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AIDS Drug Assistance Programs (ADAPs) Adequate versus Ideal models. Joey Wynn, Chairman, South Florida AIDS Network (SFAN) aaa+ conference, Washington D.C. July 21 st , 2009 . Ideal versus Adequate ADAPs. Initial Dialogue about the concepts of ideal ADAP models versus adequate programs

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aids drug assistance programs adaps adequate versus ideal models
AIDS Drug Assistance Programs (ADAPs) Adequate versus Ideal models

Joey Wynn,

Chairman, South Florida AIDS Network (SFAN)

aaa+ conference, Washington D.C.

July 21st, 2009

ideal versus adequate adaps
Ideal versus Adequate ADAPs

Initial Dialogue about the concepts of ideal ADAP models versus adequate programs

(The good, bad & the ugly!)

ideal versus adequate adaps3
Ideal versus Adequate ADAPs

Our goals for today’s discussion:

  • Identify and create awareness of the importance of appropriate characteristics for ADAP Programs nationwide
  • Identify & Understand the barriers and challenges associated with evaluating ADAP Programs throughout the country (widen the net to see the real picture!)
  • Begin to identify primary questions, & needed data to answer them
  • Hold an interactive dialogue resulting in a clearer understanding and expectation of what ADAPs should be doing for their clients based on their local environments
  • Evaluate the need for further investigation into this topic and the usefulness of such data for the community
ideal versus adequate adaps4
Ideal versus Adequate ADAPs
  • Key elements (core or medical model) of a local HIV primary care system
    • Number of Patients accessing services
    • Primary care visits (System-wide capacity)
    • Laboratory diagnostics (availability and capacity)
    • Specialty Labs (Genotype, Pheno, Virtual Pheno, etc..)
    • Medications (Formulary Management, PBM, etc…)
    • Financial resources to maintain system
ideal versus adequate adaps5
Ideal versus Adequate ADAPs
  • Other elements to consider
    • Payor Sources – Funding stream Matrix
    • Financial Limitations (Rationing Care)
      • Level of Sufficiency of resources versus demand /need
    • Patient’s “Quality of Life” index
    • Loss of productive time for Patient
    • Loss of productivity levels – Staff
    • Patient mortality
ideal versus adequate adaps6
Ideal versus Adequate ADAPs
  • Who Pays for these Medications?????
    • ADAP
    • General Revenue (State Tax Dollars)
    • State Medicaid
    • Federal Medicare Programs (A,B,C,D)
    • Ryan White A – F (formerly I, II, III, IV)
    • Private Insurance Plans
    • Local Indigent Plans – Hospital DSH programs
    • Patient Assistance Progams – PAPs….. www.PPARx.org
breakdown of county health departments by pharmacy category

UNION

JUNE 2006

BREAKDOWN OF COUNTY HEALTH DEPARTMENTS BY PHARMACY CATEGORY

HOLMES

OKALOOSA

JACKSON

ESCAMBIA

SANTA ROSA

WALTON

NASSAU

WASHINGTON

GADSDEN

JEFFERSON

HAMILTON

CALHOUN

LEON

MADISON

BAY

DUVAL

BAKER

SUWANNEE

LIBERTY

WAKULLA

COLUMBIA

TAYLOR

CLAY

GULF

LAFAYETTE

BRADFORD

FRANKLIN

ST JOHNS

ALACHUA

GILCHRIST

PUTNAM

DIXIE

FLAGLER

LEVY

MARION

VOLUSIA

LAKE

CITRUS

SEMINOLE

SUMTER

HERNANDO

ORANGE

BREVARD

PASCO

OSCEOLA

HILLSBOROUGH

POLK

PINELLAS

CATEGORY I – County Allocation W/Staff Pharmacist

INDIAN RIVER

MANATEE

SARASOTA

OKEECHOBEE

ST LUCIE

HIGHLANDS

CATEGORY II – County Allocation W/O Staff Pharmacist

DESOTO

MARTIN

HARDEE

GLADES

CHARLOTTE

CATEGORY III – All Other Counties Share Communal Funding Allocation

PALM BEACH

HENDRY

LEE

BROWARD

COLLIER

MONROE

DADE

13

slide9

JUNE 2006

FLORIDA AIDS DRUG ASSISTANCE PROGRAM

DRUG EXPENDITURE BY COST

APRIL EXPENDITURE MAY EXPENDITURE

5,614,365.675,943,824.77

9

florida aids drug assistance program

JUNE 2006

FLORIDA AIDS DRUG ASSISTANCE PROGRAM

TOP TEN DRUG EXPENDITURES

Total Amount $5,214,228.88

11

slide11

JUNE 2006

FLORIDA AIDS DRUG ASSISTANCE PROGRAM

ADAP FORMULARY- TOTAL 69 MEDICATIONS

*By prior authorization only #Seasonal availability only Pediatric formulations may be available by special arrangement with Central Pharmacy

14

medicare part d standard drug plan benefit in 2006
Medicare Part D Standard Drug Plan Benefit in 2006

Out-of-pocket

Threshold

Catastrophic

Coverage

Total Spending

$250

$2250

$5100

75% Plan Pays

Coverage

Gap

80% Reinsurance

$ +

Deductible

≈ 95%

Total

Beneficiary

Out-Of-Pocket

25%Coinsurance

$250

$750

$3600 TrOOP

15% Plan Pays

5%Coinsurance

Direct Subsidy/

BeneficiaryPremium

BeneficiaryLiability

Medicare Pays Reinsurance

ideal versus adequate adaps14
Ideal versus Adequate ADAPs
  • The Ideal ADAP would have:
    • Culturally appropriate staff with evening & weekend hours
    • Ample staffing resources and counseling options available for adherence services, drug reaction management, utilization review & Pain management services
    • A variety of geographic locations
    • Negotiated the lowest prices possible
    • Delivery options available for certain cases
    • The broadest, robust formulary possible
    • Web-based options for eligibility that used existing data from local service delivery system & ease of use for clients & case managers
    • Experienced staff for drug to drug interactions
    • A widely known process to use in the medical community
    • Frequent reporting about the program available easily with the community
    • Established outcomes & performance indicators
    • Annual Report on outcomes & expenditures
    • An evaluation component for Insurance purchasing and Premiums assistance
    • A co Pay assistance program
    • A P.A.P. service model on site
ideal versus adequate adaps15
Ideal versus Adequate ADAPs
  • Reality Check!!!!! Typical Barriers to care:
    • Inadequate funding
    • Lack of staffing resources
    • Complex infrastructure – (band-aid effect)
    • Indigent Population vulnerabilities
    • Geographic accessibility
    • Hours of operation
    • State Gov’t Bureau
ideal versus adequate adaps16
Ideal versus Adequate ADAPs
  • Questions and Answers:
    • Where do we go from here?
    • Is this topic useful?
    • Which stakeholders would benefit from this type of information?
ideal versus adequate adaps17
Ideal versus Adequate ADAPs

Thank you for your time and your thoughts