The S.C. Legislature is considering a bill that could lay the groundwork for AIDS patients on Medicaid to be treated with generic drugs, outraging patients and doctors who say the generics now available are significantly less effective than newer drugs not yet available in non-brand form.

In addition to blasting the bill, hundreds of advocates who rallied Wednesday in Columbia pressured the legislature to increase funding for a government-funded AIDS drug assistance program. The most recent data shows 386 people on a waiting list for the program.

Of 20 drugs available to treat AIDS in the U.S., only three are available in generic form, advocates said. All three of those are first-generation drugs that are rarely prescribed because newer drugs are considered more effective and have fewer side effects.

"It's not like blood pressure medicine, which has lots of generic options," said Dr. Kent Stock, who practices at the Lowcountry Infectious Disease clinic in West Ashley. "With HIV, there just aren't enough generics available to adequately treat patients."

S.C. Department of Health and Human Services spokesman Jeff Stensland tried to allay concerns Wednesday, saying patients would get generics only if they had the same level of effectiveness. Patients still would get brand-name drugs when generics are unavailable.

The bill before the Legislature, which a Senate committee passed narrowly Tuesday, would require the state to approve Medicaid prescriptions for AIDS, cancer and mental illness drugs before patients get them. The state would recommend medications from a "preferred drug" list, likely to contain generics, Stensland said. The focus primarily would be on cancer and mental health drugs, which have in some cases been over-prescribed, he said.

The proposal, which aims to cut the state Medicaid agency's gaping budget deficit, also includes a measure that would allow it to cut doctors' Medicaid reimbursement rates.

Officials from the S.C. HIV/AIDS Council, though, focused their ire on the question of generics.

"HIV drugs are not the same as penicillin or pain meds where it makes sense to use generics," said Bambi Gaddist, executive director of the Columbia non-profit. "The AIDS generics are old drugs that just aren't prescribed anymore. To go back to the old drugs that don't work and aren't effective is to take a step decades back."

Stock, president of the Charleston County Medical Society, considered the physician's perspective: "You don't want to force doctors to make poor decisions because they need to use a generic."

Wednesday's rally also highlighted the dearth of state funding for AIDS Drug Assistance Program, the state- and federally-funded program that now covers drug costs for about 2,000 residents a month. The waiting list has grown as more newly diagnosed patients compete for fewer resources amid state budget cuts. South Carolina has about 17,000 reported HIV-positive cases.

If funding remains level, the number of people on the waiting list is projected to rise dramatically over the next two years, said Anand Nagarajan, the state director of the program. By June, 900 people are expected to be waiting for drugs through the assistance program. That figure will rise to 2,000 by June 2012, according to state projections.

People on the list can qualify for free drugs from pharmaceutical companies, but the application process for obtaining those drugs from private companies can take months, patient advocates said.

Advocates want the state to budget $10 million for the program in the upcoming budget year.

A handful of legislators who attended the rally at the Statehouse -- including state Sen. Brad Hutto, D-Orangeburg, who said it makes fiscal sense to cover the drugs -- backed the request.

"I realize it's a tough budget, but this is one that if we don't fund it now, we'll pay bigger expenses on the back end when people show up in the ER," he said.