As of March 2007, four states have reported waiting lists for their AIDS Drug Assistance Programs (ADAPs) totaling 571 HIV-positive people in need, according to the 2007 National ADAP Monitoring Project Report. The annual survey of United States ADAP programs, prepared by the Kaiser Family Foundation and the National Alliance of State and Territorial AIDS Directors (NASTAD), also points out that the number of people living with HIV/AIDS in the United States receiving antiretrovirals through these programs has more than tripled in the last decade.
ADAPs are federal- and state-funded programs that provide medications to treat HIV and AIDS-related complications to low-income, uninsured, or underinsured people living with HIV/AIDS. For the past 11 years, the National ADAP Monitoring Project has conducted a comprehensive survey of all state and territorial ADAPs and, in its annual reports, provided the latest available data on the status of these programs.
With close to 142,000 current enrollees, the report says, ADAPs reach approximately one-quarter of all people with HIV/AIDS in care. Approximately two-thirds of those served are people of color, more than half have incomes at or below the Federal Poverty Level (FPL) – the FPL was $9,800 annually for a family of one in 2006 – and almost three-quarters are uninsured.
As the nation's prescription drug safety nets for people living with HIV/AIDS, ADAPs help to secure access to life-saving treatment. However, the protection offered by these safety nets varies considerably across the country and, ultimately, what one gets depends on where one lives. For example, ADAP income eligibility in June 2006 ranged from 125% of the FPL in one state to 500% of the FPL or more in four states.
Formulary coverage – the specific medications for HIV and AIDS covered by these programs – varies significantly from state to state. In some states, only a few drugs are covered – including one state (South Dakota) that does not cover any protease inhibitors and several that do not cover Fuzeon® (enfuvirtide) – whereas other states provide extensive coverage to a wide variety of medications.
According to the report, this variation is the result of the way in which ADAPs, and the Ryan White Program overall, are structured. As discretionary grant programs, not entitlements, they are dependent on annual federal appropriations and funding from states and other sources where available – resources that are not necessarily tied to the number of people who need services and the cost of their care.
ADAPs must delicately balance available program capacity with client demand. To do so, ADAPs use the "levers" available to them, particularly through setting income and other eligibility criteria and determining the composition of their formularies. In some cases, the report concludes, this balancing act becomes one of difficult trade-offs between serving more people with less services and serving less people with more.
Waiting lists, while much fewer in number than in previous reports, remain a reality. Waiting lists reached their peak in mid-2004, but began to decline soon after, largely due to the introduction of the President's ADAP Initiative, time-limited funds to address waiting lists, and to increases in state funding; some ADAPs also report that the new Medicare Part D prescription drug benefit helped to alleviate their waiting lists. Still, in March 2007, four states reported waiting lists, totaling 571 people, the highest number of people on waiting lists in more than 12 months.
Another issue raised in the report is the latest reauthorization of the Ryan White program, particularly its new minimum ADAP formulary requirement. The National ADAP Monitoring Project points out that this is likely to offer both new opportunities and challenges to ADAPs and their clients. As of July 1, ADAPs will be required to cover at least one medication from each approved antiretroviral drug class. Currently there are four, but this provision will apply to any future classes of antiretrovirals. While this will certainly expand access to highly effective medications not previously available in some cases, it may also strain ADAP resources in others, which itself could result in access limitations to other components of the program.
These and other overarching trends and findings concerning ADAPs, along with comprehensive background information regarding these programs, can be found in the full 2007 report, posted by the Kaiser Family Foundation.
Source:
National ADAP Monitoring Project 2007 Annual Report; Kaiser Family Foundation
