Transcript State Perspective: Update from Arkansas

Kevin Dedner, MPH
Section Chief
HIV/AIDS & Hep C Section
Center for Health Protection
Arkansas Department of Health
Analogy of ADAPs
What fuels the faucet?
• Funding
• Client utilization:
• Based on trust
• Well-targeted testing
What causes leaks in the faucet?
• Clients transitioning out of care
• Clients lost to care
• Clients incarcerated
• Clients transitioning to other payers
(i.e. –
Medicaid and Medicare)
• Clients gaining employment and
employer sponsored insurance
• Clients moving our of state
Status of State ADAPs
Native
Hawaiian/Pacific
Islander
<1%
American
Indian/Alaskan
Native
<1%
Multi-Racial
1%
Other
<1%
Unknown
2%
Asian
1%
Non-Hispanic
Black/African
American
33%
Hispanic
26%
Non-Hispanic
White
35%
Transgender
<1%
Unknown
<1%
Female
23%
Male
77%
Age Unknown
<1%
>64 Years
2%
<12 Years
<1%
13-24 Years
3%
45-64 Years
45%
25-44 Years
50%
Federal Poverty Level
Unknown
3%
>400% FPL
2%
301-400% FPL
6%
201-300% FPL
15%
101-200% FPL
31%
≤100% FPL
42%
0%
5%
10%
15%
20%
Percent of Clients
25%
30%
35%
40%
45%
Medicaid
11%
Medicare
13%
Dually Eligible (Medicaid & Medicare)
Payer
2%
Private Insurance
17%
Uninsured
72%
0%
10%
20%
30%
40%
Percent of Clients
50%
60%
70%
80%
ADAP Budget
5%
2%
2%
4%
2%
2%
3%
1%
2%
2%
1%
2%
10%
12%
15%
17%
16%
19%
19%
22%
4%
1%
2%
4%
1%
2%
18%
21%
21%
21%
Other
(includes Part
B ADAP
Supplemental)
Part A
Part B
Rebates
65%
61%
State
59%
56%
54%
51%
ADAP
Earmark
FY 2003 $1,070.5 m FY 2004 $1,186.9 m FY 2005 $1,299.0 m FY 2006 $1,386.3 m FY 2007 $1,427.9 m FY 2008 $1,532.1 m
ADAP Client Utilization
120,000
110,047
101,987
100,000
94,577
96,404
96,121
2004
2005
2006
Clients Served
85,825
80,000
60,000
40,000
20,000
0
2003
2007
2008
40%
29%
Percent Change
30%
20%
15%
10%
10%
5%
3%
0%
-1%
-10%
2002-2003
2003-2004
2004-2005
2005-2006
2006-2007
2007-2008
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What Happen?
◦ Tremendous Growth in the Program

2006 to 2007 = 2% increase in clients enrolled (346 to 354)
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2007 to 2008 = 22% increase in clients enrolled (354 to 433)
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2008 to 2009 = 54% increase in clients enrolled (433 to 667)
◦ State Budgets under strain- Reduced Funding from
States
◦ Downturn in the Economy
 People lost their jobs and healthcare insurance
ADAP Growth Over 4 Year Period
667
702
433
354
April 1, 2007
April 2008
May 1, 2009
July 31, 2009
ADAP Weekly Growth Since Reducing FPL
710
702
700
690
681
680
674
670
674
681
676
676
667
666
667
667
668
660
650
640
22-May 29-May
5-Jun
12-Jun
19-Jun
June 25
3-Jul
10-Jul
17-Jul
24-Jul
31-Jul
12-Aug
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Provide care to those who need it most
Ensure consistency in services available to
clients
Provide a stable funding stream to providers
and clients
Stabilize the program
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Reduced income eligibility from 500% to 200% FPL effective May 26, 2009.
Curtailed outreach activities
Reviewed and reduced dental treatment plans.
Implemented weekly monitoring report of expenditures, commitments, and
caseload.
Reviewed the formulary. The following changes were made.
◦ 56 drugs are being removed.
◦ 12 drugs will require prior authorization.
A Patient Assistance Program was developed.
Established an Advisory Group that has met two times.
Conducted 11 focus group sessions statewide: 5 with patients and 6 with
providers. Results are being compiled.
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Required Medicare Part D clients with incomes <150% FPL to apply for Low
Income Subsidy.
Sought Patient Assistance for Hepatitis C patients. The state has 10 slots
available. Medications cost $16,000 per year.
Dismissed clients with incomes >200% FPL.
◦ Notify October 1.
◦ Effective January 1.
Strengthen the policy on payments of insurance premiums and drug co-pays
to assure it is cost effective.
ADAP Waiting Lists and Cost-Containment
ADAPs with Waiting Lists (2,090 individuals, as of July 1, 2010)
Florida: 523 individuals
Hawaii: 10 individuals
Idaho: 26 individuals
Iowa: 97 individuals
Kentucky: 198 individuals
Louisiana: 112 individuals*
Montana: 20 individuals
North Carolina: 783 individuals
South Carolina: 187 individuals
South Dakota: 22 individuals
Utah: 112 individuals
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Arizona: reduced formulary
Arkansas: reduced formulary, lowered financial eligibility to 200% of FPL
Colorado: reduced formulary
Georgia: waiting list as of July 1, 2010
Illinois: reduced formulary
Iowa: reduced formulary
Kentucky: reduced formulary
Louisiana: capped enrollment, discontinued reimbursement of laboratory
assays
Missouri: reduced formulary
North Carolina: reduced formulary
North Dakota: capped enrollment, cap on Fuzeon, lowered financial eligibility
to 300% FPL
Utah: reduced formulary, lowered financial eligibility to 250% FPL
Washington: client cost sharing, reduced formulary (for uninsured clients
only)
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Arizona: waiting list
California: proposed elimination of ADAP services in city and county jails
Florida: reduced formulary, lowered financial eligibility
Illinois: reduced formulary, lowered financial eligibility, monthly expenditure
cap
Ohio: reduced formulary, lowered financial eligibility, capped enrollment,
client cost sharing, annual and monthly
expenditure caps
Oregon: reduced formulary, client cost sharing, annual expenditure cap
Wyoming: reduced formulary
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Funding
Co-infections
Unmet Need
Lost to Care
Late Testers (Targeted Testing)
Access to Care
Homophobia/Stigma/Discrimination
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National Alliance of State & Territorial AIDS
Directors
Southern AIDS Coalition
Arkansas Department of Health
Kevin Dedner, MPH
HIV/STD/Hepatitis C Section
Arkansas Department of Health
4815 West Markham, Slot 33
Little Rock, AR 72205
Direct Dial: 501-661-2408
Toll Free: 1-888-499-6544
Fax: 501-661-2082
[email protected]