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).
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.
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)
|State||Number of Individuals on ADAP Waiting List||Percent of the Total ADAP Waiting List||Increase/Decrease From Previous Reporting Period||Date Waiting List Began|
|North Carolina||95||1%||9||January 2010|
|South Carolina||65||1%||35||March 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)
|State||Lowered Financial Eligibility||Disenrolled Clients|
|Arkansas||500% to 200% FPL||99 clients (September 2009)|
|Illinois||500% to 300% FPL||Grandfathered in current clients from 301-500% FPL|
|North Dakota||400% to 300% FPL||Grandfathered in current clients from 301-400% FPL|
|Ohio||500% to 300% FPL||257 clients (July 2010)|
|South Carolina||550% to 300% FPL||Grandfathered in current clients from 301-550% FPL|
|Utah||400% to 250% FPL||89 clients (September 2009)|
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
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