some forced to choose between mortgage, & hiv meds.

[ubotts]

http://ads.qctimes.com/articles/2008/03/30//news/local/doc47ef021a4670f763611155.txt


The Quad-City Times
Davenport, Iowa
Sunday, March 30, 2008

Some forced to choose between mortgage, HIV meds

By David Heitz

Brian Clark of Davenport has a decision to make: Pay his mortgage, car payment and electric bill, or buy a one month’s supply of the medication that keeps him alive.

Clark, the manager of Mary’s on 2nd, a bar in Davenport, is one of several Iowa Quad-Citians falling through the cracks when it comes to getting help paying for his pricey HIV medications. In Iowa, a single person who makes up to $20,800 per year — or $10 per hour — can qualify for help under the AIDS Drug Assistance Program, or ADAP.

In Illinois, there’s more money to go around, said Monica Wainwright, a case manager for AIDS Project Quad-Cities. In that state, a single person can make $40,840 and still qualify.

“I might have to move to Illinois, for God’s sake,” said Clark, who has insurance for prescriptions under Medicare Part D but who has fallen into the “doughnut hole.”

That means Clark is responsible for the next $3,808 worth of medications before the insurance company will begin to pay again. After that, he will have to pay only 5 percent of the drug’s cost until next year, when the cycle begins all over again. Clark’s premium for the drug coverage is about $110 per month. Before he fell into the doughnut hole, he was paying about $85.44 per month in co-payments.

But coming up with $1,200 per month for medication for the next few months is not easy when you have a house payment and a car payment. What’s more, it’s going to happen every year. “If this was a one-time thing, I could scrape and save and not eat for a while.”

Clark is not alone. Wainwright said she has several clients who are being forced to choose between paying for their medications or having a roof over their head. Extra help is available from Social Security when people fall into the doughnut hole, Wainwright said, but a single person cannot make more than $15,315 per year to qualify for that.

Wainwright said she has some clients who meet the income guidelines, but have assets exceeding the $11,990 limit (excluding the home a person lives in and their personal vehicle). “Even if you’re talking about someone who is making $30,000 or $35,000 per year, that’s a decent income around here for a single person, but you have to consider the fact that the person has to live, pay rent or a mortgage, utilities, gas to and from work, plus when you throw in the thousands of dollars in co-pays and premiums, there’s nothing left.

“It just doesn’t make sense to expect those people to get themselves through the coverage gap.”

Gaye Shannon Burnett, project director for the Rock Island County Council on Addictions, which provides case management for people living with HIV in Illinois, said most of her clients qualify for help with their medications.

As for Clark, he has about one month’s worth of medications left. Then, he said, “I’m lost. I really don’t know what to do.”

He said he called his insurance company to consider switching to another plan, but that really is not an option for him, especially since he does not take generic medications. “They said to me, and I’m being serious, ‘We suggest you go on welfare. That’s the only thing we can figure out so you can get your drugs.’ ”

Clark said he has been on the medications he currently takes for several years. The pills have brought him back from a 135-pound, sickly person who would become exhausted after doing a load of laundry to a  185-pound workhorse with a lot of sass.

For now, Wainwright said Clark’s only hope may be assistance from the pharmaceutical companies. “We may just say, ‘This is an extreme situation, can you help us out?’ That’s kind of where we’re at right now.”

She expects this may just be the tip of the iceberg. “I’m honestly really surprised that I haven’t heard from any other people who are case managers in the state of Iowa that have run into this, but I’m willing to bet that it’s going to happen sooner or later.”


David Heitz can be contacted at (563) 383-2202 or dheitz@qctimes.com