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The ADAP Watch

April 13, 2012

Since the release of final FY2011 Ryan White grant awards in September 2011, including $40 million in ADAP emergency relief funding for 30 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 67 percent since a high of 9,298 individuals on September 1, 2011.

Most states included on this ADAP Watch saw their waiting list numbers remain steady from last week's Watch, however, South Carolina's number decreased by 144 individuals due to cost savings from Medicare Part D wrap around payments and subsequent collection of rebate revenue, allowing re-enrollment of some individuals. Georgia's number increased by 62 individuals due to addition of new applicants to the program.

As states move individuals from their waiting lists into their ADAPs, new individuals continue to be enrolled and again added to their waiting lists. In addition, many ADAPs continue to struggle 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 new ADAP FY2012 grant year (began April 1, 2012). As a result of the variability of ADAP enrollment and funding, waiting lists will likely remain and continue to fluctuate until additional funding is received.

ADAP base and supplemental awards for FY2012, which include an additional $15 million appropriated by Congress, were recently issued to states. The Emergency Relief Funding (ERF) for ADAPs, including both the $35 million in new funding that President Obama announced on World AIDS Day and the $40 million in ERF continuation funding, has not yet been awarded. NASTAD understands that the distribution methodology for the $35 million in new funding will require ADAPs to apply and compete for the funding. The funding opportunity announcement (FOA) for both components of the ERF is expected to be released soon and awards are expected to be made in July 2012, although exact details are not available. NASTAD continues to advocate for thoughtful yet swift release of available funding as these awards will impact various cost-containment measures.

Finally, we have seen positive developments in the FY2013 budget for ADAP. President Obama's FY2013 budget proposal 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
(3,097 individuals in 10 states*, as of April 12, 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
Florida50316%-7June 2010
Georgia95731%62July 2010
Idaho110.3%2February 2011
Louisiana**36812%-26June 2010
Montana40.1%-2January 2008
Nebraska2207%1October 2011
North Carolina1244%7January 2010
South Carolina00%-144March 2010
Utah00%0May 2011
Virginia91029%-36November 2010

* As a result of FY2011 ADAP emergency funding, Alabama, Florida, Georgia, Idaho, Louisiana, Montana, North Carolina, 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 April 12, 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
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 ADAPs), 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, 10 ADAP waiting list states 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 end 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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