Texas HIV Medication Program

Dwayne Haught, MSN, ACRNMay 31, 2007

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?

Web Sites

http://www.dshs.state.tx.us/hivstd/meds

http://aidsinfo.nih.gov/guidelines/