Number of People on ADAP Waiting Lists Nationwide Falls to 813; 13 States Using Other Cost-Containment Measures, Reports Say
The number of people on waiting lists nationwide for enrollment in AIDS Drug Assistance Programs has fallen to 813 in nine states as of Nov. 22, down from 1,108 people in seven states in July 2002, according to documents released on Wednesday by the National Alliance of State and Territorial AIDS Directors and the Kaiser Family Foundation, the Montgomery Advertiser reports (Davis, Montgomery Advertiser, 12/16). ADAPs are federal- and state-funded programs that provide HIV/AIDS-related medications to low-income, uninsured and underinsured HIV-positive individuals. President Bush in June ordered the immediate release of $20 million to purchase AIDS-related drugs for states with ADAP waiting lists, but only the 10 states that had waiting lists at the time of the order -- Alabama, Alaska, Colorado, Idaho, Iowa, Kentucky, Montana, North Carolina, South Dakota and West Virginia -- can apply for the funding. The Health Resources and Services Administration is coordinating the program with a pharmacy benefit manager to purchase the drugs and distribute them directly to individuals on the states' ADAP waiting lists as of June (Kaiser Daily HIV/AIDS Report, 10/8). According to a Kaiser Family Foundation fact sheet, five of the 10 eligible states had eliminated their waiting lists by November: three (Idaho, Kentucky and Montana) because of funding received through the initiative and two (Colorado and South Dakota) because of additional state appropriations (Kaiser Family Foundation fact sheet, 12/15). According to NASTAD's "ADAP Watch," nine states currently have ADAP waiting lists. Of the 813 individuals included on the waiting lists, 758 are eligible for coverage under Bush's initiative. Four states -- Arkansas, Hawaii, Nebraska and Wyoming -- that now have waiting lists are ineligible for Bush's initiative. Thirteen states -- Alabama, Arkansas, Hawaii, Indiana, Louisiana, Minnesota, Missouri, New Hampshire, Oklahoma, South Dakota, Texas, Utah and Washington -- have implemented other ADAP cost-containment strategies since April 2003, including capped enrollment, medication-specific waiting lists, annual or monthly expenditure caps and cost-sharing. In addition, Arkansas, Hawaii, Louisiana, Massachusetts, Oregon and Wyoming are anticipating new or additional ADAP restrictions during fiscal year 2004, which ends March 31, 2005 (NASTAD release, 12/15).
Waiting Lists Do Not Include All in Need
The ADAP waiting lists do not include all people living with HIV/AIDS who need treatment or who cannot afford the cost of treatment, according to the Advertiser. "It's really much more than those 813 people," Jennifer Kates, director of HIV policy for the Kaiser Family Foundation, said. Jane Cheeks, Alabama's state AIDS director, estimated that there are between 4,000 and 5,000 unreported AIDS cases in Alabama (Montgomery Advertiser, 12/16). "We've never been able to provide for everybody who needs the service," Cheeks said, adding, "We just don't have enough money." Cheeks said that there are 15 to 20 new applications for the state's ADAP each month, which surpasses the number of people leaving the program, according to the Birmingham News (Parks, Birmingham News, 12/16).
ADAPs After Bush Initiative Expires
Murray Penner, director of NASTAD's care and treatment program, said that it is unclear whether the Bush administration will allocate more money for ADAP next year because the recently passed appropriations bill did not contain a continuation of the $20 million funding for the program. "Congress chose not to put the language in and treated the $20 million as a one-time expenditure," Penner said (Montgomery Advertiser, 12/16). Arkansas may have to cut the number of people eligible for treatment under its ADAP from 418 to 184 after funding from Bush's initiative expires at the end of FY 2004, according to the Arkansas Democrat-Gazette. Arkansas Health Department officials said that the agency is trying to ensure that HIV-positive people currently enrolled in the state's ADAP continue to receive treatment, and the agency has met with pharmaceutical company representatives to discuss options, according to the Democrat-Gazette. However, critics of pharmaceutical company expanded access programs said that the programs require "repeated paperwork" and do not provide a "reliable, uninterrupted source of medications," according to the Democrat-Gazette (Smith, Arkansas Democrat-Gazette, 12/16). Craig Thompson, executive director of AIDS Project Los Angeles, said, "It is clear, that in a short period of time, a large number of people accessed lifesaving medications through the president's initiative," adding, "What is less clear is how these people will get their drugs next year, or how we will account for the people who weren't eligible on June 23 but need drugs now. This report proves that circumventing the current system will not work. We need a broad, structural solution to ADAP, not a quick fix" (APLA release, 12/15).
All of the documents, as well as an audiocast of a teleconference discussing the new data, are available online.