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The ADAP Watch

February 24, 2012

As of February 23, 2012, there are 4,251 individuals on ADAP waiting lists in eleven (11) states.  Alabama has eliminated their waiting list as a result of the client recertification process; Alabama maintains a capped enrollment on their program and will reinstitute a waiting list when that cap is reached. To see a list of states with access restrictions please visit NASTAD's website.

Since the release of final FY2011 Ryan White grant awards in September 2011, including $40 million in ADAP emergency relief funding for states with waiting lists or other cost-containment measures in place, some ADAPs were able to reduce the overall number of individuals on their waiting list. The number of individuals on waiting lists has decreased 53 percent since a high of 9,298 individuals on September 1, 2011. However, as states have removed individuals from their waiting lists, they have continued to add new individuals to their program. In addition, many ADAPs are struggling financially, including those without any cost-containment measures currently in place, and are beginning to anticipate the need for cost-containment measures and waiting lists in the upcoming ADAP FY2012 grant year (beginning April 1, 2012). As a result of these factors, waiting lists will likely continue to grow until additional funding is received.

New ADAP grant awards for FY2012, which will include an additional $15 million appropriated by Congress, are anticipated by April 1. In addition, the $35 million in additional funding that President Obama announced on World AIDS Day has not yet been finalized. We understand that HRSA is developing a distribution methodology that will require a competitive application by ADAPs. The funds must be awarded by September 30, 2012, but the timing of release of this funding to states remains unknown. NASTAD continues to advocate for thoughtful yet swift release of this funding as these awards will impact various cost-containment measures.

Finally, we have seen positive developments in the FY2013 budget for ADAP. President Obama released his detailed FY2013 budget proposal on February 13, 2012 which includes a $67 million increase for the AIDS Drug Assistance Program (ADAP) over FY2012 levels, for a total of $1 billion. The FY2012 ADAP earmark included in the FY2013 budget includes the $35 million announced on World AIDS Day.

To see information on pharmaceutical company co-payment assistance and patient assistance programs, please visit the Positively Aware website or the Fair Pricing Coalition's website.

ADAPs With Waiting Lists
(4,251 Individuals in 11 States*, as of February 23, 2012)
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
Florida1,08526%136June 2010
Georgia1,07225%61July 2010
Idaho30%0February 2011
Louisiana**44010%-252June 2010
Montana100.2%1January 2008
Nebraska1674%24October 2011
North Carolina1453%4January 2010
Ohio00%0July 2010
South Carolina2827%6March 2010
Utah00%0May 2011
Virginia1,04725%-19November 2010

* As a result of FY2011 ADAP emergency funding, Alabama, Florida, Georgia, Idaho, Louisiana, Montana, North Carolina, Ohio, South Carolina, Utah and Virginia were able to reduce the overall number of individuals on their waiting lists.

** 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 February 1, 2012)
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 February 1, 2012)

Alabama: capped enrollment, reduced formulary
Arizona: reduced formulary
Arkansas: 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
Nebraska: reduced formulary
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
Kentucky: reduce formulary
Montana: reduce formulary
Nebraska: disenroll clients based on medical criteria
Oregon: reduce formulary
Puerto Rico: reduce formulary
Tennessee: establish waiting list
Washington: lower financial eligibility
Wyoming: establish waiting list, lower financial eligibility, institute client cost sharing

Access to Medications

Case management services are being provided to ADAP waiting list clients through ADAP (2 ADAP), Part B (9 ADAPs), contracted agencies (6 ADAPs), and other agencies, including other Parts of Ryan White (5 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.

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

This article was provided by National Alliance of State and Territorial AIDS Directors. You can find this article online by typing this address into your Web browser:

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