Transcript www.adapadvocacyassociation.org

Robbing Peter to Pay for Paul's HIV Care
Jesse Fry
Coverage Continuum
Private Health Insurance
˄˅
Patient Assistance Programs
˄˅
AIDS Insurance Continuation Program (AICP)
˄˅
AIDS Drug Assistance Program (ADAP or Part A pharmacy)
˄˅
“Medicaid-pending” (possibly with RW wrap-around
˄˅
Medicaid (w/o Medically Needy or other waiver programs)
˄˅
Medicaid (w/o Part D)
˄˅
Medicare (w/o Part D)
DISCLAIMER:
If you're already doing this stuff, or the state in
which you advocate is doing this stuff, don't take
offense, pronounce it! Show off! Also, I'm not
trying to 86 anybody's job...just making
suggestions to make things better.
AIDS Insurance Continuation Program
(AICP)



AICP sustains private health insurance
coverage for PLWH at risk of losing it.
Key advantage: Patient stays with her
established care team, including pharmacist.
Factoid: About two-thirds of AICP clients
medically and financially qualified for Florida
Medicaid.
“Saturation is for sponges.”
Ray Croc
Founder of McDonald's
MAX-OUT
AICP !!!
Coverage Continuum
Private Health Insurance
˄˅
Patient Assistance Programs
˄˅
AIDS Insurance Continuation Program (AICP)
˄˅
AIDS Drug Assistance Program (ADAP or Part A pharmacy)
˄˅
“Medicaid-pending” (possibly with RW wrap-around
˄˅
Medicaid (w/o Medically Needy or other waiver programs)
˄˅
Medicaid (w/o Part D)
˄˅
Medicare (w/o Part D)
What's so bad about Medicaid?



Virtually 100% coverage of antiretrovirals in
most states
Choice of doctors, nurse practitioners,
healthcare team (AAHIVM, ID society...)
Fun fact about HIV diagnostic tests: In
Florida, it's written into state law, every year, in
the appropriations bill that Florida Medicaid
shall pay for genotypic and phenotypic assays.
Jesse's Favorite Data Integrity and Use Rules:
(I know, such a nerd...)
1. Get your data into a format you can easily query.
2. Query the bat snot out of it.
Part B Grantees:
Review new client intake processes, statewide,
and if necessary, standardize to make sure the
first two data points every case manager collects
are:
1. Does she have any healthcare coverage?
2. Does she qualify financially
and medically for Medicaid?
Not just for eligibility determinations; Use data
liberally, lather, rinse, repeat.
Case Question:
If he qualifies for Medicaid and doesn't have
health insurance, and ADAP is on a waiting list,
what do you do?
State ADAP's:
Share your goals and successes
with state-based advocacy groups.
Ryan White Grantees:
Don't wait for HRSA to tell you to do something
with data, for Pete's sake, just do it.
And not just to get a SPNS grant, either.
Partner with pharmaceutical companies
on their Patient Assistance Programs.
What works, what doesn't, how it could be better.
“It's easier to criticize than to praise.”
Barbra Streisand
(I know, I know, super gay. But she said it, so there you go.)
It's still the low...
(That's law, pronounced, LOW...)
Funds from HRSA budget, allocated for Ryan
White programs are:
FUNDS OF LAST RESORT
Suggested Solution: The softer side.
Transition from “inventory-based” dispensing to
“specialty and retail pharmacy-based” dispensing.
Makes fiscal sense
Patient self-sufficiency
Patient adherence
Convenience
Own the position in the minds of members of
Congress as credible sources of information on
HIV treatment advocacy.
Book on “Positioning”:
Positioning: The Battle for your Mind
Ever had an empty file folder
shaken in your face
by a screaming member
of Congress?
Let's break this down...
Don't put all of your political eggs
in the same partisan basket?
Urge HRSA to require that all “overlapping”
Consortia and Planning Councils to merge,
forming one planning body.
Fun Fact:
If Congress doesn't pass a budget this session
it will be the first time since 1974.
“Creative Destruction”
Google it.
“ANTI-CAPITALISM”
“ANTI-GOVERNMENT”
ANTI-CREATIVITY
Knock it off, already.
“Samson killed 1,000 Philistines
with the jawbone of an ass.
Everyday, at least as many sales are killed
with the same weapon.”
Anonymous
Posted on copier room wall
at an advertising agency.
Books on Creativity:
A Whack on the Side of the Head
A Kick in the Seat of the Pants
Coverage Continuum
Private Health Insurance
˄˅
Patient Assistance Programs
˄˅
AIDS Insurance Continuation Program (AICP)
˄˅
AIDS Drug Assistance Program (ADAP or Part A pharmacy)
˄˅
“Medicaid-pending” (possibly with RW wrap-around
˄˅
Medicaid (w/o Medically Needy or other waiver programs)
˄˅
Medicaid (w/o Part D)
˄˅
Medicare (w/o Part D)
“If you're not transitioning clients toward selfsufficiency, you're not doing your job.”
Suzanne Stevens
Bureau of HIV/AIDS, DOH, Florida
Jesse Fry
[email protected]