Key state HIV program in disarray after contract switch

A change in contractors for a state-run AIDS program has resulted in enrollment delays and left some patients unable to get necessary medications and timely medical care, according to legislators and nonprofit organizations across California.

The AIDS Drug Assistance Program, which helps more than 30,000 low-income HIV and AIDS patients pay for medications and insurance premiums, switched pharmacy and enrollment contractors in July. Since then, clients and service providers have reported numerous problems with the program, which is overseen by the California Department of Public Health.

Patients have been turned away by pharmacies, forced to postpone medical procedures or dropped from the program for no apparent reason, according to staffers at APLA Health and the San Francisco AIDS Foundation.

In addition, the online system to enroll applicants was shut down in November after security breaches and is still not working. Potential clients and enrollment workers have to send applications by fax and regularly have trouble getting documents through.

"It’s a mess," said Courtney Mulhern-Pearson, director of state and local affairs with the San Francisco AIDS Foundation, a nonprofit service and advocacy organization. "This is the state’s safety net program and the cornerstone to the state’s response to the HIV epidemic. To have it all of a sudden not work and to have that system be thrown in disarray has been so destabilizing, not only for our clients but also for the enrollment workers."

One Los Angeles client, a 37-year-old Hollywood resident, said his insurance policy was cancelled after the AIDS Drug Assistance Program failed to send the premium to the correct address. As a result, the man, M.G., who only wanted his initials used because not everyone in his life knows he is HIV-positive, got turned away at the pharmacy.

"I was on my last pill for HIV medication," he said. "It was very scary. I thought, ‘What am I going to do now?’"

The state’s contract with Oakland, Calif.-based Ramsell Corporation, which had handled both enrollment and pharmacy benefits, ended in July. To replace it, the state contracted with A.J. Boggs & Company to do the enrollment and Magellan Rx Management to provide the pharmacy benefit services. The reason for the change was to reduce administrative fees and drug reimbursement rates, said public health department spokeswoman Ali Bay.

Since then, AIDS service organizations have written numerous complaint letters, contacted legislators and sent representatives to Sacramento to meet with public health department officials. State senators Ed Hernandez, Kevin De León and Scott D. Wiener also sent letters to the department insisting that the problems be fixed.

Wiener’s letter said he was "astounded that these systems issues have yet to be resolved and continue to arise six months into the transition" to the new vendors. The AIDS Drug Assistance Program, he wrote, is essential to keep HIV patients healthy and reduce their chances of infecting others.

"This is matter of life and death for some people," Wiener said in an interview. "When I learned that the [AIDS Drug Assistance Program] enrollment was essentially in meltdown … I was horrified."

The Department of Public Health’s director, Karen Smith, responded to Wiener in a letter last week saying her agency’s first concern was to ensure clients receive "life-saving medications without any disruption in treatment." She said the state is "working diligently to address these concerns as quickly as possible."

To help ensure uninterrupted access, the state has allowed its pharmacy benefit provider to authorize an emergency, 30-day supply of medications for enrolled patients who encounter obstacles at the pharmacy. Smith wrote that the state is also trying to resolve the online security issues and to get the enrollment site back up as soon as possible. But she noted that the problems may be "more serious" than the department initially thought.

In the meantime, Smith wrote, the department has shortened the application, streamlined the enrollment process and extended the reenrollment and recertification deadlines for clients.

Craig Pulsipher, state affairs specialist with APLA Health, said he appreciated that the state has provided emergency medication access and responded to some of the concerns. But clients, enrollment workers, pharmacists and doctors are still facing hurdles, he said.

Pulsipher said he and others had warned the state it wasn’t allowing enough time to prepare for the changeover. The Los Angeles Department of Public Health, for example, had asked the state in June to postpone the transition for six months. About 10,000 L.A. County residents rely on the AIDS Drug Assistance Program.

In a letter to the public health department, Mario Perez, director of L.A. County’s HIV and STD program division, wrote that patients need "unfettered access to antiretroviral therapy," and any administrative changes to the AIDS Drug Assistance Program that can hamper that access "must be thoughtfully planned and adequately tested."

Pulsipher said he tried to give the state the benefit of the doubt, knowing difficulties arise during every transition. But, he said, "clearly things haven’t been resolved."

"We anticipated some of these issues and those concerns weren’t heeded," he said. "And now we find ourselves here six months later with a system that is broken."

Meanwhile, patients are struggling to get the services they need. M.G, the patient who nearly ran out of drugs, said a surgical procedure to relieve pain in his neck was cancelled. He spent hours calling the AIDS assistance program and his insurance company, he said. He also had to pay about $500 to get his insurance reinstated.

A representative from the state AIDS program wrote to Pulsipher in an e-mail that the insurance payment had been sent to the wrong address. "We understand the severity of this issue and we will work … to ensure that this does not happen again," the email said.

Finally, M.G. was able to get his medicine and have the surgery. Now, he plans to call the state and the insurer every month to make sure his drugs and services are covered.

The program was "supposed to be helping me," he said. "And because of them, I was denied the medication that is keeping me alive."

This story was updated to reflect that AIDS Project Los Angeles has changed its name to APLA Health.