President Bush in Philadelphia last week announced that the administration would make available $20 million for AIDS Drug Assistance Programs in states with waiting lists for HIV-positive people to receive antiretroviral drugs. ADAPs -- which are supported with both state and federal Ryan White CARE Act funds -- provide HIV/AIDS-related medications to low-income, uninsured and underinsured HIV-positive individuals (Kaiser Daily HIV/AIDS Report
, 6/24). The number of people on waiting lists for enrollment in ADAPs has increased nationwide from 1,263 in April to 1,629 in June, according to a report released earlier this month by the National Alliance of State and Territorial AIDS Directors
. Alabama, Alaska, Arkansas, Colorado, Idaho, Iowa, Kentucky, Montana, North Carolina, South Dakota and West Virginia have waiting lists and/or access restrictions. In addition, Alabama, Arkansas, Colorado, Indiana, Oklahoma, South Dakota, Utah and Washington have implemented other cost-containment strategies since April. According to NASTAD, Massachusetts, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, New Mexico, Oregon, South Carolina and Texas are anticipating new or additional restrictions during fiscal year 2004, which ends March 31, 2005 (Kaiser Daily HIV/AIDS Report
The new funding announced by Bush last week could help the 353 people on Alabama's ADAP waiting list, the Birmingham News reports. At a cost of $10,000 per patient annually, Alabama should receive about $3.52 million, according to the News. However, Dr. Charles Woernle, assistant state health officer for disease control and prevention, said he is waiting for "official documentation" ensuring that the state will receive sufficient funds to cover all patients on the waiting list. Although HIV-positive people on ADAP waiting lists have been receiving free drugs from pharmaceutical companies, the process to secure the drugs is "tedious and complicated," Woernle said, adding that it is "more efficient [to] have a direct pipeline to get folks the drugs they need." Jim Raper, a nurse practitioner and the administrative director at the University of Alabama--Birmingham's 1917 Clinic, said that moving people off the waiting list and out of pharmaceutical company programs will allow the clinic's social workers to find housing and provide counseling and other services for HIV-positive people. However, the ADAP program is not necessarily "in the clear," according to the News. "It begs the question, how long will that money be forthcoming and what happens to the next person who comes up after we liquidate the waiting list?" Woernle asked (Abrams, Birmingham News, 6/28).
Although Arkansas needs $5.1 million annually to care for its 460 ADAP beneficiaries, the program receives only $3.1 million each year and is not one of the states set to receive funding under Bush's plan, according to Lola Thrower of Arkansas' ADAP. Thrower was one of several doctors and public health officials who testified on Monday before a state Joint Minority Health Subcommittee. Michelle Smith of the Jefferson Comprehensive Care System said during her testimony that the Ryan White CARE Act funds that her organization receives are inadequate to meet the group's growing needs. Doctors and public health officials at the hearing said that minorities in the state were receiving insufficient education about the risks of certain diseases, including HIV/AIDS. Although minorities comprise only 19% of Arkansas' population, they account for 43% of the state's AIDS cases. However, the committee said that the possibility of increased funding was unlikely, according to the Associated Press (Hammer, Associated Press, 6/29).
Iowa is one of the 10 states set to benefit from the federal money, which will help the Iowa's ADAP treat the 16 people on its waiting list, the Des Moines Register reports. However, it does not address the program's long-term funding problems, Iowa ADAP manager Holly Hanson said, adding that the funding is "just a Band-Aid." In addition, the requirements tied to the new funding will create "a lot of administrative work," Hanson said. None of the funding will go directly to the state ADAP. As a result, Iowa will have to gather information on the drug regimens of the 16 people on the waiting list and report them to the federal agency that oversees the state ADAP. Because the state does not keep individual drug records and because of frequent drug changes, Hanson said that the process will be "complicated," according to the Register. In addition, only the 16 people who were on the waiting list at the time of the announcement will be eligible for the funding, meaning that anyone who has applied for ADAP coverage since then will be placed on a waiting list, Hanson said, adding that she receives about 12 new applications each month, the Register reports (Sagario, Des Moines Register, 6/28).
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Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of the Kaiser Family Foundation, by The Advisory Board Company. © 2004 by The Advisory Board Company and Kaiser Family Foundation. All rights reserved.