ADAP Watch is a monthly newsletter that monitors cost containment measures for AIDS Drug Assistance Programs (ADAPs). If waiting lists begin to grow as a result of the highlighted fiscal issues, NASTAD will publish the ADAP Watch more frequently.

ADAP Watch

June 20, 2013
As of June 11, 2013, there were 227 individuals on AIDS Drug Assistance Program (ADAP) waiting lists in three (3) states. 
  • Eleven ADAPs, including three with current waiting lists, have had cost-containment measures in place since April 1, 2013 (reported as of June 11, 2013).
  • Four ADAPs reported considering implementing new or additional cost-containment measures by the end of ADAP’s current fiscal year (March 31, 2014).  
  • One ADAP reported being able to eliminate or improve previous cost-containment measures during the last quarter.


ADAPs with Current or Anticipated Cost-Containment Measures, Including Waiting Lists, as of June 11, 2013
 ADAPs with Current or Anticipated Cost-Containment Measures, Including Waiting Lists,  as of June 11, 2013

ADAPs with Waiting Lists
(227 individuals in 3 states, as of June 11, 2013)

 

State

Number of Individuals on ADAP Waiting List

Percent of the Total
ADAP Waiting List

Increase/Decrease from Previous Reporting Period

Date Waiting List Began

Alabama

210

93%

+114

June 2010

Idaho

0

0%

0

October 2012

South Dakota

17

7%

0

August 2012




Factors Leading to ADAPs Considering or Implementing Cost-containment Measures
  • Reduced or insufficient federal ADAP funding (9 ADAPs)
  • Increased clients/demand due to job loss/unemployment (9 ADAPs)
  • Escalating drug costs (7 ADAPs)
  • Increased utilization from already enrolled clients (6 ADAPs)
  • Increased insurance/Medicare Part D wrap around costs (6 ADAPs)


Latest ADAP News
 
In FY2013, ADAP was originally funded at $851 million, a cut of $82 million, due to sequestration ($47 million) and the non-continuation of FY2012 emergency relief funding (ERF) ($35 million) that President Obama announced on World AIDS Day 2011. The ERF funding was awarded to 15 states and territories in August 2012.
 
Following the passage of the FY2013 Continuing Resolution, the Office of Management and Budget (OMB) sent a letter to Congress authorizing a transfer of $35 million to ADAP to continue the emergency funding. The FY2013 funding level for ADAP is now $886 million. Unlike the previous transfer, a portion of the FY2013 $35 million came from other parts of Ryan White and HIV prevention funding at the Centers for Disease Control and Prevention (CDC). The remaining funding came from other programs at the Health Resources and Services Administration (HRSA), CDC, the Administration for Children and Families (ACF) and the Substance Abuse and Mental Health Services Administration (SAMHSA).
 
The HRSA operating plan which details funding amounts for all programs at the agency can be found hereThe $35 million transfer does not affect the sequestration cut. HRSA will be sending a funding opportunity announcement (FOA) for the $35 million in ERF shortly for current and new grantees. 
 
Finally, changes to the Ryan White Part B/ADAP formula distribution will take effect in FY2013.  These changes will 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 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 and the transfer of funds from Part A for some Transitional Grant Areas (TGAs) will also take place. 
 
HRSA has indicated that final FY2013 notice of awards (NOAs) that include these shifts and cuts will be transmitted to states by the end of June. NASTAD anticipates that ADAPs may institute additional cost containment measures once their final awards are known and state funding is finalized (most state fiscal years begin on July 1).
 


Waiting List Client Demographics
ADAP waiting list clients, by Race/Ethnicity, as of June 11, 2013

ADAP waiting list clients, by Gender, as of June 11, 2012

Waiting List Organization: Waiting list clients are prioritized by one of two models:
  • First-come, first-served model:  placing individuals on the waiting list in order of receipt of a completed application and eligibility confirmation (3 ADAPs).
  • Medical criteria model:  based on hierarchical medical criteria based on recommendations by the ADAP Advisory Committee (0 ADAPs). 
Access to Medications: All three ADAPs with waiting lists confirm that case management services assist clients in obtaining medications through the HarborPath ADAP waiting list program or pharmaceutical company patient assistance programs (PAPs) while clients are on the waiting list.



ADAPs with Other Cost-containment Strategies
(since April 1, 2013i, as of June 11, 2013)

Enrollment Cap

Expenditure Cap

Financial Eligibility

Formulary Reduction

Other

Alabama
Idaho
Indiana
Utah
Illinois: (monthly)
New Mexico:  (monthly)
South Dakota:  (annual)
Illinois
Alabama
Alaska
Illinois
Louisiana
Maine
Georgia: cap on insurance premiums

iADAPs may have other cost-containment strategies that were instituted prior to April 1, 2013.

 ADAPs Considering New/Additional Cost-containment Measures
(before March 31, 2014
ii)

Expenditure Cap

Waiting List

Other

Arizona: (annual)

Arkansas
Utah

Wisconsin


iiMarch 31, 2014 is the end of ADAP FY2013. ADAP fiscal years begin April 1 and ends March 31.

ADAPs that Eliminated/Modified Cost-containment Measures
(since April 1, 2013iii
)


Other

Washington: stopped requiring use of PAPs during insurance enrollment


iiiADAPs may have other cost-containment strategies that were eliminated/modified prior to April 1, 2013.



About ADAP: ADAPs provide life-saving HIV treatments through directly purchasing medications or providing insurance coverage and wrap-around services to low income, uninsured, and underinsured individuals living with HIV/AIDS in all states, territories and associated jurisdictions.

About PAPs: 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. 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. In addition, the HarborPath program is available to serve individuals on ADAP waiting lists as well as individuals in select states (see the HarborPath website for more information). 

About NASTAD: NASTAD strengthens state and territory-based leadership, expertise, and advocacy and brings them to bear on reducing the incidence of HIV and viral hepatitis and on providing care and support to all who live with HIV and viral hepatitis. NASTAD’s vision is a world free of HIV/AIDS and viral hepatitis. For more information, visit www.NASTAD.org. To receive or unsubscribe from The ADAP Watch, please contact Christopher Cannon.

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