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ADAP Funding Crisis

February 27, 2004

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

The STEP's Ezine is posting the following article to educate and inform about the fiscal crisis of the ADAP program and the possibility of future reductions in benefits to those living with HIV/AIDS in our community.

What Are ADAPs?

AIDS Drug Assistance Programs (ADAPs) provide life-saving HIV/AIDS medications to uninsured and underinsured individuals living with HIV disease in the 50 states, the District of Columbia and the U.S. territories. ADAPs are not entitlement programs but are dependent on federal and state discretionary funding, which determines how many clients ADAPs can serve and what levels of service states can provide.

Why Are ADAPs in Fiscal Crisis?

There are two major factors contributing to the ADAP problem:

  • Inadequate funding: Since 2002, ADAPs have not received adequate federal funding with the FY 2002 budget for the program falling short by $62 million and the FY 2003 budget by $79 million. Adding to this effect is a FY 2004 budget that falls $180 million short in meeting current ADAP need. Moreover, many states are also under increasing fiscal pressure and are unable to contribute sufficient funding to make up for the federal shortfall.

  • Increased utilization/demand for services: People who have access to antiretrovirals are living longer, increasing utilization of the program by 154% since 1996, the year highly active antiretroviral therapy (HAART) was made available.

What Do ADAPs Need?

  • ADAPs will require $319 million in additional funding through FY 2005. The programs could be made whole immediately if $180 million of that funding were made available in a FY 2004 emergency supplemental. The President's preliminary 2005 budget provides $35 million, which, while welcome, is inadequate to meet the growing need.


  • The passage of the Early Treatment for HIV Act (ETHA), which would provide states the option of covering patients under Medicaid at an earlier stage of their disease, before they become disabled and are vulnerable to life-threatening and expensive-to-treat opportunistic infections. A majority of ADAP patients would qualify under ETHA in any state that adopted this progressive legislation, thus immediately relieving pressure on that state's ADAP program.

What Are the Effects of the Fiscal Crisis on ADAPs?

  • As of January 22, 2004, 791 ADAP-eligible clients are on state ADAP waiting lists, an increase of over 100 clients since November 2003. Due to capped enrollment, these people will not be able to access treatment until someone else moves off the program, dies, or additional funding is made available.

  • As of January 22, 2004, 15 state ADAPs have taken steps to limit access to life-enhancing HIV treatments and 8 more have announced plans to do so in the near future. Steps taken included capping enrollment, reducing formularies, reducing eligibility or, in the worst cases, removing already enrolled people from the program.

  • Due to insufficient funding, many ADAPs are no longer able to cover important new therapies for HIV or treatments for HIV/hepatitis C (HCV) coinfection, the fastest growing cause of death among people living with HIV.

Why Should ADAPs Be Adequately Funded to Meet Estimated Need?

  • To conform to federal HIV treatment guidelines: The United States Department of Health and Human Services Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents recommend that antiretroviral treatment be offered to all patients with 350 or fewer CD4 cells or over 55,000 viral load.

  • Treating HIV earlier in the course of the disease saves money: Numerous peer-reviewed studies have shown that it is both more medically sound and cost-effective to treat HIV early rather than late in the progression of the disease. A recent study from The University of Alabama at Birmingham showed that treating HIV early costs an average of $14,000 per year, while waiting until the patient is disabled (when he or she would normally qualify for Medicaid) costs an average of $34,000 per year.

  • Treating HIV saves lives: AIDS related death rates have declined by over 64% since the introduction of HAART in 1996. A 2003 study by Price-Waterhouse-Coopers demonstrated that early access to effective HIV therapy decreased AIDS-related death rates by 50%.

  • Treating HIV lowers transmission rates: Medications can help reduce the spread of HIV to HIV-negative partners. A study conducted by the National Institute of Allergy and Infectious Diseases shows that risk of HIV transmission drops when a patient's viral load drops below 1500. A second study published in 2004 in the journal AIDS states that the widespread use of new HIV medicines reduced HIV infectivity by 60%.

Who Do ADAPs Serve?

  • Over 90,000 unduplicated clients per month in November 2003, an increase of nearly 10,000 clients per month since June 2002.

  • Predominantly low-income individuals: Over 80% of ADAP clients have incomes at or below 200% of the federal poverty level (FPL), and about half of all ADAP clients earn 100% or less of the FPL ($8,860 per year).

  • Uninsured or underinsured individuals: 71% of ADAP clients have no other form of insurance, while 29% have insurance that does not adequately reimburse for the HIV treatments they are prescribed.

  • Predominantly racial and ethnic minorities: 33% of ADAP clients are African American, 24% are Hispanic, 37% are white and 5% are other races or ethnicities.

All data is from the National Association of State and Territorial AIDS Directors and the National ADAP Monitoring Report, April 2003, Henry J. Kaiser Family Foundation.

Note from the STEP Ezine editor: Washington State APDP (AIDS Prescription Drug Program) has added coverage for Hepatitis C treatment to its program.

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

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This article was provided by Seattle Treatment Education Project. It is a part of the publication STEP Ezine.
See Also
2014 National ADAP Monitoring Project Annual Report (PDF)
ADAP Waiting List Update: 35 People in 1 State as of July 23
More on ADAP Funding and Activism