Post on 02-Jan-2016
transcript
Texas HIV Medication Program (THMP)
Texas AIDS Drug Assistance Program (ADAP)
Implemented 1987 RWCA Funded in 1990 4th Largest ADAP in the USA Goal: “access to life sustaining
medications for low income Texans with HIV”
Texas HIV Medication Program
Budget ~ $82 Million/year Funding 60% Federal RW/40% State
GR 14,909 clients served FY2006 Distribute meds through 450
community pharmacies in Texas Process > 1,000 prescriptions per
day
Texas HIV Medication ProgramEligibility Criteria
Texas Resident HIV positive Low Income - < 200% of FPL
$20,420/year single person Add $6,960 for each additional family
member Uninsured/Underinsured for
prescription medications
Demographics-Race/Ethnicity
Source: THMP-HIV 2000Texas-Texas Epidemiological Profile, 2006
THMP Clients Served in Q1 FY 2007 Compared to Persons Living with HIV/AIDS Texas
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
White Black Hispanic Other or Unknown
THMP
Texas
Demographics-Gender
Source: THMP-HIV 2000Texas-Texas Epidemiological Profile, 2006Note: Transgender excluded (less than 1% of population)
THMP Clients Served in Q1 FY 2007 Compared to Persons Living with HIV/AIDS Texas
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Female Male
THMP
Texas
Demographics
N=9,859 Note: Transgender excluded (less than 1% of population)
0
500
1,000
1,500
2,000
2,500
3,000
3,500
White (Non-Hispanic) Black or African American(Non-Hispanic)
Hispanic or Latino (anyrace)
Other
Female Male
THMP Clients Served in Q1 FY 2007
Drug Expenditures by Class
Total Expenditures: $81,971,352 (FY 2006)
NNRTI & NRTI18%
OI and PCP2%
PI32%
RTI47%
EI1%
Top Ten Drug Expenditures
$0
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
$3,000,000
$3,500,000
Truva
da
Kaletra
Reyata
z
Combivir
Sustiv
a
Epzico
mTriz
ivir
Atripla
Virace
pt
Viread
Quarter 1, Fiscal Year 2007
Texas HIV Medication Formulary
Limited in scope Includes 43 medications in over 100
formulations/dosages All FDA approved ARVs 10 of 14 PHS recommended drugs to
prevent and treat OIs
Issues and Trends
17% of new applications for services are coming from incarcerated populations
40% of new applicants report $0 income
73% of new applications report incomes of less than 100% FPL ($10,210/yr)
Issues and TrendsCost Containment
More people alive with HIV today than ever before
People staying on the program for much longer periods than previously
Intense usage of the program/complex regimens
Issues and TrendsCost Containment
Newer drugs with convenient dosing schedules, improved side effects, and different resistance profiles are brought to market at much higher prices
Older drugs continue to rise in cost annually at twice the rate of inflation
New classes of drugs have been much more expensive
Issues and TrendsNew Drug Classes
Two new powerful ARV drugs are scheduled for release this year
Both are New classes
Integrase Inhibitor CCR5 Antagonist
Both are oral Expect that they will have a huge
impact on treatment regimens
Issues and TrendsResistance
Resistance can be considered a natural response to the selective pressure of a drug
Resistance forces changes to 2nd and 3rd line drugs/regimens $$$$$ more costly Limits future treatment options Some clients have run out of treatment
options Drug resistant HIV is transmissible
Resistance
HIV creates billions of new viruses in the body each day
The goal of multi-drug tx is to reduce the amount of HIV in the body as low as possible
Combination tx with a minimum of three drugs has been shown to be most effective
Resistance With billions of viruses being made
every day, many random differences…. like mistakes can happen when any new virus is being made
The mistakes/differences are mutations Mutations that change the parts of the
virus where ARVs are meant to work can cause the virus to resist the drug
Resistance
Drug resistance doesn’t happen because HIV is smart and figures a way to get around the drug
Resistance mutations happen randomly
Potent ARV combinations can reduce the amount of HIV in the body to very little
Resistance
The less HIV being made in the body The less chance of random mutations
happening The less mutations happening The less likely a drug resistant
mutation will occur
Adherence Basically adherence is taking your
drugs as prescribed Many studies are looking at the
relationship between drug adherence and resistance
If you take your drugs as scheduled can you develop resistance?
How adherent do you need to be to prevent resistance?