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The ADAP Watch

November 18, 2011

As of November 17, 2011, there were 6,595 individuals on AIDS Drug Assistance Program (ADAP) waiting lists in 12 states. This is a 28 percent decrease from the 9,217 individuals on the August 2011 ADAP Watch. Eighteen ADAPs, including 9 with current waiting lists, have instituted additional cost-containment measures since April 1, 2009 (reported as of November 9, 2011). In addition, 10 ADAPs, including two with current waiting lists, reported they are considering implementing new or additional cost-containment measures by the end of ADAP's current fiscal year (March 31, 2012).


ADAPs With Current or Anticipated Cost-Containment Measures, Including Waiting Lists, November 2011

ADAPs With Current or Anticipated Cost-Containment Measures, Including Waiting Lists, November 2011

Waiting List Organization: An ADAP waiting list using a first-come, first-served model is structured to place any individual applying to ADAP on the waiting list in order of receipt of a completed enrollment application and eligibility confirmation. Of the 12 states with ADAP waiting lists, six ADAPs utilize a first-come, first-served model for prioritizing clients.

An ADAP waiting list using a medical criteria model is structured based on a hierarchical criteria typically established by the state based on recommendations from its ADAP Advisory Committee. Of the 12 states with ADAP waiting lists, five ADAPs utilize a medical criteria model for prioritizing clients.

One ADAP utilizes an income criteria model to prioritize clients on their waiting list.

Waiting List Client Demographics: African Americans and Hispanics represent 60% (43% and 17%, respectively) of clients on ADAP waiting lists. Combined, Asians, Native Hawaiian/Pacific Islanders, and Alaskan Native/American Indians represent approximately 2% of the total ADAP waiting list population. Multi-racial ADAP clients represent 1% of the total ADAP waiting list population. Non-Hispanic whites comprise 24% of clients on ADAP waiting lists.

Almost three-quarters (73%) of ADAP clients are men. One quarter (26%) of ADAP waiting list clients are women.

ADAP Waiting List Clients, as of November 9, 2011

Access to Medications: Case management services are being provided to ADAP waiting list clients through ADAP (2 ADAP), Part B (9 ADAPs), contracted agencies (5 ADAPs), and other agencies, including other Parts of Ryan White (4 ADAPs).

For clients on ADAP waiting lists who are currently on or in need of medications, 11 ADAP waiting list states can confirm that ADAP waiting list clients are receiving medications through either pharmaceutical company patient assistance programs (PAPs), Welvista, or other mechanisms available within the state.

Factors Leading to Implementation of Cost-Containment: ADAPs reported the following factors contributing to consideration or implementation of cost containment measures:

About ADAP: ADAPs provide life-saving HIV treatments to low income, uninsured, and underinsured individuals living with HIV/AIDS in all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, the Federated States of Micronesia, American Samoa, and the Republic of the Marshall Islands. In addition, some ADAPs provide insurance continuation and Medicare Part D wrap-around services to eligible individuals. Ryan White Part B programs provide necessary medical and support services to low income, uninsured, and underinsured individuals living with HIV/AIDS in all states, territories and associated jurisdictions.

ADAPs With Waiting Lists
(6,595 Individuals in 12 States*, as of November 17, 2011)
StateNumber of Individuals on ADAP Waiting ListPercent of the Total ADAP Waiting ListIncrease/Decrease From Previous Reporting PeriodDate Waiting List Began
Alabama751%11October 2011
Florida3,21349%20June 2010
Georgia1,52523%70July 2010
Idaho50.1%0February 2011
Louisiana**4757%29June 2010
Montana90.1%-2January 2008
Nebraska90.1%1October 2011
North Carolina951%9January 2010
Ohio00%0July 2010
South Carolina651%35March 2010
Utah130.2%4May 2011
Virginia1,11117%7November 2010

* As a result of FY2010 ADAP emergency funding, Hawaii, Idaho, Iowa, Kentucky, South Dakota, and Utah eliminated their waiting lists; Idaho reinstituted a waiting list in February 2011 and Utah reinstituted a waiting list in May 2011.

** Louisiana has a capped enrollment on their program. This number represents their current unmet need.


ADAPs With Other Cost-Containment Strategies: Financial Eligibility
(445 Individuals in 6 States, as of November 9, 2011)
StateLowered Financial EligibilityDisenrolled Clients
Arkansas500% to 200% FPL99 clients (September 2009)
Illinois500% to 300% FPLGrandfathered in current clients from 301-500% FPL
North Dakota400% to 300% FPLGrandfathered in current clients from 301-400% FPL
Ohio500% to 300% FPL257 clients (July 2010)
South Carolina550% to 300% FPLGrandfathered in current clients from 301-550% FPL
Utah400% to 250% FPL89 clients (September 2009)

ADAPs With Other Cost-Containment Strategies (Instituted Since April 1, 2009, as of November 9, 2011)

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Alabama: reduced formulary
Arizona: reduced formulary
Arkansas: reduced formulary
Colorado: reduced formulary
Florida: reduced formulary, transitioned 5,403 clients to Welvista from February 15 to March 31, 2011
Georgia: reduced formulary, implemented medical criteria, participating in the Alternative Method Demonstration Project
Illinois: reduced formulary, instituted monthly expenditure cap ($2,000 per client per month), disenrolled clients not accessing ADAP for 90 days
Kentucky: reduced formulary
Louisiana: discontinued reimbursement of laboratory assays
North Carolina: reduced formulary
North Dakota: capped enrollment, instituted annual expenditure cap
Ohio: reduced formulary
Puerto Rico: reduced formulary
Utah: reduced formulary
Virginia: reduced formulary, restricted eligibility criteria, transitioned 204 clients onto waiting list
Washington: instituted client cost sharing, reduced formulary, only paying insurance premiums for clients currently on antiretrovirals
Wyoming: capped enrollment, reduced formulary, instituted client cost sharing


ADAPs Considering New/Additional Cost-Containment Measures (Before March 31, 2012***)

Alaska: reduce formulary
Florida: lower financial eligibility
Hawaii: establish waiting list
Kentucky: reduce formulary
Montana: reduce formulary
Oregon: reduce formulary
Puerto Rico: reduce formulary
Tennessee: establish waiting list
Washington: establish waiting list
Wyoming: establish waiting list, lower financial eligibility, institute client cost sharing

*** March 31, 2012 is the end of ADAP FY2011. ADAP fiscal years begin April 1 and ends March 31.




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