September 4, 2012
As of August 30, 2012, there are 170 individuals on ADAP waiting lists in six states. With the recent receipt of the ADAP Emergency Relief Funding (ERF), Alabama officially closed their waiting list and removed their enrollment cap that was previously in place as a means to contain costs. Two states, Georgia and Virginia were able to transition their remaining waiting list clients into their programs. Virginia experienced the largest decrease this week with 275 individuals. Georgia and Louisiana also had significant decreases of 130 and 120 respectively. To see a list of states with access restrictions please visit NASTAD's website.
In July 2012, 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 and $40 million in continued emergency funding from FY2011. All applications were funded at the requested amount. The last $6 million in emergency funding has recently been awarded to states that previously applied to ensure that they can eliminate further cost containment measures. While the emergency funding has had a positive effect on the number of individuals on waiting lists, 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 or re-engagement of individuals lost to care as part the National HIV/AIDS Strategy. ADAPs will continue to require increased 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 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 to work this month.
ADAPs work with clients to ensure they receive medications through other programs while they are on the wait 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.
|ADAPs With Waiting Lists|
(170 individuals in 6 states*, as of August 30, 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||25||15%||16||January 2010|
|South Dakota||9||5%||3||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
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 per client per month)
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