Recipients, Unable to Afford Costly AZT Themselves, Are Fearful : Subsidy on Vital AIDS Drug Ending

WASHINGTON —  Paul Murrah, a Dallas accountant, has not been able to work much since he was diagnosed as having AIDS-related complex last August. Still, his condition has improved considerably this year, which he attributes to the AZT he has been taking since December.

Murrah has no health insurance and, with an income of about $600 month from his few remaining clients, makes too much money to qualify for Medicaid, which would cover the $800-a-month cost of the drug.

Similarly, Kurt Rahn, a former student at Georgia State University who has AIDS, receives $467 a month in Social Security disability payments, making him too “rich” for Medicaid, with its $354-a-month eligibility limit. Nevertheless, every four weeks he goes to the pharmacy at Grady Memorial Hospital in Atlanta, pays $5 and receives a month’s supply of AZT.

Thousands Being Aided

For the last 18 months, Murrah and Rahn and thousands of others like them across the nation have been beneficiaries of a $30-million federal program that has purchased or subsidized the AIDS drug for those who could not otherwise afford it.

But the program, which was approved by Congress as a one-time emergency fund, is scheduled to end Sept. 30, with little chance that lawmakers will renew it.

“I think, when the realization comes that the funds are ending, there is going to be a hue and cry about what’s going to happen next,” said Dr. Samuel Matheny, associate administrator for AIDS in the Health Resources Services Administration, the federal agency in charge of disbursing the money to the states. “We’re extremely concerned that there are inequities in . . . receiving the drug.”

Congress and federal officials have asked the states to come up with funds to keep the program alive, but prospects are uncertain--and vary from one state to another. Murrah and Rahn, and others who depend on the life-prolonging treatment, hardly find this comforting. They are scared.

“My income would not buy very much AZT after paying the rent and buying a sandwich or two,” Murrah said. “Unless I can get it from a virtually free source, I’m in trouble.”

Fund Set Up by Congress

Shortly after AZT was approved for marketing in this country, the fund was established by Congress as part of the fiscal 1987 supplemental appropriations bill, and the money was made available through fiscal 1988, which ends on Sept. 30.

At the time, lawmakers realized that about 6,000 AIDS patients with limited incomes and no health insurance--who had been receiving AZT free on a “compassionate plea” basis when it was an experimental drug--would then have to buy it. Further, they knew it would take some time before states--if they chose to do so--could add AZT to their list of Medicaid-covered outpatient drugs.

The $30 million was divided among the states according to their need, and the states were given the discretion of setting up their own programs to disburse the money and determine who was eligible for the benefit.

But the government specified that the fund was a one-time only emergency measure. And it urged congressional authorizing committees and state legislatures to establish programs to ensure that the funds would continue after the $30 million in federal money was spent. But there has been little action in the states or on Capitol Hill.

Drug Costs $10,000 a Year

Since the program began, all but two states--Alabama and Colorado--have added AZT to the list of outpatient drugs covered by Medicaid. But, because the drug costs so much--up to $10,000 a year--it is still largely unaffordable for middle-income people who lack insurance. And, to qualify for public assistance, those individuals would be forced to “spend down” their savings to virtual poverty.

“AIDS has provided us with the example of the 15% to 20% of the population with no health insurance,” said Dr. Joseph Wilber, medical director of AIDS programs for the state of Georgia. “Most are non-elderly who were employed in small businesses with no insurance, or who were between jobs or self-employed.”

California received $6.7 million from the program and has only spent $1.7 million thus far, according to Anna Ramirez of the state AIDS program. As a result, California--unlike most of the states receiving grants from the fund--has estimated that there is enough money to cover patients until the end of April, although new patients will not be added to the program after Sept. 30. As of June 30, about 700 were enrolled, Ramirez said.

The eligibility requirements for participation in California were restrictive at first, limiting the program to those with an annual income of $11,000 or less. In January, the limit was raised to $22,000 and, in April, to $40,000, Ramirez said.

Program Saved Lives

In many states, there was an especially frustrating situation that enabled some patients to receive AZT under Medicaid--for a limited time--but then disqualified them after they became eligible for Social Security disability payments. The emergency federal fund literally saved the lives of those patients. Wilber, of the Georgia AIDS program, explained:

“Once you have AIDS, you are considered officially disabled and eligible for Social Security disability. But, it takes six months before you can get it. During that time, if your income is less than $375 per month for a single male, you can qualify for Medicaid--which will purchase AZT. So, for the first six months, you’re all set. Then your Social Security check comes in, and it averages between $400 and $500. Now, you are no longer eligible for Medicaid--and you can’t get your AZT. And it costs $800 a month by prescription. And you can’t refuse your Social Security check. Many would rather not get Social Security--and still get their AZT and their bills paid.”

So, when Georgia began participating in the emergency AZT fund, the state set an income limit of $500 a month--thus, Social Security disability recipients like Kurt Rahn were covered, Wilber said.

“As long as I’ve been on AZT, I’ve been better off,” Rahn said. “So, sure, I’m worried.”

Once the money runs out, many of the patients remaining on the rolls may be dropped. Rahn may be more fortunate than some of the others, however, because he lives in the Atlanta area.

“Grady Memorial Hospital will continue to purchase the medicine for those who are being treated there, which will add $1.5 million to the hospital’s deficit,” Wilber said. “The people outside the city, I’m afraid, are out of luck. They will have to get it on their own. I think a lot of people will move to Atlanta and start going to Grady.”

No one knows what will happen to those patients--and an estimated 6,000 others around the country--after Sept. 30.

“All this just highlights the problem of indigent health care in this country,” Wilber said. “No one has decided who is going to pay the bills.”