ADAP Waiting List Update: 2,030 People in 9 States as of July 12

As of July 12, 2012, there are 2,030 individuals on ADAP waiting lists in nine states. Since last week, Florida experienced an increase of 154 clients on their waiting list while Georgia's decreased of 95 clients. Louisiana, Nebraska, and Virginia experienced minor decreases, while Alabama and Idaho's numbers remain steady. Virginia announced last Friday that they will begin to transition all financially eligible wait-listed clients with CD4 counts above 500 into their ADAP in the order that they were originally placed on the waiting list. Previously, clients with CD4 counts below 500 were given priority enrollment. Virginia anticipates all clients will be transitioned into the program and their wait list eliminated by mid-September 2012. To see a list of states with access restrictions please visit NASTAD's website.

The total number of individuals on waiting lists has decreased 78 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.

The Senate Appropriations Committee approved a FY2013 Labor-HHS-Education Appropriations bill that includes a $30 million increase for ADAP over FY2012 funding levels while continuing the $35 million announced on World AIDS Day as part of the ADAP base funding. President Obama's FY2013 budget proposal included a $67 million increase for ADAP over FY2012 levels, for a total of $1 billion. The President's FY2013 budget also includes the $35 million announced on World AIDS Day. The House is expected to begin mark-up of their Labor-HHS Appropriations bill on July 18.

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, was anticipated to be awarded by July 1, 2012. There has not been an update regarding the release date. This additional funding is expected to further 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).

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 end 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.