October 16, 2012
Virginia's first waiting list for its AIDS drug assistance program for low-income individuals has been eliminated in less than two years due to an increase in funding, a host of cost-saving maneuvers, and partnerships among local, state, and federal groups. Due to budget constraints, new enrollment to the state's AIDS Drug Assistance Program (ADAP) was closed in November 2010 to everyone except pregnant women, children, and people being treated for potentially fatal infections that exploit weakened immune systems.
Before the eligibility restrictions took effect in November 2010, there were more than 3,500 enrolled. Approximately 2,700 people were enrolled in the program as of June of 2012. Nearly 600 were on the waiting list, which ended in August. The monthly cost per patient also decreased -- from $2.9 million in June 2010 to an average of $1.7 million this year. The state found approximately $10.3 million in program savings through Medicare rebates and removing inactive clients. During 2011, state contributions of about $4.8 million also helped keep 451 clients -- with average monthly client costs of $906 -- on the program. However, nearly all of the funding for the program comes from the federal government through Part B grant funds from the Ryan White HIV/AIDS Treatment Extension Act of 2009. Virginia competed for -- and won -- $3 million in emergency relief funding in 2011 and 2012.
As more funding became available, the state gradually loosened its eligibility requirements. From November 2010 through this June, nearly half of the wait-listed people could enroll in the program. Others found coverage through Medicaid or private insurance, were no longer eligible, or could not be contacted. "I think that the ability to eliminate the wait list is critically important both to individual and public health," said Diana L. Jordan, director of the Virginia Department of Health's Division of Disease Prevention. "I think the key is that earlier treatment reduces HIV transmission as well."
Some, however, such as Brandon M. Macsata, CEO of the nonprofit ADAP Advocacy Association, states that while the elimination of waiting lists is welcome news, he believes that Virginia has created what he calls an "invisible waiting list," by removing more expensive drugs from the program and tightening eligibility requirements over the last two years.