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MAC Meeting Minutes February 21, 2014

OFFICIAL MINUTES
Texas HIV Medication Advisory Committee Meeting
February 21, 2014


The February 21, 2014 meeting of the Texas HIV Medication Advisory Committee (MAC) was held at 4110 Guadalupe Street, Building 582-West Auditorium, in Austin, Texas.

MAC Members in Attendance: Philip Keiser, M.D., Chair, Natalie Vanek, M.D., Vice-Chair, Mary Paul, M.D., Yolanda Rodriguez-Escobar, Ph.D., Nancy Miertschin, M.P.H., Fernando Garcia, M.D., David Huse, Bruce Turner, Frank Rosas

DSHS Staff in Attendance: Shelley Lucas, Janna Zumbrun, Imelda Garcia, Felipe Rocha, Rachel Sanor, John Allen, Mary Richards

Registered Guests: Brendan Snyder, Tyler Hunter, Kimberly Paulus, Becky Gonzales, Roberto Perraza, Roger Grotzinger, Januari Leo, Mike McBride, Jack McClure, Jay Dee Fredericksen, Mark Vane, Linda Cantu, Suzanne Erickson, Holly Turner, Sylvia Moreno, Patrick Martin, Eric Kim, Dan Tucker


Action and Discussion Items Covered:

  1. The meeting was called to order by Dr. Keiser at 12:04 pm, February 21, 2014.


  2. The committee reviewed and unanimously approved the September 13, 2013 meeting minutes.


  3. Janna Zumbrun, Assistant Commissioner for Disease Control and Prevention Services, introduced Imelda Garcia as the new Section Chief for Infectious Disease Prevention.


  4. Felipe Rocha, Manager of the TB/HIV/STD Viral Hepatitis Unit, presented an update on the THMP Budget, explaining that the update serves as a momentary snapshot in time and therefore subject to revision as additional data becomes available. Current projections for the 2014 Fiscal Year indicate a small defecit that would be offset by inventory on hand. No official word yet from HRSA as to the actual total in upcoming Ryan White funding to be awarded. At this point a total of $22.8 million in rebates received was being projected for the current Fiscal Year, but the full amount received wouldn’t be known until September or October at the earliest since they’re issued based on prior dispensation.


  5. Rachel Sanor presented ADAP/SPAP update reports detailing clients served by month, medication expenditures, number of prescriptions filled by month, and the top ten drugs dispensed for State FY 2014 to date.


  6. Janna Zumbrun gave an Affordable Care Act update in regards to ADAP. The Texas Insurance Assistance Program (TIAP) is currently assisting around 85 patients enrolled in COBRA continuation with their prescription copays. DSHS is currently reviewing the ACA and what impact it has on all the agency’s programs, not just restricted to ADAP, and is seeking to develop standardized policies across the agency. Many of the 15,000 recipients currently served by standard ADAP are ineligible for ACA policies due to issues of citizenship or incomes below 100% of the Federal Poverty Level (FPL); the prime candidates for ACA assistance through ADAP would be those within 100-200% of the poverty guidelines, which may consist of roughly one-third of the Texas ADAP recipient population. For those under 100% of FPL and therefore ineligible for federal subsidy assistance through the ACA, the premiums can vary greatly and would prove costlier for the ADAP to assist in wrapping around such policies in lieu of continued standard ADAP enrollment. Janna stated that the initial pilot program expansion, if approved, would need to consist of a manageable amount of clients to work out all the complexities involved with the ACA policies.


  7. Dan Tucker from Salix Pharmaceuticals and Eric Kim, Pharm D, gave a presentation on the drug Fulyzaq (crofelemer), which is taken twice daily to treat non-infectious diarrhea caused by antiretroviral therapy in HIV-positive patients. Committee members expressed concerns about the expense of the drug and the precedent it would establish in terms of approving nonantiretroviral amedications to the ADAP formulary and the impact it could have on the budget. Dr. Paul noted that the drug is not approved for pediatric patients. The Salix representative stated the company has a patient assistance program in place for patients up to 500% of Federal Poverty Level, in addition to a 90-day startup program for new recipients.


  8. No one amongst the Committee made a motion to recommend adding Fulyzag to the THMP formulary, so the drug was not considered further.


  9. The next MAC meeting was tentatively scheduled for May 30, 2014, from 12pm-3pm.


  10. There were two public comments. Patrick Martin from The Resource Group in Houston stated that case managers in Houston were enrolling clients in ACA plans and local resources aren’t robust enough to handle the potential influx of enrollees, so any assistance the TIAP pilot expansion could offer would be appreciated towards stretching their local funds further. Januari Leo with Legacy Community Health Services in Houston thanked the Committee and the Texas ADAP for all their work and research being done on behalf of the patients. She expressed that the TIAP expansion has the potential to be very cost effective and can address coverage gaps and maximize effectiveness of insurance coverage in Texas for this population.


  11. The meeting was adjourned by Dr. Keiser at 1:21 pm.


Approved by:
Phillip H. Keiser, M.D. – Chairman, Texas HIV Medication Advisory Committee
Date

Last updated June 29, 2016