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President Bush's $20 Million ADAP Initiative

December 15, 2004

What is the President's $20 million ADAP Initiative?

On June 23, 2004, President Bush announced immediate availability of an additional $20 million in drug therapies for ten states with AIDS Drug Assistance Program (ADAP) waiting lists as of June 21, 2004. The ten states eligible to participate in this program are: Alabama, Alaska, Colorado, Idaho, Iowa, Kentucky, Montana, North Carolina, South Dakota and West Virginia. The Health Resources and Services Administration (HRSA) within the Department of Health and Human Services is coordinating the program with the ten states, which is being administered outside of the regular ADAP structure. HRSA has contracted with a pharmacy benefits manager (PBM) to directly purchase and distribute the drugs to individuals on the waiting lists in the ten states.

What are the details of the President's ADAP Initiative?

As of November 22, 2004, details of the direct purchase program include:

Are ADAPs still in crisis since the announcement of the Initiative?

State ADAPs are ever-changing programs due to a variety of factors, including changes in demand, changes in state Medicaid programs and the variability of state and federal funding. Since the President's announcement, developments that have implications for this program include (as of November 22, 2004):

What will happen to persons on the direct purchase program in FY2005?

HRSA expects states to begin transitioning persons from the direct purchase program to ADAPs when the FY2005 ADAP fiscal year commences on April 1, 2005. Congress did not, however, provide states funding to bring these persons onto their ADAP rolls, treating the $20 million as a one-time-only expense. Therefore, there is no guarantee that individuals receiving medication through this program will be transitioned into ADAPs when the FY2005 ADAP fiscal year begins on April 1, 2005.

What does NASTAD recommend for transitioning the clients into ADAPs?

Although the $38.7 million increase for ADAPs in the Consolidated Appropriations Act 2005, signed by President Bush on December 7, 2004, provided some relief to the programs, it does not solve the long-term ADAP fiscal crisis. In FY2006, it is estimated that at a minimum a $100 million is needed for ADAPs to maintain fiscal solvency and to enroll new clients in state ADAPs. Supplemental funding during FY2005, through the ADAP earmark, must be provided to the ten states that are included in the President's Initiative so that the individuals covered by this program can be enrolled in ADAP programs and avoid costly treatment interruptions.

What challenges are ADAPs facing regarding funding and funding allocations?

What is NASTAD doing to address the ADAP crisis?

NASTAD formed the ADAP Crisis Task Force in February 2003 in order to respond to the nationwide fiscal crisis that ADAPs face. Through negotiations with companies that manufacture antiretroviral drugs, the Task Force was successful in obtaining significant and multi-year pricing concessions on HIV/AIDS drugs. NASTAD has reached agreements with ten companies, collectively saving ADAPs and the federal government over $65 million during FY2003, with savings of approximately $87 million anticipated during ADAP's FY2004 ending March 31, 2005.

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