ADAP Coverage Varies Widely by State; Several States Implement Cost-Containment Measures, Report Says
People living with HIV/AIDS receive widely varied coverage from AIDS Drug Assistance Programs depending upon where they live, according to the eighth annual National ADAP Monitoring Project Report, the AP/San Luis Obispo Tribune reports (Sherman, AP/San Luis Obispo Tribune, 5/19). In addition, many states have imposed cost-containment measures despite a 9% increase in the overall ADAP budget between fiscal year 2002 and FY 2003, Reuters reports (Richwine, Reuters, 5/19). The report, which was released on Wednesday by the Kaiser Family Foundation, the National Alliance of State and Territorial AIDS Directors and the AIDS Treatment Data Network, is based on the results of an annual survey of states that requested ADAP program data and information for June 2003, FY 2003 and other specified periods (Kaiser Family Foundation release, 5/19). ADAPs -- which are funded with both state and federal money -- provide HIV/AIDS-related medications to low-income, uninsured and underinsured HIV-positive individuals (Kaiser Daily HIV/AIDS Report, 5/14). All states, territories and associated jurisdictions receiving ADAP funding through the Ryan White CARE Act are surveyed, and 54 of the 57 ADAPs responded to the current survey, according to a Kaiser Family Foundation release (Kaiser Family Foundation release, 5/19). The report showed that even though overall total funding for ADAPs has increased, the money has not "kept pace with soaring demand" for antiretroviral drugs, the Washington Post reports. Congress increased federal funding for state ADAPs from $714 million in FY 2003 to $749 million in FY 2004, according to the Post. President Bush has proposed adding $35 million for FY 2005 (Connolly, Washington Post, 5/20).
Enrollment, Waiting Lists
Several factors -- including an increasing number of HIV-positive people, rising antiretroviral drug costs and fiscal constraints for federal and state governments -- have led some state programs to implement cost-saving measures, such as capping enrollment and reducing the number of HIV medications offered, according to the report (Kaiser Family Foundation release, 5/19). According to the report, state ADAPs last year served 136,000 people living with HIV, a 10% increase over 2002, the AP/Tribune reports. About 80% of participants were men, 60% were between the ages of 25 and 44 and most were poor and minority (AP/San Luis Obispo Tribune, 5/19). The report found that as of April 2004, 13 ADAPs -- Alabama, Alaska, Arkansas, Colorado, Idaho, Indiana, Kentucky, Montana, North Carolina, Oklahoma, South Dakota, Washington and West Virginia -- had implemented cost-containment measures. For example, 11 states have closed enrollment to new clients, and nine of these states reported 1,263 people on waiting lists for medications; two states have reduced the number of drugs provided; three states have limited monthly or annual per-capita expenditures; one state increased client cost-sharing; and 10 states are expected to implement further cost-containment measures by the end of the fiscal year ending March 31, 2005, according to the report.
The report also showed that the "scope and availability" of coverage under ADAP programs varies significantly nationwide. For example, eligibility criteria in North Carolina is 125% of the federal poverty level, or about $11,000 per individual per year, compared with at least 500% of the federal poverty level in Delaware, Massachusetts, New Jersey and New York. In addition, the number of medicines covered by ADAPs range from 18 in Colorado to 474 in New York, with open formularies in Massachusetts, New Hampshire, New Jersey and the Northern Mariana Islands (Kaiser Family Foundation release, 5/19). Seventeen of the 57 ADAPs offer all of the 14 drugs highly recommended by the U.S. Public Health Service/Infectious Diseases Society of America guidelines to prevent opportunistic infections, the Post reports (Washington Post, 5/20). Colorado and Louisiana do not provide any of these drugs or drugs for other HIV-related diseases (Kaiser Family Foundation release, 5/19). Sixteen ADAPs do not cover all of the FDA-approved antiretrovirals; one state, South Dakota, does not cover any protease inhibitors, according to the report (Reuters, 5/19). Five states -- Colorado, Delaware, Indiana, Minnesota and Oklahoma -- had net decreases in their budgets, according to the report. Although the federal ADAP earmark increased for each state, ADAPs receive funding from several sources, some of which remained flat or were cut, meaning that a state's overall ADAP budget could be less than a previous year, according to the report. The report said that although recent budget increases have "generally helped states to serve more people and spend more on drugs over time, the demand for medications still exceeds the resources available in many states," according to the release (Kaiser Family Foundation release, 5/19).
Kaiser Family Foundation Director for HIV Policy Jennifer Kates said that budget constraints are causing an "upswing in the number of states looking at and instituting cost-containment measures" (AP/San Luis Obispo Tribune, 5/19). She added, "While ADAPs play a critical role in the care system for people with HIV, they are often forced to make difficult decisions that may limit access to care for some in need and what people get often depends on what state they live in" (Kaiser Family Foundation release, 5/19). Murray Penner, NASTAD director of care and treatment programs, said that the "pool of individuals with HIV continues to grow" and "[o]ver the last three years, there have been insufficient federal earmarked funds to meet the increased new demands." Cathy Cox, executive director of Lexington, Ky.-based AIDS Volunteers, which provides HIV/AIDS services in 72 counties in Kentucky, said, "When people with HIV and AIDS can't access medications, it nullifies all the other advances," adding, "Access to medication is the only reason people are living longer and healthier" (Isaacs, Lexington Herald-Leader, 5/20).