AIDS Drug Assistance Program Report Offers Sobering View of Programs

AIDS Drug Assistance Programs (ADAPs) are facing growth problems that have resulted in restricted access to drugs and capped enrollment in at least 10 US states and territories, according to the April 2002 annual ADAP report of the National ADAP Monitoring Project, prepared by the Henry J. Kaiser Family Foundation.

As of February 2002, Alabama, Georgia, Idaho, Kentucky, Maine, North Carolina, South Dakota, Texas, Wyoming and Guam had restrictions. Maine, Texas and Guam reported capped or restricted access to antiretroviral drugs; others had expenditure caps and capped enrollment.

ADAP in Texas anticipates deficits of $7 million in 2002, $12 million in 2004 and $16 million in 2002. Problems for states like Texas surfaced even as the national ADAP budget grew by 12 percent, to $810 million in fiscal year 2001 -- a fourfold increase since FY 1996. State ADAP funding also increased by an average of 12 percent to $149.6 million in FY 2001, although 16 states provided no state funding and relied solely on federal funds. The report makes it clear that even double-digit funding increases are not keeping pace with the need.

Ten states serve 77 percent of all ADAP clients, according to June 2001 data, and the top five serve 61 percent of all clients. Among other key findings:

• Eighty percent of ADAP clients were men; 34 percent were African-American; 24 percent were Hispanic; 38 percent were white non-Hispanics.
• Nearly 80 percent of clients reported incomes of less than 200 percent of the federal poverty level (or $17,200 per year), while 44 percent reported incomes of less than the federal poverty level ($8,590).
• Most clients were uninsured. Six percent received Medicaid; 10 percent received Medicare; 11 percent had private insurance.
• States reporting capped enrollments and waiting lists included Alabama, Georgia, Kentucky, North Carolina and South Dakota. Texas, Maine and Guam have restricted access to protease inhibitors/antiretrovirals. Idaho has a monthly per capita expenditure cap; Wyoming has a yearly per capita expenditure cap.
• ADAP formularies ranged from 18 drugs covered in Louisiana and Utah to 471 drugs in New York. Massachusetts and New Jersey have changed to an open formulary since last year's report.
• Nineteen states provide resistance testing coverage; 15 of these cover both genotypic and phenotypic testing.

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