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Lately there's one drug every AIDS patient wants. It's Neupogen, an injectible medication that boosts the white blood cell count and is currently the gold mine of AIDS meds. The patient for whom it is prescribed can, with the right connection, make $200 to $300 for a box of ampoules that retails for $1700. Here the shrewdness of the sellers comes into play. A doctor can determine from monthly blood tests whether a patient is taking Neupogen. The savvy ones inject their Neupogen for a few days before their next doctor's appointment, having saved the rest to sell. "You have to be smart," advises Aaron, who just turned 40 and has been HIV positive since the Eighties. "I got some in a box right now I'm about to get rid of."
Patients who've been in the sales business a long time have their own brokers who not only transport them to pharmacies to fill prescriptions but make house calls to buy medications, and even pay commissions for bringing in other customers. "I use Mr. Manny," Aaron confides. "That's what everyone call him. He works with his son. Child, that boy owns a big house, and he just bought himself a brand-new pickup truck." Aaron is tall and big boned, and his deep voice has a musical, feminine lilt to it. His naturally fleshy face is worn and scarred from more than fifteen years of rough life on the street, selling his body for crack and knowing AIDS is catching up with him. Every time he becomes sick he tells himself he must stop the crack for good, but once he begins feeling better, he's back on it.
From time to time Aaron will take some of his AIDS medicine, but because he (like many other Medicaid recipients) regularly visits different doctors at different clinics, he winds up every month with more medication than he'd need even if he were following a strict regimen and not selling everything he gets his hands on. Such doctor- and clinic-hopping is common and legal, even though it's basically just a way to convince as many doctors as possible to write as many prescriptions as possible. Unless the doctors are in contact with one another, they don't know what their patient has or hasn't been taking. And physicians at privately owned clinics normally are not in touch with one another.
Aaron says he usually goes once a month to the Metro-Dade clinic and to the Specialty Medical Care Center on NW 36th Street. So he receives double the number of prescriptions. Since Medicaid doesn't pay for unlimited prescription drugs per month, one way Aaron gets around possible problems is by paying cash for some of his cheaper prescriptions, such as like Percocet, a narcotic painkiller that isn't an HIV medication but is prescribed to AIDS patients. "I [fill] two Percocet [prescriptions]," he explains. "One I pay for and the other I don't, and both I sell."
When he thinks back a few years ago, before many of the really expensive drugs were in wide circulation, drugs such as Atovaquone, Crixivan, Combivir, Sustiva (each costing from $400 to almost $700 per month), and before the advent of Neupogen and Epogen (another injectible medication, modestly priced at about $250 for a month's supply), Aaron remembers how much time and work it took just to earn a few hundred dollars.
That was before he had a regular broker and sometimes had to shop around bottles of medicine to different buyers. He'd spend hours near pay phones at shopping centers, waiting for a runner he'd beeped to return the call. Then if he were lucky, the man would feel safe enough to meet him at a pharmacy to complete the transaction of exchanging a prescription or bottles of pills for cash. Today, Aaron says, he can make $1000 in a good month selling AIDS meds. The market is booming. "They got it going on more than ever because there are more AIDS drugs now," he says cheerily. "I call my man, first of the month, tell him to meet me at the pharmacy, he meets me at the pharmacy."
In an attempt to cut down on doctor-hopping and the accompanying prescription proliferation, the state Agency for Health Care Administration has requested permission from federal officials in Washington, D.C., to restrict Medicaid patients to only one doctor and one pharmacy. That request is expected to be granted and to take effect in about a year. Meanwhile most clinics have already tried, to some degree, to keep closer tabs on their patients and to run off the hustlers who wait outside.
"They would post up outside," recounts Albena Sumner, director of social services for the Specialty Medical Care Center. "One guy with a van. You get in and they give you money. You have runners who will approach patients and hustle patients. It took us a long time to clean this up. We got rid of 200 patients who we knew were just running scams." Yet as happens after most crackdowns, the vigilance has simply forced participants to move elsewhere or to vary their routines.
"There's so much 'game' out there I can't keep up with it," huffs one young woman waiting at the Floral Park Healthcare Center, just across 54th Street from the Metro-Dade clinic. Floral Park, however, is not game-friendly. It's not a place where patients run in for ten minutes and leave with a pocketful of prescriptions. Off-duty City of Miami police officers keep watch during working hours and have instructions to banish from the clinic anyone they spot selling or soliciting or otherwise making trouble.