As a result of these changes, and others over the years, a combination of the Federal Government requirements and the administration by Magellan and PACE have made the application process burdensome. This has resulted in cause for anxiety for many patients who need this medication. So, I thought I would review this application in my blog for everyone living in Pennsylvania (Please consult your case manager for additional assistance if you need it! That is what they are there for!). You will see how this application in itself is a barrier to care. It is confusing and any mistake will result in a denial of service for medication. As we all know a denial can mean a delay in obtaining medication, which in turn increases the likelihood of medication resistance and increases in viral load resulting in what? Higher transmission rates!
PAGE 1 - A.K.A - Let's confuse the hell out of our patients.
The first page looks innocent enough right? WRONG. See that box titled "SPBP Eligibility Mandatory Criteria"? The third criteria states "Your prescribing physician must sign and date page 5." (SPBP Application). First, why the hell would anyone be applying to a program to pay for HIV medications that does not have HIV? Second, if a person is REAPPLYING for the program the box to the right states that the physician's signature is "Not Required". Seems simple enough right? Think again. Your physician or nurse practitioner is still required to provide a signature on page 4 of the application. Every patient is also required to disclose CD4 and Viral Load information (we'll get to that in a minute). This page represents the first barrier to care.
Page 2 - This page is relatively straight forward.
Nothing to worry about here, just need to provide simple name, address, phone number, and demographic information. Except for that little part about requiring you to disclose whether or not you have a case manager. Forgetting to check this box may result in a denial letter. Better cross those t's and dot those i's.
Page 3 - DANGER WILL ROBINSON! DANGER!
You better make sure that you provide a copy of current insurance or be ready to explain WHY you do not have insurance. Hmmmm....what could be a reason why someone with HIV is applying for SPBP and does not have insurance? Could it be insurance affordability or perhaps that fact a person will die without the medication? This section represents yet another barrier to HIV care.
Here is the page I mentioned above in page 1. Make sure you still get your prescribing clinician's signature along with your CD4 or Viral Load count from your last test. Failing to provide this information will result in denial of service. Also, be sure to check off that little box below regarding income. Apparently, forgetting to check this box causes problems also.
Page 5 - Proof that you have HIV.
If you have just received an HIV + Diagnosis, I am sorry...please do not let this application discourage you from obtaining access to treatment. Take care of your health! Even if the Pennsylvania ADAP program prevents you from doing so. Finally, this section is just really stupid. Why would anyone be applying for a program that does not have HIV? The drugs have no psychoactive effect and there are better ways of determining if SPBP is being used for other purposes without alienating and stressing out patients...trust me, the HIV stigma causes more than enough stress. Still....if you do not get this page signed what happens? DENIED.
Pages 6 and 7 - What would obtaining medical treatment be in a country that values profit over care than requiring you to release private information! YAY! Seriously, this needs to be signed or you will be denied care.
Page 7 (Page 6 Continued)
Page 8 - Last, but not least, page 8.
This page is also one of the few pages that are fairly straight forward.....if unnecessary and burdensome to people living with HIV.
Another thing about this lengthy application is that the Federal Government, Pennsylvania Department of Health, and the Pennsylvania Department of Public Welfare is they are more concerned with protecting their assets than protecting the welfare and the health of their citizens. These barriers have also caused people to drop out of care, which is linked to a cascade effect that results in only 25% of HIV patients receiving the care they need to remain virally suppressed. Keeping the HIV virus suppressed is key to reducing HIV transmission. However, the Pennsylvania ADAP program application does little to help reduce this cascade. If anything, it decreases access to care. To the State of Pennsylvania I say this....please stop outsourcing our government to for-profit organizations. The unnecessary and over burdensome requirements of this application have resulted in reduced quality of care and are causing people to drop out of care.