September 29, 2006
GETTING AWAY WITH MURDER?
Update readers will remember Mississippi's deadly 2005 law limiting Medicaid prescription drug coverage to no more than five drugs per recipient per month, only two of which can be brand name drugs. (Life-saving AIDS-related drug regimes typically require multiple pills, many of which are available only in brand-name form.)
Well, now it looks like Governor Haley Barbour and his top Medicaid administrators are getting caught misrepresenting the steps they claimed they'd be taking to help out people living with HIV/AIDS. After over a year of claims they'd be filing for a Medicaid waiver with the feds to get funding and approval to cover needed meds, it's now clear there's no waiver - and no meds for folks in Mississippi who desperately need them.
Background – the drug cap and the lawsuit
Although Mississippi has informally permitted beneficiaries living with HIV to receive more than two brand-name drugs per month, they (like everyone else) are still limited to no more than five drugs overall per month. Paying for antibiotics for a cold, for example, becomes impossible for a poor person taking four HAART meds plus an antidepressant.
Valencia Robinson of AIDS Action in Mississippi (AAIM), explained, "When people have the five cap prescription limit, they have to decide between getting their diabetes meds and their AIDS meds. All the medication is needed. What are you going to do? This month, I will take my insulin. Next month, I will take my HIV meds. That's crazy. People living with HIV/AIDS cannot get off their drug regimens."
Mississippi state government has already come under fire for this dangerous limit. Housing Works worked with local groups to file the Denning v. Barbour lawsuit, where plaintiffs demonstrated that the five-drug limitation is extremely harmful, particularly for people living with HIV.
Dr. Michael Saag (an internationally renowned HIV doctor) explained to the court that the five-drug cap is "dangerous, harmful, and life-threatening for Mississippi Medicaid recipients living with HIV and AIDS." Dr. Saag explained:
"In addition to their HIV/AIDS medications, patients living with HIV typically develop a host of other maladies, from heart disease to renal problems, neurological disorders to intestinal disorders, all of which require medication. Depression and other mental health disorders are also common in persons living with HIV/AIDS, and often require drug therapy. Metabolic disorders such as diabetes and high cholesterol are very common in people with HIV/AIDS and often need to be treated with medications. Finally, as noted, unusual infections are the hallmarks of HIV/AIDS, and many HIV-infected persons get more than one infection."
"Because these recipients are by definition poor," Dr. Saag concluded, "the great majority will not have the financial resources to get the medicine that they need. The result will be unnecessary suffering, severely shortened life expectancies, and the untimely death of many poor people in Mississippi."
MS waiver - is it happening?
In response, Governor Barbour and Mississippi Medicaid expressly represented to the court that they were seeking a waiver to exempt people living with HIV/AIDS and hemophilia from the five-drug cap, in an attempt to portray the drug limits as less harmful and thus win the case. The defendants told the court:
"There will be exemptions to the cap based on therapeutic categories. In September 2005, DOM began the waiver application process with CMS to institute a Primary Care Case Management program for HIV/AIDS patients and hemophiliacs. Once approved by CMS, HIV/AIDS patients and hemophiliacs will be allowed ten prescriptions a month in addition to access to the 90-day Maintenance Drugs discussed below."
Defendants consistently reiterated their assertion: "Further, Mississippi is in the process of applying for an HIV/AIDS and hemophiliac waiver from CMS and will follow California, Florida, and Washington in exempting these patients as a therapeutic class from the general prescription limit."
It now appears that this was all a litigation ploy.
Despite their promises and the urgent need, Mississippi has apparently abandoned its application for a waiver. After nearly one year, no waiver is in place. The same officials who first offered it as a solution now refuse to discuss it.
When counsel for the Denning plaintiffs pressed for a status report on the waiver application, lawyers for the state had the nerve to write, "As I am sure you can appreciate, the Division [of Medicaid] believes it would be inappropriate to comment given that the matter is still in litigation."
The silence lends itself to cynical interpretations. Did Governor Barbour and the State of Mississippi abandon the waiver without notifying the court, the plaintiffs, or the public? If you're living with HIV/AIDS on Medicaid in Mississippi, you wanna know the answer bad.
"Right now in Mississippi, our AIDS rate is much lower than our HIV rate," Robinson said. "We have this opportunity- if we can get people into care and on all the meds they need, we can keep them from getting deadly sick."
AIDS activists across the country should press for three things: (1) a straight answer from Governor Barbour and his lawyers; (2) a decision from the judge in Denning; and (3) political pressure on the Governor and Mississippi Medicaid to force them to hold to their word - so they can't get away with murder.