ADAP Waiting List Update: 1,805 People in 9 States as of July 19

As of July 19, 2012, there are 1,805 individuals on ADAP waiting lists in nine states. This week, Florida experienced a decrease of 172 individuals on their waiting list due to attrition and re-assessed program capacity. Nebraska also experienced a decrease of 94 individuals due to integration of new funding into their program. The remaining states reported steady numbers of their 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 81 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.

Last week, HHS Secretary Kathleen Sebelius announced the release of $69 million in FY2012 emergency funding for ADAPs, including the $35 million in new funding that President Obama announced on World AIDS Day and the $40 million in continuation emergency funding from FY2011. All applications were funded at the requested amounts; 22 states applied for continuation funding and 15 states applied for the new funding from World's AIDS Day. The emergency funding is expected to reduce and likely eliminate ADAP waiting lists and other cost containment measures currently in place. States will require time to incorporate the additional funding into their overall budgets and forecast program needs.

The House Appropriations Subcommittee on Labor, Health and Human Services, and Education passed a FY2013 Labor-HHS-Education Appropriations bill that is $6.8 billion less than FY2012 funding levels. ADAP received an increase of $67 million dollars for a total of $1 billion, which matches President Obama's request. However, the bill also drastically cuts other Ryan White programs by a total of $114 million. The full committee mark-up of the bill is expected next week. The Senate version of the bill provides a $30 million increase for ADAP. The appropriations process is expected to be drawn out as there are such differences between the House and Senate versions.

As a result of the receipt of $69 million in emergency funding, it is likely that ADAP waiting lists will decrease and/or be eliminated over the next several weeks and months. However, it is important to remember that ADAPs continue to see new enrollment of individuals based on increased efforts to identify new individuals living with HIV or re-engage individuals lost to care and will continue to require additional funding in order to keep new waiting lists from being implemented. 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.