MDCH says poor patients needing n-PEP on their own

The Michigan Department of Community Health says that Michigan residents without insurance or cash to pay the $1,000 tab for a one month prescription to prevent infection with HIV after an exposure are on their own in finding ways to pay for the drugs.

“As indicated in the Position Statement on Non-Occupational Post-Exposure Prophylaxis (n-PEP), all decisions regarding administration of n-PEP should be made after a physician evaluates the risks of transmission, other health concerns, and the relative risks and benefits of nPEP for each individual patient,” said Kelly Niebel, spokesperson for MDCH. “At present, individuals for whom n-PEP is appropriate, but who are without health insurance, can obtain assistance in paying for administration of n-PEP through hospital compassionate care programs and through pharmacy assistance programs offered by drug manufacturers.”

The use of anti-retrovirals in preventing infection in a person who has been exposed to HIV is called non-occupational post-exposure prophylaxis, or n-PEP. Michigan Messenger reported that the MDCH lacked any statewide policy on the medical intervention in December of 2009. The department finally released a white paper on the issue in April of 2011 — even though a top official had promised a policy in early 2010.

The problem with MDCH’s recommendation for people to access the medications is the tight timeframe in which n-PEP must be started to be effective. In order for it to work, n-PEP must be started within 72 hours of an exposure — either via sex or needle sharing — or it does not work, studies have found.

Mark Peterson, a director of the advocacy group Michigan Positive Action Coalition(MI-POZ), said the funding question is part of a larger process of addressing HIV in the United States.

“We’re at a very interesting place in both the prevention and care of HIV. Now, with the increase in research around biomedical prevention mechanisms, we’re seeing new opportunities and perhaps even blurring the lines between prevention and care,” Peterson said in an email to Messenger. “n-PEP should be one piece in an overall HIV continuum of services. Right now in the face of funding restrictions, constraints and rescissions, those of us who are advocates for HIV prevention and care need to urge our local, state and national policy makers to ensure people have access to this important HIV prevention tool at as low of a threshold as possible. Waiting around for a few days debating about payment renders this option moot. We need to do better and create a more responsive process.”

The federal government has said it will be pushing more interventions with medications in the coming years as part of an aggressive implementation of the National HIV/AIDS Strategy. In a conference call to recognize the 30th anniversary of the AIDS epidemic’s first descriptions in the federal disease surveillance programs, officials from the CDC and the Office of National AIDS Policy talked at length about how the government was going to rely heavily on chemo-prophylaxis in addressing the epidemic. Studies have shown that the medications stop the virus’ ability to replicate itself, thus reducing the viral load, a measure of virus in the blood, as well as shoring up the CD4s, a key component of the immune system that HIV hijacks as part of its process of replicating itself. From the White House blog:

“[Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention (CDC)] discussed CDC’s investments in helping state and local jurisdictions track and report CD4 and viral load measurements in order to track community viral load. Research studies have demonstrated that when a community is able to lower the mean viral load across all people living with HIV in that community that this leads to a lowering in HIV incidence. Therefore, tracking community viral load is an important tool for reducing the number of new infections. CDC is doing important work to support states and localities in building their capacity to track community viral load.”

While the state says patients should rely on hospital charity programs and compassionate access programs from pharmaceutical companies for n-PEP, Ingham County is doing things a little differently.

“It’s very unusual in Ingham County to have someone who is really low income and uninsured who can’t get medications because we will sign them up for the Ingham Health Plan, which covers nPEP,” said Marcus Cheatham, spokesperson for Ingham County. “In those rare cases where we have someone who doesn’t qualify for the Ingham Health Plan or anything else, we’ll work with a pharma program like Gilead’s Advancing Access program and get them a supply that way. Since we began creating our n-PEP policies, we don’t know of a single case of someone who may have been exposed who left here without nPEP because they couldn’t pay for it.”

But Cheatham had a caution as to whether Ingham’s program could be replicated in other counties with health plans.

“People may face more barriers in jurisdictions where the County Health Plans can’t cover as many people or have more limited formularies,” he said.

Ingham has been pushing n-PEP as prevention as part of a larger program to address what authorities have labeled a “crisis” in increased HIV case reports in the county.

Rod McCollum is a multimedia journalist who reports often on HIV in the African-American gay men’s community. The Chicago based reporter tells Michigan Messenger that the MDCH recommendations are troubling.

“The issue with n-PEP is that it is regarded as a boutique intervention,” he said. “The issue in Michigan a perfect example of that.”

He says the money and access concerns are part of larger concern in relation HIV in the African American gay men’s community.

“It’s a class issue. It’s a race issue. Black and brown people generally have lower incomes and less access to medical care. That means this hits them the hardest,” he said. “These are the death panels Sarah Palin was warning about. It’s the bureaucrats that are holding up medications that can save lives.”