A recent article in the Wall Street Journal discusses the high number of Americans who have developed resistance to most existing therapies and who are waiting for new medications to become available for salvage therapy. The number (estimated at 40,000) shocked me, although it probably should not have. People who have been in treatment for a dozen or more years have not only benefited from the development of HAART, they have gone through the various phases of understanding of how HIV should be treated. From monotherapy to "the cocktail" to "hit early, hit hard" to "wait and see" with a little "drug holiday" thrown in for some. At every step of the way, they have had more and more opportunities to develop resistance, presumably even if they were fully compliant with their treatment throughout.
The WSJ ends on the high note that several companies are developing new therapies that should be available over the next few years. One or two of those should be available within the next 12 months.
This is not such a high note if these medications cannot be included in any of the existing safety net programs, especially ADAP. Most Medicaid formularies will add the drugs to their formularies, but Medicare Part D providers are not, under current law, required to add them. All of the ADAP programs will likely try to add them, but funds are in critically short supply. If the new drugs are priced at the high end of the spectrum, adding them will be even more difficult.
The word from the Texas HIV Medication Program is good--we are not facing a shortfall in this biennium right now. However, there may not be enough slack on the program's funds to add new therapies. This is why we advocated for a "needs" budget rather than a "current services" budget for THMP when testifying regarding the DSHS LAR.