ADAP Waiting List Update: 65 People in 3 States as of March 14

As of March 14, 2013, there are 65 individuals on ADAP waiting lists in three states. Idaho added two individuals in the last month. South Dakota's waiting list remained the same. Florida has not formally closed their waiting lists, but is currently enrolling new clients into their program and does not have any individuals on their waiting list. Louisiana eliminated their waiting list on February 28, 2013.

Based on recent developments at the federal level, NASTAD believes that waiting lists will soon begin to increase as states begin to learn their FY2013 funding levels. The federal government is currently operating on a six month Continuing Resolution (CR), through March 27, 2013. Due to this, ADAPs will only receive partial awards for their FY2013 funding which begins on April 1, 2013.

Congress will likely finalize a CR to fund the government for the remainder of FY2013 this week. The pending CR does not include the $35 million in emergency relief funds (ERFs) announced by President Obama on World AIDS Day (December 1) in 2011 and awarded to 15 states and territories in August 2012. NASTAD estimates that this could result in an estimated 7,920 current ADAP clients losing access to life-saving medications.

NASTAD, in conjunction with community partners, is working with Congress to address this issue, but it is highly unlikely that the $35 million in ERF funds awarded to states in FY2012 will be included in FY2013 funding.

In addition to the likely $35 million cut, sequestration took effect on March 1, 2013. Sequestration will likely result in an additional 5.2% cut to ADAP's FY2013 funding. Details on how the Health Resources and Services Administration (HRSA) will implement the sequestration cuts as well as any other cuts for ADAP are not yet known.

Finally, additional changes to the Ryan White Part B/ADAP formula distribution will take effect for FY2013. These will also likely result in funding shifts for state ADAPs. Only name-based HIV cases reported to CDC will be used in the formula calculations and the hold harmless provision will also decrease to 92.5% of states' FY2012 award. Ongoing shifts in the proportion of the nation's living HIV/AIDS cases will occur as well.

NASTAD monitors cost containment measures for ADAPs on a weekly basis and currently publishes the ADAP Watch monthly. If waiting lists begin to grow as a result of the above fiscal issues, NASTAD will publish the ADAP Watch more frequently.

Uninsured or underinsured individuals living with HIV who are ineligible for ADAPs can access needed medications using the common patient assistance program (PAP) application form to apply for multiple PAPs. This form can be found on NASTAD's website and the HRSA website. 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.

Please contact Christopher Cannon if you have questions.

ADAPs with Other Cost-containment Strategies (from April 1, 2012 through February 6, 2013*)

Enrollment Cap:
Idaho
Indiana
Utah
Wyoming

Expenditure Cap:
Illinois: (monthly)
Kentucky: (annual)
New Mexico: (monthly)
South Dakota: (annual)

Formulary Reduction:
Florida
Illinois
North Carolina
Puerto Rico
Tennessee
Utah
Virgin Island (U.S.)

Other:
Montana: elimination of all support services
Washington: pay insurance premiums only if client is prescribed and taking ARVs

* ADAPs may have other cost-containment strategies that were instituted prior to April 1, 2012.

ADAPs Considering New/Additional Cost-Containment Measures (before March 31, 2013**)

Alabama (capped enrollment)
Maine (formulary reduction)

**March 31, 2013 is the end of ADAP FY2012. ADAP fiscal years begin April 1 and ends March 31.

ADAPs That Eliminated/Modified Cost-Containment Measures (Since December 17, 2012***)

North Carolina (formulary increased)

*** ADAPs may have eliminated/modified other cost-containment strategies prior to December 17, 2012.