Transcript Securing HIV/AIDS Drugs for the Nation`s Poor and Uninsured

ADAP:
SECURING HIV/AIDS DRUGS
for the
NATION’S POOR and UNINSURED
Carl Schmid
Deputy Executive Director
The AIDS Institute
William McColl
Political Director
AIDS Action Council
Early Treatment of HIV Summit
Washington DC
July 20, 2009
GOALS & METHODS
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Joint project by The AIDS Institute & AIDS
Action Council
Analyze ADAPs & how well they are meeting
goal of providing medications
Conducted 30 Interviews
Offered an Overall Assessment & 25 Policy
Recommendations
Use for Health Reform, Appropriations, NAS &
Future Ryan White Reauthorization
OVERALL ASSESSMENT
 Despite
a budget of $1.4 billion in
federal and state funds
 ADAP is not fully meeting the needs
of people living with HIV/AIDS
 45 percent of people needing
medications not receiving them
 Great disparities between the states in
their ADAP coverage.
HOW DID WE GET HERE?
 Ryan White HIV/AIDS Program
– Impact of Treatment Modernization Act
 Medicare Part D
– Impact on ADAP
TREATMENT MODERNIZATION
ACT

Formula Changes
– Move from AIDS to HIV/AIDS

Increase in ADAP Supplemental
– From 3% to 5% of ADAP

Drug Formulary Requirement
 Core Medical Services
 Carry-over Funds/Unobligated Balances
Redistribution
Medicare Part D
 Picked up ADAP Clients
– Savings $73-89 million in FY06
 ADAPs Wrap Around Part D
– But not all states do so
 Cost Burden on some Beneficiaries
 Administrative Headache
 Creation
of SPAPs
FACTORS INFLUENCING ADAP
GROWTH
New
infections
Increased costs
Increased testing efforts
Loss of insurance coverage
OTHER FACTORS
INFLUENCING ADAP GROWTH
New
Medications
Changing Treatment Guidelines
Coverage of Additional
Services
FACTORS INFLUENCING ADAP
BUDGETS

Federal Annual Appropriation
– Small Annual Growth
– Much less than required

State Budgets
– Current Fiscal Crisis in many States

Price of Medications
 Drug Company Rebates
State ADAP Funding
LIMITATIONS ON ACCESS TO
THE PROGRAM
 Need
for adherence services
 Need for Medical Care and Support
Services
 State Service Variability & Cost
Containment Measures
 Distribution of Funds
OTHER ISSUES
Patient
Assistance Programs
Limited New Drugs &
Research
Unobligated Balance Rule
POSSIBLE SOLUTIONS

Increased Federal Appropriations
– By President & Congress

State Actions
– Work at State Level, particularly states that
make no or little contribution to ADAP
– Review Current State match requirements
– Encourage States to use ADAP Dollars for
Insurance Programs
POSSIBLE SOLUTIONS

Drug Prices
– Continue Current Price Negotiations
– Access to DOD Prices

Medicare Part D
– Allow ADAP Expenditures to count toward True Out-
of-Pocket Expenses
– Encourage States to Wrap Around Drug Benefit with
ADAP dollars
– Encourage States to Create State Pharmacy Assistance
Programs
POSSIBLE SOLUTIONS

Medicaid Expansion
– Early Treatment for HIV Act
– Ensure states enact at state level

Create an ADAP Entitlement, along with all
Ryan White Services
 Increase Access to ADAP Drugs & Services
– Greater Use of ADAP Dollars for Adherence &
Outreach
– Greater Use of Minority AIDS Initiative Dollars for
Outreach
– Increased Funding for all Ryan White Programs
POSSIBLE SOLUTIONS

Addressing State Variability
– Establish a floor for eligibility (350% of FPL)
– Require all Antiretrovirals & OI Drugs on
Formularies
– Greater Portability
– Adjust Hard Harmless, while Increase
Appropriations
– Develop a Severity of Need Index
– HRSA Review ADAP Supplemental Criteria
POSSIBLE SOLUTIONS

Unobligated Balances
– HRSA Review Current Policy
– Increase Amount Allowed to Carry-over from
2-5% and relax one or both penalties

ADAP Rebate Dollars
– Clarify it is not program income
POSSIBLE SOLUTIONS

Congress Investigate Number of Patients on
Pharmacy Assistance Programs & Address
ways to meet their needs

Public Policies that encourage companies to
research and develop new drugs
CONCLUDING THOUGHTS
 FY10
Budget & Appropriations
 Ryan White Extension
 Health Reform
 Future Review of Ryan White
Program, including ADAP
THE FULL REPORT CAN BE
ACCESSED AT:
www.theaidsinstitute.org/downloads/
ADAPReportMarch2009TheAIDSIns
titute.pdf
or
www.aidsaction.org/images/pdf/aids_
drug_assistance_program.pdf
Thank you!
[email protected]
[email protected]