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Special Edition: October 31, 1997
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PA approves Viracept after ACT UP Halloween threat
Hard on a Halloween deadline set by ACT UP Philadelphia and other AIDS activities, Pennsylvania Public Welfare Secretary Feather O. Houstoun has announced that effectiveSaturday, Nov. 1, the department will add viracept -- the latest protease inhibitor approved by the U.S. Food and Drug Administration (FDA) -- to its Special Pharmaceutical Benefits Program (SPBP) in treating people with HIV/AIDS.
With today's announcement, the state program now covers 57 different types of HIV/AIDS drugs and treatments.
The SPBP program in Pennsylvania provides HIV medications to people who have no health insurance. The state was among the first in the nation to promptly add protease inhibitors to the "formulary" -- the list of drugs available -- when they began to be approved by the U.S. Food and Drug Administration two years ago. However, when Viracept was approved earlier this year, state welfare department policy director Peg Dierkers said that the Ridge Administration wanted to determine the cost impact of adding the drug before proceeding.
Sources at the state Department of Public Welfare (DPW) told fastfax that Dierkers, the former director of the South Central AIDS Assistance Network, has been the primary force in delaying the addition of Viracept to the SPBP formulary. She has been severely criticized by people living with HIV disease over the past year for resisting efforts to assure quality HIV care through the state's mandatory managed care program for Medicaid recipients and delaying added cost reimbursements for highly-expensive AIDS care.
The SPBP, was started in 1987 to help moderate-income people with HIV and AIDS pay for expensive medications. In addition to paying for HIV/AIDS drugs, the SPBP also pays for clozaril, an anti-psychotic medication which is used to control schizophrenia.
"When the FDA approves a drug for the treatment of HIV and AIDS, the Department of Public Welfare goes through a comprehensive review process before we add it to our formulary. This ensures the financial viability of the program and continuation of services to persons already in the program without creating barriers such as waiting lists," Houstoun said. "We are optimistic that viracept can significantly enhance the quality of life for people living with AIDS and HIV.
"Until a cure is found, Pennsylvania will continue to be thoughtful and judicious in its review of drugs to assist people who otherwise might be unable to get the medications they need to survive. We care about helping those living with HIV and AIDS to maintain the best quality of life possible, to remain in their homes and communities and to avoid having to rely on further public assistance if possible."
In a letter to Dierkers, ACT UP Philadelphia delivered an "ultimatum" requiring the state to add Viracept to the drug program and accused the state of refusing to add the drug because it competes directly with a drug manufactured by Merck and Company, which is headquartered in Blue Bell in suburban Philadelphia.
Merck is the most profitable corporation in Pennsylvania, as well as one of the largest. The activist group went on to promise unspecified "tricks" if the drug isn't added by Halloween.
"The state promised to automatically add each protease inhibitor to its drug program automatically after approval. We see once again that the state was lying," said ACT UP's John Bell.
Bell said, "We know that the current administration owes a lot to suburban Philadelphia, where Merck is one of the biggest employers. DPW Secretary Feather Houstoun is really bending over backward to help out Governor Ridge's friends. Why else would the state refuse for almost an entire year to add the drug when it isn't even going to cost them any extra money?"
Adding Viracept to the state's list should contribute only minimally to the growth of the SPBP program, Bell said, because the drugs are priced similarly and people with HIV use one or the other of the two drugs. Doctors are not supposed to prescribe the two together.
Viracept, manufactured by the Southern California firm Agouron Pharmaceuticals, is another protease inhibitor similar to Merck's Crixivan, except that it is much easier to take. It can be taken with food, and the rigid dose scheduling required by Crixivan is not required. In Pennsylvania, Merck's protease inhibitor Crixivan continues to hold the held the lion's share of the protease inhibitor market. However, in areas where Viracept is allowed to compete, Merck rapidly loses market share because most doctors choose to initiate therapy with Viracept, and some encourage their patients to switch to Viracept if they are already on another drug.
"Feather Houstoun [state welfare secretary] has been practicing medicine without a license," said ACT UP's Asia Russell. "She and DPW are making a decision for each person with HIV in the state which drugs they can use. Doctors have written numerous letters stating how their patient's health suffers without access to all available medications. Patients have called to complain, and all DPW says is 'We'll only take longer if you keep bothering us with these phone calls.' Everyone deserves to live, and Feather Houstoun is shortening the lives of people with HIV. We don't care about Merck's market share. DPW must add Viracept to the state's formulary by Halloween or we are going to nail them."
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