An e-mail pal of ours asked us some questions about our medical costs:

1. How much are the drugs you take?
2. How much are the procedures (doctors' visits and tests) you have done?
3. What options are there for people who don't have insurance?

Here we try and answer these questions.

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How much are the drugs Wes takes?
The short answer:
Project Inform says that the average single-drug therapy (which is no longer acceptable) was $2,500/year ($208/month). And that triple-drug combination therapy (which, in part, adds an expensive protease inhibitor) is between $12,000-$15,000/year ($1,000-$1,250/month).

The longer answer:
Triple-drug combinations still aren't all the drugs that people with AIDS need - they're just the anti-HIV drugs. Also needed are the drugs to combat the opportunistic infections (OIs) that may appear in an HIV-weakened immune system.

Wes is on a quadruple-drug combination [at least he was when this was written in late 1996], plus additional drugs for OIs. Most of Wes' drugs are listed below. The retail cost of his drugs is about $24,000/year ($2,000/month).

(Fortunately, Wes does not pay the retail cost. He is lucky to have prescription drug coverage from his employer as part of his long-term disability benefits. This is very rare. His insurance plan requires that he obtain his medications through a mail-order pharmacy. This pharmacy bills the insurance company directly, and bills Wes a fixed amount ($5 for generics and $21 for brand-names) as his co-payment. As a result, Wes doesn't know the retail cost of the individual drugs he's on because he never sees the total bill. But he knows a ballpark cost for some of his medications - and their collective cost. Those are listed in the table below.)

Additionally, Wes takes about $100/month in different vitamins.

Wes' total unreimbursed portion for all his medical care (drugs, vitamins, procedures) was $5,273 in 1995. (Note: About $1,000 of this is related to 4/95 sinus surgery.)

What drug/strength	Dosing (monthly #)	Why is Wes on it?	Approximate cost per dose (monthly cost)
3tc (Epivir; lamivudine) 150 mg	1 tablet BID (#60)	Antiretroviral for HIV	$3.33 ($200) [a reader in Florida wrote that his actual cost was $208.37]
AZT (Retrovir; zidovudine) 100 mg	2 tablets TID (#120)	Antiretroviral for HIV	$3.33 ($400) [a reader in Florida wrote that his actual cost was $259.00]
B-12 (cyanocobalam) injection	1 cc 3x/week	Increases B cells, which Wes is low in. Helps neurologic & brain function. May prevent OIs.	Cheap
Bactrim D.S. 800/160	1 tablet QD (#30)	PCP prophylaxis & toxoplasmosis of the brain prophylaxis	Cheap
Biaxin 500 mg	1 tablet BID (#60)	Infections.	Expensive
Crixivan (indinavir) 400 mg	2 tablets TID (#180)	Protease inhibitor.	($900) [a reader in Florida said that he was on Viracept, and that its cost was $508.00 for 250mg 270tabs]
Diflucan 100 mg	1 tablet QD (#60)	Antifungal.	$3 ($90)
D4T (Zerit; stavudine) 40 mg	1 tablet BID (#60)	Antiretroviral for HIV.	$3.33 ($200)
Effexor 37.5mg	1 tablet BID (#60)	Antidepressant	Unknown
Gamma globulin	1 cc 3x/week	Helps reduce infections.	About $30.
Zantac tab 150 mg	1 tablet BID (#60)	Reduces production of stomach acid. Wes had a burning stomach before he started Zantac. May increase T-cells with AZT.	Unknown
Zovirax tab 400mg	1 tablet BID (#60)	Herpes prophylaxis, may be synergistic with AZT. May prophylax against CMV at higher doses. Also, triggers production of "cyclovir phosphate," an anti-HIV agent, in the body.	Unknown

Glossary:
BID = 2x/day
QD = 1x/day
TID = 3x/day

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How much are the procedures (doctors' visits and tests) Wes has done?
Important note:
Wes' doctor is relatively expensive. So are Wes' tests that are run in-house at the all-in-one-building the doctor is housed in. Many of these procedures can be found at less cost.

What?	Why/how often?	Retail cost (Medicare cost)1
Bloodwork
CBC (Complete Blood Count)	Check for anemia (side-effect of AZT) or if white blood count is elevated (sign of infection)/3 months	$35 ($10.75)
Chemistry	Make sure anti-HIV drugs aren't messing up the liver or pancreas/monthly	$65 ($15.28)
HIV PCR	"Viral load"/3 months	$320 (unknown)
T4 count	"T-cell count"/3 months	$170 ($51.40)
Procedures
CT (Computerized Tomography)	Wes gets this done before he has sinus surgery	about $800 (unknown)
MRI (Magnetic Resonance Imaging)	An MRI of the brain can show if there are toxoplasmosis lesions	about $1,200 (unknown)
Office visit	Checkup/3 months	$75 ($34.93)
X-ray (chest)	periodic	$135 ($34.26)
X-ray (sinus)	periodic	$75 ($31.80)

¹ If a doctor "accepts assignment" of Medicare benefits, this means that he or she will take whatever Medicare pays as full payment of the charge.

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What options are there for people who don't have insurance?

1. ADAP (AIDS Drug Assistance Program). This is a joint state-Federal program to pay for HIV medications. The medications covered vary from state to state.
2. Medicaid. This program for the poor includes (at least in Texas) coverage for three prescriptions per month. Medicaid eligibility is difficult: In Texas, you can't make more than about $500/month to qualify for Medicaid.
3. Medicare HMO. Traditional Medicare does not include any coverage for prescription drugs. Many Medicare HMOs are, however, including some prescription drug coverage. That coverage varies from HMO to HMO - from none to unlimited coverage. Still, the patient must have the drug prescribed by a physician "gatekeeper." Additionally, it takes 2 years and 5 months from the date one goes on disability until Medicare kicks in. (The 5 month wait is when Social Security Disability Income starts. 2 years after that is when Medicare coverage begins.) This long wait for Medicare eligibility is one of the reasons why people who stop working due to disability are entitled under COBRA to maintain their work insurance policy for 33 months (2 years and 5 months) instead of the standard 18 months - if they can afford to.
4. Clinical trials. Getting into a clinical trial of a drug usually means you get the drug for free. Call (800) TRIALS-A [800-874-2572] for information on studies open to enrollment.
5. Drug access programs and financial assistance opportunities: The Project Inform Hotline at (800) 822-7422 has telephone numbers of compassionate use and expanded access programs.
6. County health departments. Coverage and eligibility vary by area, but in Houston (which is in Harris County) the county health department provides free drugs for eligible uninsured residents.