America Living With AIDS

DRUG TREATMENTS
It has been estimated that 90 percent
of the early intervention costs for HIV
infection are for prescription drugs,
principally AZT and aerosolized pentamidine (Arno, 1990). CDC estimates that approximately 60 percent
of HIV-infected individuals would
benefit from immediate treatment
with these drugs. In addition, the
majority of people currently living
with AIDS require expensive drug
therapies.
Later in this chapter, the Commission discusses the impact of the
Orphan Drug Act on the high cost of
AIDS drugs and recommends amending the law to address this concern.
The Commission also believes the
Department of Health and Human
Services should negotiate reasonable
and accessible prices for drugs developed through NIH-funded research.
This would reflect the federal government's contribution to the research
and development costs normally
undertaken by the private sector.
PR O(0 I R REIM IBURSE M NT
Public and teaching hospitals are an
important source of care for lowincome individuals who are uninsured
or who have qualified for Medicaid.
Owing to uncompensated care provided to the uninsured and low reimbursement rates under Medicaid, public hospitals have been experiencing
significant economic losses when they
provide care to AIDS patients. Private

hospitals are treating more AIDS
patients, but even they are experiencing financial strains.
As noted above, physicians have
financial disincentives to provide care
to individuals on Medicaid. Physician
reimbursement rates under Medicaid
are much lower than those from other
third-party payers, and in the final
analysis much care for HIV disease is
entirely uncompensated.
In this climate, not only
may patients be forced to
wait for care until serious
symptoms develop, but dep
they then are likely to be
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more expensive hospital
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INEFFICIENCY IN
CURRENT CARE
PATTERNS
There are marked inefficiencies in current patterns of care for people
with HIV disease. One
of the primary reasons
inefficiency exists is the
unfamiliarity of some
providers with cost-saving
regimens. Outpatient
management of AIDS in
the San Francisco area has
been proven to have substantial cost savings (Hiatt
et al., 1990). The use of
AZT also has the potential

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for reducing annual costs while extending productive lives (Scitovsky et al.,
1990).

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