The ADAP Watch

As of June 7, 2012, there are 2,170 individuals on ADAP waiting lists in nine (9) states. Since the last ADAP Watch, Utah has officially closed their waiting list and re-opened their program to full enrollment. Florida experienced a decrease of 230 individuals. The Georgia, Louisiana, and Virginia waiting lists saw modest decreases of 45, 20, and 23 individuals, respectively, while Alabama and North Carolina added individuals to their waiting lists. To see a list of states with access restrictions please visit NASTAD's website.

The total number of individuals on waiting lists has decreased 77 percent since a high of 9,298 individuals on September 1, 2011. Regular FY2011 and FY2012 ADAP funding, along with FY2011 emergency funds, have helped to alleviate some of the waiting lists and other cost containment measures. Additional funding is still needed to further decrease or stabilize the waiting lists.

FY2012 emergency funding for ADAPs, including both the $35 million in new funding that President Obama announced on World AIDS Day and the $40 million in continuation funding for FY2012, is expected to be awarded by July 1, 2012. The $35 million in new funding was available for all Part B grantees. Awards will be capped at $7 million with a minimum award of $50,000. The $40 million in continuation funding was available for competition only for the 30 Part B grantees that received FY2011 ADAP emergency funding. The new funding is expected to reduce ADAP waiting lists and other cost containment measures currently in place.

As a result of the variability of ADAP enrollment and funding, waiting lists will likely remain and continue to fluctuate, particularly with increased efforts to identify new individuals living with HIV or re-engage individuals lost to care. Many ADAPs continue to struggle financially, including those without any cost-containment measures currently in place. Four ADAPs currently anticipate the need to implement cost-containment measures or a waiting list during the ADAP FY2012 grant year (began April 1, 2012).

Finally, 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 President's FY2013 budget includes the $35 million announced on World AIDS Day. NASTAD and the HIV/AIDS community are advocating for Congress to provide an increase to ADAPs in the FY2013 Labor-HHS-Education Appropriations bill. Additionally, the $35 million in funding announced on World AIDS Day must be added to the base funding for ADAPs to ensure those dollars are available to continue providing clients with their medications. The Senate Appropriations Committee is expected to mark-up its bill in the coming weeks.

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 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
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
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***)

Alaska: reduce formulary
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.

Access to Medications

Case management services are being provided to ADAP waiting list clients through ADAP (1 ADAP), Part B (5 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.