As HIV/AIDS increasingly affects low-income populations in the United States, expensive antiretroviral drugs such as Roche's Fuzeon are starting to create a "rationing" of HIV care "rarely" seen in the country, the Wall Street Journal reports. State and federal AIDS Drug Assistance Program officials estimate that the program will need an additional $215 million in funding for fiscal year 2004 to cover the cost of treating current and new patients. However, Congress has proposed only a $35 million increase. As a result, 13 states have closed enrollment to new patients, leaving more than 700 patients on waiting lists for drugs. The number could grow to 7,000 this year if no additional funding is secured, according to the ADAP Working Group, which helps advocate for more ADAP funding. State resources have also been strained by the high price of Fuzeon, which costs roughly $20,000 per year per patient -- three times as much as most antiretroviral drugs (Fuhrmans, Wall Street Journal, 1/13). Fuzeon, which is in a new class of drugs called fusion inhibitors, is designed for HIV/AIDS patients who have failed to respond to other medications (Kaiser Daily HIV/AIDS Report, 1/7).

Rationing
Some states have decided not to cover Fuzeon because of its high cost. North Carolina's ADAP chose to purchase Fuzeon for a limited number of patients, knowing that for each new Fuzeon patient it took on, it would have to put two or three other new patients on a waiting list for less-expensive antiretroviral treatments. Roche conducts its own Fuzeon assistance program but refuses to disclose how many people receive the free treatment. The company recently announced that it would not provide medication to any ADAP-eligible patients in states where the program does not cover Fuzeon or has placed limits on how many patients receive the drug. However, Roche said it will continue to enroll patients in states with waiting lists provided that Fuzeon is covered by ADAP and the program agrees to take over coverage of the drug when it has sufficient funds(Wall Street Journal, 1/13).

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