses the power of prayer regardless of religion, prayer as a self healing tool and more. Note recent publications by Larry Dossey, M.D.- "The Power of Prayer and the Practice of Medicine" and "Prayer is Good Medicine: How to Reap the Healing Benefits of Prayer." Discussion follows short presentation.
Thursday April 9, 23, @ 6:00 - 7:30
Yoga- Energizing and Calming!
Yoga is a system of stretching and breathing that improves the flow of energy in the body when it is done as a part of your daily self care routine.
Wednesday April 22 @ 6:00 - 8:00 p.m.
Long Term Survivor Panel
Some folk have been living a long time with HIV and some with AIDS. Can you have AIDS for 10 - 15+ years and have good health? Come hear some unusual survival stories, and share your own. If you are newly diagnosed, fearful or wondering this panel may have something to offer you. (Register early. Space is limited.)
Thursday, April 30, @ 6:00 p.m. - 8:00 p.m.
Healing Touch Workshop
Pam Ladds, RN is a Healing Touch Practitioner who teaches clients, staff, social workers and everyday people how to perceive, and manipulate the human energy field to relieve pain and promote healing. Come learn ways to nurture yourself and each other through Healing Touch. This will be an experiential session!
Tuesday 7, 14, 21, 28 1998 @ 5:30 - 7:30 p.m.
"Unlimited Power -- Tapes #15-18
Do you want to learn how to improve your outlook on life? This $200.00 tape series is available for your listening education free of charge. Relax, Listen and learn. Anthony Robbins is the best selling author of "Unlimited Power," and other success focused technology.
For more information or to pre-register call Kevin D. Greene, ACT Program Coordinator at or 215-981-3330. ActionAIDS is located at 1216 Arch Street, 6th Floor, Philadelphia, PA 19107.
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