Transcript Document

The State of ADAPs
Update on the ADAP Crisis
Britten Pund
National Alliance of State & Territorial AIDS Directors
July 7, 2011
National Alliance of State &
Territorial AIDS Directors (NASTAD)
 Represents the nation’s chief health agency HIV/AIDS
and viral hepatitis staff in all 50 states, the District of
Columbia, Puerto Rico, the U.S. Virgin Islands and
the U.S. Pacific Islands
– Provides technical assistance and other support to
health department HIV/AIDS and viral hepatitis
programs
– Provides national leadership on HIV/AIDS and viral
hepatitis policy and programs
– Educates about and advocates for necessary federal
funding
Year in Review
The “Perfect Storm”
Heightened national
efforts on HIV testing
and linkages into care
Minimal increases in
federal appropriations
Fluctuations in state
funding
Increased demand due
to unemployment and
other economic
challenges
ADAP
High drug costs
Revised HIV treatment
guidelines
Patient Protection and Affordable
Care Act
 Patient Protection and Affordable Care Act (PPACA) signed into
law in March 2010.
 Some portions of reform that will impact ADAPs specifically are:
– Medicaid eligibility expansion (2014);
– Increase in the number of individuals covered by insurance plans
(2014);
– ADAPs’ Medicare Part D expenditures counting toward True Out
Of Pocket (TrOOP) expenditures (2011);
– Narrowing and closing of the Medicare Part D “doughnut hole
(ongoing);”
– An increase in the Medicaid rebate amount for purchased drugs;
and (2010)
– 340B pricing transparency.
Pharmaceutical Partners
Contributions
 In May 2010, pharmaceutical partners augmented
current agreements with ADAPs including:
– Providing deeper discounts;
– Increased rebates; and/or
– Price freezes to ADAP.
 Pharmaceutical partners expanded the reach of
Patient Assistance Programs (PAPs) and participated
in Welvista for waiting list clients.
ADAP Waiting Lists
 Over the course of 2010, 19 ADAPs reported a
waiting list.
 Several ADAPs decreased income eligibility
requirements and disenrolled clients from ADAP in
order to address shortfalls.
 In FY2010, some ADAPs began transitioning clients
off of ADAP and onto PAPs as a means of costcontainment. These clients were directed to seek
access to medications through PAPs.
ADAP Waiting Lists and
Cost-containment, as of May 2011
ADAP Waiting Lists,
as of June 30, 2011
8,615 individuals in 13 states*
Alabama: 73 individuals
Arkansas: 40 individuals
Florida: 3,562 individuals
Georgia: 1,630 individuals
Idaho: 20 individuals
Louisiana: 824 individuals**
Montana: 29 individuals
North Carolina: 292 individuals
Ohio: 485 individuals
South Carolina: 810 individuals
Utah: 25 individuals
Virginia: 817 individuals
Wyoming: 8 individuals
*As a result of ADAP emergency funding, Hawaii, Idaho, Iowa, Kentucky, South Dakota, and Utah eliminated their waiting
lists; Idaho reinstituted a waiting list in February 2011 and Utah reinstituted a waiting list in May 2011.
**Louisiana has a capped enrollment on their program. This number represents their current unmet need.
ADAPs with Cost-containment,
as of April 13, 2011
Arizona: reduced formulary
Arkansas: reduced formulary, lowered financial eligibility to 200% FPL
(disenrolled 99 clients in September 2009)
Colorado: reduced formulary
Florida: reduced formulary, transitioned 5,403 clients to Welvista from
February 15, 2011 to March 31, 2011
Georgia: reduced formulary, implemented medical criteria,
participating in the Alternative Method Demonstration Project (AMDP)
Idaho: capped enrollment
Illinois: reduced formulary, instituted monthly expenditure cap ($2,000 per
client per month)
Kentucky: reduced formulary
Louisiana: discontinued reimbursement of laboratory assays
North Carolina: reduced formulary
ADAPs with Cost-containment,
as of April 13, 2011 (continued)
North Dakota: capped enrollment, instituted annual expenditure cap,
lowered financial eligibility to 300% FPL (grandfathered in current clients
above 300%FPL)
Ohio: reduced formulary, lowered financial eligibility to 300% FPL
(disenrolled 257 clients in July 2010)
Puerto Rico: reduced formulary
South Carolina: lowered financial eligibility to 300% FPL (grandfathered in
current clients above 300% FPL)
Utah: reduced formulary, lowered financial eligibility to 250% FPL
(disenrolled 89 clients in FY2010)
Virginia: reduced formulary, transitioned 207 clients onto waiting list and
PAPs, only distributing 30-day prescription refills
Washington: instituted client cost sharing, reduced formulary (for uninsured
clients only), only paying insurance premiums for clients currently on
antiretrovirals
Wyoming: reduced formulary, instituted client cost sharing
Coordinated Strategy to Save
America’s ADAPs
 Secure additional resources for ADAP from the
federal government:
– The HIV/AIDS community is advocating for an
increase of $106 million for ADAPs for a total funding
of $991 million in FY2012.
 Maintain, restore and increase resources for ADAPs
from state governments.
 Continue agreements between ADAPs and
pharmaceutical manufacturers to provide financial
stability and augment existing agreements, when
possible.
The Outlook for the Future
 A bridge to 2014 is slowly being built and will require
much construction before ADAPs can fully take
advantage of health reform provisions.
 Weathering the current storm to reach 2014 will take
collaboration from all stakeholders involved in the
administration of the program.
Questions and Answers
Contact Information
Britten Pund
Manager, Health Care Access
NASTAD
Phone: (202) 434.8044
[email protected]
www.NASTAD.org