October 12, 2012
As of October 11, 2012, there are 104 individuals on ADAP waiting lists in five (5) states. Virginia eliminated their waiting list as of September 30. Georgia and North Carolina are currently enrolling new clients into their programs at this time and do not have any individuals on their waiting lists. However, they remain listed as they have not formally closed their waiting lists. Louisiana experienced a decrease of 26 individuals, while Florida and South Dakota had increases of 36 and six individuals, respectively, on their waiting lists.
With the recent receipt of the $75 million in ADAP Emergency Relief Funding (ERF) states have made significant reductions in their waiting list numbers, but the potential for new waiting lists developing this fiscal year (ending March 31, 2013) continues. Three states currently report having capped enrollments and several are close to reaching their cap. To see a list of states with access restrictions please visit NASTAD's website.
ADAP enrollment is not static and ADAPs continue to experience increased strain on their programs due to continued 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. Even with the recent receipt of ERF, some states are not able to eliminate their waiting lists entirely. One state anticipates new cost containment measures and four states report the potential of opening waiting lists by the end of ADAP's FY2012.
House and Senate leaders passed and the President signed a six month Continuing Resolution (CR) that funds the government through March 2013 at the Budget Control Act level. This CR does have a minimal increase of 0.6 percent from FY2012 which may provide a slight increase to overall ADAP funding. However, formula calculations associated with the Ryan White Program may result in fluctuations in ADAP funding for various jurisdictions.
In an effort to streamline and assist clients in need of medications, The Common Patient Assistance Program Application (CPAPA) was launched on September 12 and is now available on the NASTAD website or at http://hab.hrsa.gov/patientassistance/index.html. This single common application allows uninsured individuals living with HIV and/or their providers/caregivers to use one application to apply for multiple patient assistance programs (PAPs) that together provide an entire course of antiretroviral therapy. To see additional information on pharmaceutical company patient assistance or co-payment assistance programs, please visit the Positively Aware website or the Fair Pricing Coalition's website.
|ADAPs With Current or Anticipated Cost-Containment Measures, Including Waiting Lists, September 26, 2012|
Waiting List Client Demographics: African Americans and Hispanics represent 49% (32% and 17%, respectively) of clients on current ADAP waiting lists. Combined, Asians, Native Hawaiian/Pacific Islanders and Alaskan Native/American Indians represent approximately 5% of the total ADAP waiting list population. Multi-racial ADAP clients represent 1% of the total ADAP waiting list population. Non-Hispanic whites comprise 41% of clients on ADAP waiting lists. Unknown is currently 1% of the total ADAP waiting list.
Almost two-thirds (67%) of ADAP clients on waiting lists are men. Approximately one third (32%) of ADAP waiting list clients are women. Transgender are only 1% of the ADAP waiting list.
|ADAP Waiting List Clients, by Race/Ethnicity, as of September 26, 2012|
ADAP Waiting List Clients, by Gender, as of September 26, 2012
Access to Medications: Case management services are being provided to ADAP waiting list clients through Part B (5 ADAPs), contracted agencies (2 ADAPs) and other agencies, including other Parts of Ryan White (3 ADAPs).
For clients on ADAP waiting lists who are currently on or in need of medications, all five 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.
Waiting List Organization: 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 five states with ADAP waiting lists, three 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 five states with ADAP waiting lists, two utilize a medical criteria model for prioritizing clients to join the active client roll.
Factors Leading to Implementation of Cost-Containment Measures: ADAPs reported the following factors contributing to consideration or implementation of cost containment measures:
|ADAPs With Active Waiting Lists|
(104 Individuals in 5 States*, as of October 11, 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||0||0%||0||January 2010|
|South Dakota||16||15%||6||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.
|ADAPs With Capped Enrollment (as of October 11, 2012)|
|Utah||450 direct medication clients, 100 insurance clients|
Since September 2009, six ADAPs previously lowered their financial eligibility as part of their cost-containment plans. 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 report anticipating further changes to their financial eligibility.
Alabama: reduced formulary
Alaska: 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
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: restricted eligibility criteria
Washington: instituted client cost sharing, reduced formulary, only paying insurance premiums for clients currently on antiretrovirals
Wyoming: reduced formulary, instituted client cost sharing
Maine: reduced formulary
Montana: waiting list