Tag Archives: West Virginia

New River Valley Region Reports Sharp Rise in Hepatitis C

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

The New River is 360 miles long that spans three states – North Carolina, Virginia, and West Virginia – flowing from south to north (one of only a handful of rivers in the world to do so) and serves as one of the most scenic rivers in the eastern United States. It’s known for hosting some of the best white water rafting and kayaking in the U.S., and for having the third-longest single-arch bridge in the world. Nestled along some of the most rural parts of the three states in spans, the New River Valley (NRV) region is also home to a growing Hepatitis C (HCV) epidemic.

HEAL Blog has covered the exploding rates of HCV in West Virginia many times since our inception in 2013, as well as having covered those rates in the rest of the Appalachian Mountain Region (AMR). What frustrates many advocates and healthcare workers who live and work in the NRV is that the sharp increase in new HCV infections is largely a product of pharmaceutical companies’ – and healthcare providers’ – making.

Map showing the New River Valley area

Photo Source: Snipview

During the early-1990s, Perdue Pharma using rural towns and counties in the NRV as testing grounds for OxyContin, one of the most widely prescribed opioid drugs of the late-90s and early-00s. HEAL Blog has previously reported on this issue (Cassandra in the Coal Mines), and I stand by the assessment that this region and its population have been systematically targeted by the manufacturers and wholesalers of prescription opioid drugs; wholesalers have, in fact, spent several tens-of-millions of dollars settling cases in West Virginia related to oversupplying the drugs and creating “pill mills” in the state.

There is a direct link between the opioid and heroin epidemics in this region and the vast increase in new HCV infections. In December 2016, Dr. Marissa Levine warned during a meeting of the Virginia Board of Health that the state should expect a “tidal wave” of HCV and HIV primarily related to Injection Drug Use (IDU). The state saw a 21.212% increase in new HCV infections in 2015, from 6,600 in 2014 to 8,000 in 2015 (Demeria, 2016). Dr. Levine also argued that the lack of a dedicated funding stream greatly hinders the ability of the Health Department to accurately capture and track the data accurately, an argument shared by virtually every state in the U.S.

Beyond just opioid drug injection, New River Health District Health Director, Noelle Bissell, M.D., has seen a spike in acute HCV infections (as opposed to chronic conditions) linked to tattoo parlors, the use of homemade tattoo guns at parties, and in people who report more than 10 sexual partners, as well as a trend in cases associated with IDU involving methamphetamine, and in pregnant women and women of childbearing age (SWVA Today, 2017). It should be noted, however, that the Centers for Disease Control and Prevention (CDC) specifically states that the transmission of HCV via sexual activity is “not common” (CDC, 2015). The virus is inefficiently transmitted in this manner, and while it is possible in the manner Dr. Bissell describes, much of the data provided during screening is self-reported by patients – self-reporting may lead patients to purposely omit or skew their answers in an effort to avoid embarrassment or mask other behavioral risk factors.

The rural areas along the NRV are very likely to be hit with a greater explosion of HCV and HIV, and HEAL Blog will be monitoring the situation in the coming months.

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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West Virginia’s Rx Crisis

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

Over the past two years, HEAL Blog has paid much attention to the prescription opioid and heroin epidemic sweeping America’s suburban and rural areas, particularly in the 13-state Appalachian Mountain region. Nowhere is this truer than in those counties and states where coal mining is the predominant industry. Mining coal can be brutal work, and miners have historically led the pack in terms of health issues. From Black Lung Disease to various types of cancer related to the inhalation of coal dust and exposure to chemicals used by the mining industry, it is a long-standing reality that the hard life coal miners face to make a living will likely result in long-term illness, pain, and/or disability.

Compounding the myriad health issues related to mining coal is how physicians, pain advocates, and pharmaceutical companies have capitalized upon these issues in the pursuit profits. In the late 1990s, prescription opioid painkillers that were once reserved for only the sickest, most desperately hurting patients gained acceptance as an acceptable treatment for even the most minor injuries, and Purdue Pharma, maker of OxyContin, one of the most widely abused prescription opioid drugs, was key in ensuring that their products were made available to as many people as possible, despite knowing (and withholding information about) the highly addictive nature of these pills. Purdue even went so far as to provide physicians with tens-of-thousands of coupons offering free 30-day trials of OxyContin to give their patients. And, with its work- and lifestyle-related injuries causing their patients pain, coal mining regions quickly became a pipeline for overprescribed opioid drugs.

Purdue Pharma logo

Photo Source: Purdue Pharma

Recent investigations and lawsuits in West Virginia have revealed astonishing levels of overprescribing, abuse, and overdoses in the state. Drug shipping sales records from drug companies (which those companies fought to keep confidential) indicate that, between 2007 and 2012, 780,069,272 prescription opioid drugs were shipped into state, amounting to 433 pills for every man, woman, and child in the state of West Virginia (Eyre, 2016a). A single pharmacy in the town of Kermit, WV (population 392) received nearly 9 million hydrocodone pills in a period of two years. In Wyoming County, a mom-and-pop pharmacy in Oceana, WV received 600 times as many oxycodone pills than the corporate Rite Aid pharmacy just eight blocks away. This essentially unfettered flooding of prescription opioids into the state has resulted West Virginia having the top four counties – Wyoming, McDowell, Boone, and Mingo – in the United States for fatal overdoses related to prescription opioid drugs, with two more – Mercer and Raleigh – also in the top ten. Logan, Lincoln, Fayette, and Monroe counties sit in the top twenty counties for opioid-related fatal overdoses.

West Virginia map of opioid overdoses, by county

Photo Source: Gazette-Mail

To make matters worse, state regulations have required wholesale distributors to set up systems to identify “suspicious” orders for highly addictive narcotics, and to report those questionable orders to the state’s pharmacy board, a regulation that drug companies ignored. Between 2001 and June 2012, the pharmacy board received just two reports – both from Cardinal Health; since June 2012, 7,200 reports about suspicious orders have been faxed in to the pharmacy board. This sudden flow of reports only came after former Attorney General Darrell McGraw filed lawsuits against fourteen drug wholesalers. Despite these reports, the pharmacy board did nothing with them, even failing to investigate or forward the reports on to law enforcement authorities (Eyre, 2016b). The state recently reached a $3.5M settlement with drug wholesaler, H.D. Smith Wholesale Drug Company over its role in the problem (Associated Press, 2017).

The state has since made receiving these drugs more difficult, which has led many patients addicted to them to turn to cheaper, more readily available heroin, and as such has resulted in a sharp increase in the number of heroin-related overdoses, deaths, and disease transmissions (primarily Hepatitis B and C). The state’s first syringe exchange programs opened in the Fall of 2015, which will hopefully stem the spread of disease, but they are located only in the state’s major cities. Additionally, treatment facilities for addition are vastly overcrowded, underfunded, and unaffordable for those whose meager resources are already stretched past the point of breaking.

West Virginia continues to be a state to monitor, along with Indiana, Kentucky, Ohio, and Pennsylvania, where opioid addiction can often lead to the rampant spread of blood borne diseases that were once rare in the region. It is difficult to overstate the severity of the epidemic, and HEAL Blog will do its best to report on the situation.

References:

 
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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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Milk, Bread, Ground Beef, and Overdose Medication

By: Marcus J. Hopkins, Blogger

The HEAL Blog has been following the issue of opioid addiction very closely, largely because Injection Drug Users (IDUs) represent a large proportion of new Hepatitis C (HCV) infections in the U.S., particularly in rural parts of the country. The Appalachian Mountain region serves as a prime example of how heroin and opioid addiction can lead to a rash of both HIV and HCV outbreaks; it also serves as excellent proving grounds for how Harm Reduction methods can help to prevent mass outbreaks, as well as save lives.

Harm Reductions measures are those that focus on preventive measures that have been shown to lessen the risk to individuals through various legal means. As they relate to opioid addiction, one of the most important measures is increased access to Naloxone, a medication that is used to block the effects of opioid drugs, such as slowed breathing and loss of consciousness. Naloxone – sold under the brand name, Narcan – is a nasal spray that is used to counteract the effects of an opioid overdose. It is currently listed on the World Health Organization’s “List of Essential Medicines,” the most important medications needed in a basic health system, and increasing ease of access without a prescription is something for which advocates have long fought.

Last week, in the city of Huntington, WV, 26 people overdosed on opioid drugs in a period of only four hours from a particularly potent batch of heroin. Of those 26 overdose cases, none of the patients died, as first responders and hospitals were quick to react, delivering a total of 12 doses of Naloxone, including the two used by Huntington police. One patient had to be revived using three doses (Struck, 2016). The remaining patients were revived using bag valve masks, a handheld device used to provide ventilation to patients who aren’t breathing. The users who overdosed ranged in age from 20 to 59, demonstrating that the opioid epidemic affects people of virtually every age range. In Cabell County, where Huntington is located, there were 440 overdoses by June of this year, 26 of which resulted in death; the state of West Virginia, itself, ranks highest in the number of overdose deaths in the U.S.

In Kentucky, the next state over and less than fifteen miles from Huntington, Kroger grocery store locations with pharmacies on site began offering Naloxone over the counter without a prescription at 96 locations, including 80 pharmacies in the Louisville Division (Warren, 2016). Kentucky currently ranks in the top five states for overdose deaths, which makes it an excellent test market for the efficacy of offering Naloxone without a prescription. That said, the Kroger locations in Ashland, KY – the city nearest Huntington, WV – does not yet offer the drug over the counter.

Naloxone rescue kit

Photo Source: Yourblogondrugs.com

When we discuss expanding Naloxone access, there are a number of ways that access can be broadened – (1.) Naloxone can be carried by first responders; (2.) Naloxone can be carried also by state employees (such as school officials); (3.) Naloxone can be sold without a prescription to anyone. WV does not currently allow the sale of Naloxone without a prescription, although WV HB 4035 seeks to do just that. Access to first responders, including police and other emergency personnel, was expanded beyond just Emergency Medical Technicians (EMTs) in May of this year, but it is unclear, yet, whether or not HB 4035 will be ratified and made into law by the end of this year. In an election year, particularly in the latter half, little of substance seems to get done.

What is important, however, is that we continue to fight to expand access to this lifesaving drug. Politics and personal peccadillos aside, saving someone’s life should never fall prey to moralizing of whether or not opioid abuse is wrong, nor should saving a life be predicated upon whether or not one agrees with the lifestyle choices of the victim. When lives are at risk, every reasonable action should be taken to ensure that those lives are saved.

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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220 is the Magic Number

By: Marcus J. Hopkins, Blogger

Earlier this month, The Wall Street Journal reported that the CDC has listen 220 counties in the United States as being at high risk of an HIV and/or Hepatitis C outbreak, largely related to opioid Injection Drug Use/Users (IDUs). Out of over 3,100 counties in the U.S., these 220 counties – including Scott Co., Indiana, home of one of the highest profile mass HIV/HCV outbreaks in recent U.S. history – share specific factors that seem to be related to a high rate of new HIV/HCV infections, such as high unemployment rates, overdose deaths, and sales of prescription opioid painkillers.

For those of us who have been covering opioid prescription and heroin abuse issues, none of this is news. These factors have long been contributing factors to opioid and heroin abuse, but because of the remote nature of many of these counties, little attention was ever paid and little due diligence was ever done in the way of addressing their needs. These areas, while rich in natural beauty and great for those who prefer life away from the so-called “Big Cities,” are also home to some of the highest levels of endemic poverty in the U.S. Economic development in these areas has been hampered by a number of issues – lack of qualified workers, resistance or reluctance to modernization (many of these counties still lack adequate high-speed Internet access), the remote nature of the areas in relation to centers of commerce, and a regional distaste for “outsiders” – all of which leaves residents with few, if any, good options for work. Residents are lucky to find full-time employment at all, and many are forced to subsist off of part-time and contract work, the opportunities for which are few and far between.

With endemic unemployment and poverty rates high, the sad fact is that sheer boredom comes into play as a factor for drug abuse. Many of my high school friends who ended up addicted to prescription opioid drugs started not because they suffered from high levels or long-lasting chronic pain, but because they were bored, and there was nothing else to do, except for snort some pills; once those pills were made “abuse proof,” they learned how to cook them down, filter out the plastic coating with a piece of mesh, and inject them directly into their bloodstreams. Once needles come into play, what was once a way to survive the boredom turns into a full-blown addiction, anecdotally harder to kick than any other.

Map of the United States showing counties at risk for HIV and HCV outbreaks

Photo Source: Wall Street Journal

Of the 220 suspect counties shown on the WSJ’s map, the vast majority cover Kentucky, Tennessee, and West Virginia, three states as well known for their contribution to the entertainment industry’s portrayal of poverty as they are for hillbilly jokes. The jovial Appalachians from the Beverly Hillbillies still serve as a point of reference for outsiders, but that well-meaning-yet-easily-conned stereotype bears little resemblance to real life Appalachians, where striking oil would be the best thing to ever happen, but residents are far likelier to tap a vein for injection, rather than natural resources.

Compounding the problem is the reality that the remote nature of these counties makes increasing access to adequate healthcare and treatment services both difficult and costly. While telemedicine is quickly becoming a valuable resource, those resources are already stretched to capacity, with few applicants lining up for jobs and limited financial means to pay for additional staff. All three of the aforementioned states are currently facing massively budget shortfalls for a variety reasons, one of which includes the flight of higher-income citizens to states with better job prospects, leaving them to rely upon an increasingly impoverished tax base, which bodes poorly for advocates of additional funding.

Confronting this high-risk label is going to be a unique challenge for the counties in question, and there are no easy answers or quick fixes. This is going to be a multi-year, if not multi-decade, fight to expand educational, employment, and economic opportunities to these areas that will help address generations of poverty and joblessness. Those efforts must be accompanied by concurrent healthcare efforts, without which I fear that we will continue to see high levels of opioid abuse and equally high levels of accompanying HIV and HCV infections.
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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

 

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President Obama Proposes $1.1 Billion in New Funding for Prescription Opioid & Heroin Epidemic

By: Marcus J. Hopkins, Blogger

Last week, the Obama Administration announced that the President is proposing $1.1 billion in new funding to address the prescription opioid abuse and heroin use epidemic that is currently sweeping our nation’s rural and suburban areas. The funds are earmarked to spend $920 million to expand access to medication-assisted treatment efforts, $50 million in National Health Service Corps funding to expand access to substance use treatment providers, and $30 million to evaluate the effectiveness of medication-assisted treatment programs under real-world conditions.

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President Barack Obama and others listen to Charleston Police Chief Brent Webster, foreground, during an event at Charleston, W.Va., where Obama hosted a community discussion on prescription drug and heroin abuse, Oct. 21, 2015. Photo Source: VOA News

If I sound dismissive of this effort, it’s because there are some strings attached to this proposal that makes it yet another example of how little people understand the severity of the issue and the difficulties associated with trying to address it in a rural setting. The $920 million will be allocated to states based on the “…severity of the epidemic and on the strength of their strategy to respond to it.”

The last part of that is the kicker – really, How Do You Solve a Problem Like Maria? One of the most difficult barriers to overcome in the hard-hit Appalachian Mountain Region is one of access; there simply are too few places for people with any health condition to turn.

For the past few years, the state of West Virginia has been besieged by budgetary, economic, and employment woes. In a state where the per capita income is $22,966, it’s hardly surprising that financial issues abound. Those issues are further compounded by a dearth of private and public services available across the state. We have food deserts (areas where there are no grocers or markets providing fresh foods), healthcare deserts, utility deserts – if a map of all the available services were created of West Virginia, it would resemble an actual desert, replete with a handful of oases where these services are available.

Despite the state’s efforts to combat a nearly two-decade-long opioid abuse and heroin use epidemic in the state, the fact of the matter is that there just aren’t enough physical resources – literally, buildings in place – with the capacity to serve as treatment hubs. More troubling is a proposal by the current Republican legislature to combine county health departments into nine multi-county districts, essentially forcing residents from dozens of already underserved counties to have to travel even further to get to a single health department facility. The report suggests potential savings of $12.5 million or more to the state…but doesn’t bother to take into account issues of accessibility, affordability, or the impact that this would have on one of the least healthy states in the nation.

While additional funds are always appreciated, if past precedent is indicative of anything in West Virginia, it’s that Federally-allocated, but state-administered funds for state improvements rarely go very far in a state beset by geographic and economic hardships that have been allowed to go unaddressed for decades, intransigence and failure to adapt being the name of the game in the state. How is West Virginia – the state with the highest rate of opioid overdoses in the nation – supposed to compete for these funds when the state’s legislators are actively attempting to cut healthcare costs at the expense of healthcare access? If we are to receive funds based on the strength of our plans to confront this healthcare crisis, how will it look when, rather than expanding access, we are going about shrinking it?

This additional funding proposal has the potential to be a game changer…in states with legislatures who actively seek to expand access. To be honest, I am somewhat concerned by the caveat that these funds are designed to support medication-assisted treatment efforts. Even if they are effective in reducing dependency on opioid drugs, it seems ironic that addiction to one type of drug should be addressed by the use of another type of drug. Perhaps this proposal needs a bit more work, and a lot more focus on proven harm reduction efforts, such a accessible and legal syringe exchange programs, accessible treatment and rehabilitation centers, and more attention paid on the prescribing side of the issue.

Overall, I thank the President for his consideration, and welcome him to expand his thinking to include other types of treatment.
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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

 

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Opioid Prescription Abuse – Data vs. Addiction

By: Marcus J. Hopkins, Blogger

Every so often, I get the opportunity to speak with the hospice nurses who provide care services for my grandfather, and when they discover the focus of my research, I consistently hear the same thing – we have a huge problem with opioid addiction, abuse, and heroin usage in the state of West Virginia. Because their jobs specifically focus on providing hospice care, they’re not too engaged with the HCV aspect of the issue, but they have horror stories about relatives, friends, and neighbors looting their patients’ supply of opioid prescription drugs (from OxyContin to morphine) and either using it themselves or selling it on the street. But, the consensus is the same – this opioid epidemic is way out of control, and there doesn’t seem to be anyone doing anything about it.

This aspect – the “doing something about…” – is, perhaps, the most contentious issue within the opioid abuse conversation: what’s going to work, what is working, and who’s going to pay for it. These questions plague not only the people on the ground dealing with the fallout from opioid abuse, but the legislators tasked with combating a burgeoning problem. Additional concerns are raised about how to best cope with the growing addiction to opioid drugs, and frankly, there are simply no easy or cheap solutions to the problem.

Photo of opioid prescription drugs and an IU needle spread across money.

Photo Source: ReinventingAging.org

Tensions are further increased when “no nonsense”-style elected officials in the vein of Maine’s Paul LePage go off the rails talking about drug pushers coming to impregnate their white girls and bringing back the guillotine to deal with them. While this type of fast and loose language plays well with a certain segment of [mostly conservative] constituents, it plays a harmful role in demonizing not the repercussions of drug abuse and addiction, but the people who are involved. This creates (and reinforces) a social stigma, which research suggests serves as an internal barrier to seeking addiction treatment.

Two of the most successful legislative harm reduction strategies are Prescription Drug Monitoring Programs (PDMPs) that collect, analyze, and monitor electronically transmitted prescribing and dispensing data and Doctor Shopping Laws that attempt to prevent patients from seeking multiple prescriptions from multiple physicians for controlled substances.

PDMPs are highly effective tools for monitoring the rate of prescriptions being issues by physicians, as well as for tracking which patients receive those medications. Unfortunately, many states with those laws do not make reporting to PDMPs mandatory, which leaves it up to the physicians and pharmacists in those states whether or not they will participate. If there is less than an optimal participation rate, the purpose of monitoring the issue is not being served.

Doctor Shopping Laws are designed to penalize patients who visit multiple doctors in order to increase their on-hand supply of controlled substances (most frequently, opioid drugs). They make it illegal for patients to procure or attempt to procure controlled substances by fraud, deceit, misrepresentation, or subterfuge, and the penalties for getting caught vary by state. But, again – these laws only work if physicians and pharmacists are participating.

Another interesting aspect in relation to those harm reduction methods is how those laws affect law abiding citizens. There are concerns that these laws create a hostile environment, in which physicians are less likely to prescribe medically necessary medications for fear of violating state law. This could potentially leave patients in the lurch when trying to obtain a prescription to for valid use as prescribed. Should those patients be unable to receive a prescription from one physician, they may run the risk of running afoul of doctor shopping laws if they go to another physician in seek of help. While these scenarios are, at this point, purely anecdotal, it raises a serious concern about access to necessary treatment methods.

Sadly, this is one of the prices we must potentially pay if we wish to legitimately attempt to conquer our nation’s issues with opioid addiction. The consequence of making these drugs more difficult to obtain is that people who legitimately need them face the same hurdles as those attempting to procure them illegally. Good policy is, however, made when there is data and research to back up the initiative, whereas bad policy is often made when we cave to arguments of Pathos – stories, inspirational quotes, and vivid, emotional appeals.
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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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The ACA Took My Security Away

By Marcus J. Hopkins, Blogger

I’ve gone on record several times that I’m no fan of the Affordable Care Act (ACA). Several provisions of the act have rubbed me the wrong way since its passage, most of all the requirement that everyone purchase health insurance – a product that can be offered at any price, with no caps on the premium. This year, I finally purchased coverage under the marketplace, after two years of having qualified for Medicaid in the state of West Virginia, and I find that my frustrations are further justified.

I have been a client of WV’s AIDS Drugs Assistance Program for three years, now, and have, for the most part, been satisfied with the services they provide. When I found out that they would cover the price of health insurance premiums, I made the leap, and following their advice, signed up for the plan that seemed to best serve my needs.

President Obama signing the Affordable Care Act

President Obama signing the Affordable Care Act.

I did my research, spending hours looking at the three different plans they would pay for, checking the formularies (which were identical) to ensure that my HIV medication – Stribild – would be covered by the prescription plan. I tried to ensure that my monthly premium would remain low enough to be affordable, so I would pose the least amount of burden on the program, to reserve money for others who require more assistance than I.

Imagine my surprise, then, when I checked to see how much my prescriptions would be, and couldn’t find a price for my medication on their website. After calling Highmark West Virginia’s customer service line, I was told that my drug was “covered,” per se, but that I would be paying $100/month out of pocket for it. The customer service representative (CSR) suggested an alternative therapy – Atripla – which is no longer being actively prescribed, because it’s a ten-year-old drug, and there are better options.

Infuriated that I had gotten so much wrong about my coverage, I called my local ADAP representative to see what I should do, only to find out that there wasn’t really much. They will pay for the cost of medications, but it requires approval from the ADAP director, with whom I’ve had little luck getting in contact for the past year. Also, I was now responsible for paying the co-pays for visits and any associated bills for labs.

These are the kinds of problems that ADAP and Ryan White were designed to solve for people. I have, in the past, touted the wisdom of ADAP paying for primary insurance premiums for its clients as a way to defray some of the costs associated with treatment, but now I see the folly – each visit will cost me $30, because my doctor is a specialist; each month, I’ll be shelling out over $100 for medication; God only knows how much labs are going to cost.

For the first time since I qualified for Ryan White, I find myself panicked, because these were problems that I’d never had to face since I gained access to the program. The insecurity and financial worry – how will I afford my treatment; will I be able to still pay my bills just for life, much less for meds – Ryan White was supposed to be there to help me face those concerns.

Finally, after over a week of waiting for a response from either my local representative or my ADAP director, I decided to advocate for myself, and ended up turning to the Patient Access Network (PAN) Foundation – a Patient Assistance Program (PAP) designed to help people afford the cost of medications. I filled out an application online in fewer than ten minutes, and was approved immediately. Sure, there were extra steps involved in added a secondary insurance to my local pharmacy, but it all worked out for me, and now, I won’t have to worry about the cost of medications.

Now…whether or not I’ll have to cover the $30 visit fee for each visit has yet to be seen. I am grateful to the PAN Foundation for stepping up to help out where my ADAP program has failed. I cannot recommend their service enough, and encourage all people who are facing similar concerns to check them out at the link below this paragraph.

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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