Subject: Medicaid Coverage For AIDS Drugs Is Found to Vary 
Date: Published: 5/26/89 (70 lines)
Source:  Wall Street Journal.  Copyright Dow Jones & Co. Inc. 

    Technology & Health:  
    Medicaid Coverage
    For AIDS Drugs
    Is Found to Vary
    ----   
    By Marilyn Chase
    Staff Reporter of The Wall Street Journal

    A nationwide survey of state Medicaid agencies reveals
 wide inconsistencies in the coverage for drugs used to treat
 acquired immune deficiency syndrome.
    National Gay Rights Advocates, a public interest law firm,
 surveyed the policies of all 50 state Medicaid agencies and
 found sharp variations in their reimbursement policies
 respecting seven drugs commonly used to treat AIDS and
 related infections, including the antiviral drug AZT and
 pentamidine for AIDS-related pneumonia.
    "The survey points out broad inequities within the
 Medicaid system as a whole, and points out the need for
 national coordination" of AIDS drug coverage, said attorney
 Benjamin Schatz, director of AIDS Civil Rights Projects at
 the law firm, which is based in San Francisco.
    He added that "this isn't some abstract debate about
 reimbursement.  This is life and death for thousands of
 Americans."  About 40% of AIDS patients are dependent on the
 joint federal-state program to meet their health needs.
    The report notes, however, that "one clear and encouraging
 pattern emerges from the confusion:  most Medicaid agencies
 are willing to look well beyond (Food and Drug
 Administration) labeling indications to determine their
 AIDS-related drug distribution policies."
    For example, more than 40 states said their programs would
 pay for the drugs Fansidar and Dapsone to treat AIDS-related
 pneumonia, even though neither drug technically is labeled
 for this use.  Similarly, 37 states covered the aerosol form
 of pentamidine for AIDS pneumonia, even though at the time of
 the survey it was only licensed in its injectable form.
    One finding cheered by the survey team is the fact that
 most state agencies covering a drug will make the drug
 available to people regardless of their stage of AIDS
 infection.  Thus, of the 49 states covering AZT for people
 with AIDS, 41 also pay for the drug for Medicaid recipients
 who are infected by the virus but still healthy.  Many such
 "asymptomatic" people take AZT as an AIDS preventative, even
 though tests validating such use remain incomplete.
    Similarly, 30 of 37 states that pay for aerosol
 pentamidine to prevent pneumonia in AIDS patients also fund
 its use by infected but healthy people when it's prescribed
 by a physician.
    Despite the positive trend, the advocacy group recommended
 eliminating "arbitrary differences" in state drug policies.
 For example, the report says North Carolina's Medicaid
 program only allows AZT for adults because FDA labeling
 doesn't specifically indicate use for children, despite
 encouraging studies released a year ago by the National
 Cancer Institute.
    The study also urged Medicaid to speed coverage for
 persons with AIDS-related complex and to provide funding for
 experimental agents granted investigational new drug status.
 Under such a program, experimental drugs are distributed to
 patients in advance of formal FDA market approval.

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