August 10, 2012
As of August 9, 2012, there are 1,125 individuals on ADAP waiting lists in seven states. With the recent receipt of the ADAP Emergency Relief Funding (ERF), many states report continued decreases in the number of individuals on their waiting list this week. Even with the receipt of the ERF, many states are still experiencing increased demand for their programs. For example, South Dakota instituted a waiting list on August 3, 2012; their previous waiting list was eliminated on August 25, 2010. Wyoming, which has a capped enrollment on their program, reports that they anticipate instituting a waiting list by the end of FY2012 (March 31, 2013). To see a list of states with access restrictions please visit NASTAD's website.
In July 2012, the Department of Health and Human Services (HHS) Secretary, Kathleen Sebelius, announced the release of $69 million in FY2012 emergency funding for ADAPs, including $35 million in new funding that President Obama announced on World AIDS Day (2011) and $40 million in continued emergency funding from FY2011. All applications were funded at the requested amount; 22 states applied for continuation funding and 15 states applied for the new funding from World's AIDS Day. The emergency funding has resulted in the reduction and elimination of some ADAP waiting lists and other cost-containment measures currently in place. And yet, ADAP enrollment is not static and other ADAPs continue to experience increased strain on their programs due to new enrollment of individuals based on increased efforts to identify new individuals living with HIV and re-engagement of individuals lost to care as part the National HIV/AIDS Strategy. ADAPs will continue to require additional funding to keep new waiting lists from being implemented. Two ADAPs currently anticipate the need to implement new cost-containment measures or a waiting list during the ADAP FY2012 grant year (began April 1, 2012).
The House Appropriations Subcommittee on Labor, Health and Human Services, and Education passed a FY2013 Labor-HHS-Education Appropriations mark 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 Obamas request. The House Subcommittee allocated $2.3 billion for the Ryan White Program, which is a cut of $47 million from FY2012 funding levels. Due to the increase in ADAP and this overall cut to the total Ryan White Program, actual cuts to the Ryan White Program will amount to approximately $114 million. The Senate version of the bill provides a $30 million increase for ADAP. House and Senate leaders have agreed to a six month Continuing Resolution (CR) that will fund the government through March 2013 at the Budget Control Act level, which will be approximately flat-funding from FY2012. Both chambers will vote on the CR when they return after the August recess.
ADAPs work with clients to ensure they receive medications through other programs while they are on waiting lists. 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.
As of August 9, 2012, there were 1,125 individuals on AIDS Drug Assistance Program (ADAP) waiting lists in seven (7) states. This is a 63 percent decrease from the 3,079 individuals on the April 2012 ADAP Watch. Twenty-one ADAPs, including seven with current waiting lists, have instituted additional cost-containment measures since April 1, 2009 (reported as of August 2, 2012). In addition, two ADAPs reported they are considering implementing new or additional cost-containment measures by the end of ADAPs current fiscal year (March 31, 2013).
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 seven states with ADAP waiting lists, four 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 seven states with ADAP waiting lists, three ADAPs utilize a medical criteria model for prioritizing clients to join the active client roll.
African Americans and Hispanics represent 52% (47% and 5%, 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 0% of the total ADAP waiting list population. Non-Hispanic whites comprise 19% of clients on ADAP waiting lists. Unknown is currently 28% of the total ADAP waiting list.
Almost three-quarters (71%) of ADAP clients on waiting lists are men. Approximately one quarter (28%) of ADAP waiting list clients are women.
Case management services are being provided to ADAP waiting list clients through ADAP (1 ADAP), Part B (7 ADAPs), contracted agencies (4 ADAPs) and other agencies, including other Parts of Ryan White (2 ADAPs).
For clients on ADAP waiting lists who are currently on or in need of medications, seven ADAPs with waiting lists 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.
ADAPs reported the following factors contributing to consideration or implementation of cost containment measures:
|ADAPs With Waiting Lists|
(1,125 individuals in 7 states*, as of August 9, 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|
|North Carolina||3||.2%||3||January 2010|
|South Dakota||4||.4%||4||August 2012|
* As a result of FY2012 ADAP emergency funding, Alabama, Florida, Georgia, Idaho, Louisiana, Montana, Nebraska, North Carolina, and Virginia were able to reduce the overall number of individuals on their waiting lists.
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 its eligibility level to 250% FPL. Arkansas lowered its eligibility level to 200% FPL. Previously, income eligibility for the states noted above was 400% FPL or higher. 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 clients that were previously eligible based on their income level into their programs. No other ADAPs currently anticipate further changes to their financial eligibility.
Alabama: reduced formulary, capped enrollment
Alaska: 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)
Kentucky: reduced formulary
Louisiana: discontinued reimbursement of laboratory assays
Montana: reduced formulary
Nebraska: reduced formulary
North Carolina: reduced formulary
North Dakota: capped enrollment, instituted annual expenditure cap
Puerto Rico: reduced formulary
South Dakota: annual expenditure cap ($10,500)
Tennessee: reduced formulary
Utah: reduced formulary
Virginia: reduced formulary, restricted eligibility criteria
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
Maine: reduced formulary
Wyoming: institute waiting list