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The ADAP Watch

April 20, 2012

As of April 19, 2012, there were 3,079 individuals on AIDS Drug Assistance Program (ADAP) waiting lists in 10 states. This is a 25 percent decrease from the 4,118 individuals on the February 2012 ADAP Watch. Seventeen ADAPs, including seven with current waiting lists, have instituted additional cost-containment measures since April 1, 2009 (reported as of April 11, 2012). In addition, five ADAPs, including one with a current waiting list, reported they are considering implementing new or additional cost-containment measures by the end of ADAP's current fiscal year (March 31, 2013).

ADAPs With Current or Anticipated Cost-Containment Measures, Including Waiting Lists, April 2012

ADAPs With Current or Anticipated Cost-Containment Measures, Including Waiting Lists, April 2012

Click image to enlarge.

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 10 states with ADAP waiting lists, five ADAPs utilize a first-come, first-served model for prioritizing clients to join the active client roll.

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 10 states with ADAP waiting lists, six ADAPs utilize a medical criteria model for prioritizing clients to join the active client roll.

Waiting List Client Demographics

African Americans and Hispanics represent 58% (47% and 9%, respectively) of clients on current ADAP waiting lists. Combined, Asians, Native Hawaiian/Pacific Islanders and Alaskan Native/American Indians represent approximately 1% of the total ADAP waiting list population. Multi-racial ADAP clients represent 1% of the total ADAP waiting list population. Non-Hispanic whites comprise 26% of clients on ADAP waiting lists. Unknown is currently 14% of the total ADAP waiting list.

Almost three-quarters (72%) of ADAP clients on waiting lists are men. Approximately one quarter (27%) of ADAP waiting list clients are women.

ADAP Waiting List Clients by Race/Ethnicity and Gender, as of April 11, 2012

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Access to Medications

Case management services are being provided to ADAP waiting list clients through ADAP (1 ADAP), Part B (6 ADAPs), contracted agencies (7 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, nine 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.

Factors Leading to Implementation of Cost-Containment Measures

ADAPs reported the following factors contributing to consideration or implementation of cost containment measures:

ADAPs With Waiting Lists
(3,079 Individuals in 10 States*, as of April 19, 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
Florida42714%-76June 2010
Georgia105834%101July 2010
Idaho80.2%-3February 2011
Louisiana**35612%-11June 2010
Montana40.1%0January 2008
Nebraska2227%2October 2011
North Carolina1405%16January 2010
South Carolina00%0March 2010
Utah00%0May 2011
Virginia86428%-46November 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 (Instituted Since September 2009, as of April 19, 2012)

Six ADAPs have previously lowered their financial eligibility as part of their cost-containment plans since September 2009. Illinois, North Dakota, Ohio and South Carolina lowered their eligibility level to 300% FPL. Utah lowered their eligibility level to 250% FPL, and Arkansas lowered their eligibility level to 200% FPL. Previously, all states had FPLs of 400% and above. As a result of these measures, a total of 445 individuals in three states, Arkansas (99), Ohio (257), and Utah (89), were disenrolled. Illinois, North Dakota, and South Carolina grandfathered their clients that fell within the income levels into their programs. No other ADAPs currently anticipate further changes to their financial eligibility.

ADAPs With Other Cost-Containment Strategies (Instituted Since April 1, 2009, as of April 11, 2012)

Alabama: reduced formulary, capped enrollment
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
Tennessee: 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, 2013***)

Alabama: reinstitute a waiting list
Alaska: reduce formulary
Arizona: instituting client cost sharing
California: instituting client cost sharing
Georgia: instituting client cost sharing
Virginia: enrolling clients into PCIPs

*** March 31, 2013 is the end of ADAP FY2012. ADAP fiscal years begin April 1 and ends March 31.

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.

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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