The State of ADAPsUpdate on the ADAP Crisis Britten Pund National Alliance of State & Territorial AIDS Directors July 7, 2011
National Alliance of State & Territorial AIDS Directors (NASTAD) • Represents the nation’s chief health agency HIV/AIDS and viral hepatitis staff in all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands and the U.S. Pacific Islands • Provides technical assistance and other support to health department HIV/AIDS and viral hepatitis programs • Provides national leadership on HIV/AIDS and viral hepatitis policy and programs • Educates about and advocates for necessary federal funding
Patient Protection and Affordable Care Act • Patient Protection and Affordable Care Act (PPACA) signed into law in March 2010. • Some portions of reform that will impact ADAPs specifically are: • Medicaid eligibility expansion (2014); • Increase in the number of individuals covered by insurance plans (2014); • ADAPs’ Medicare Part D expenditures counting toward True Out Of Pocket (TrOOP) expenditures (2011); • Narrowing and closing of the Medicare Part D “doughnut hole (ongoing);” • An increase in the Medicaid rebate amount for purchased drugs; and (2010) • 340B pricing transparency.
Pharmaceutical Partners Contributions • In May 2010, pharmaceutical partners augmented current agreements with ADAPs including: • Providing deeper discounts; • Increased rebates; and/or • Price freezes to ADAP. • Pharmaceutical partners expanded the reach of Patient Assistance Programs (PAPs) and participated in Welvista for waiting list clients.
ADAP Waiting Lists • Over the course of 2010, 19 ADAPs reported a waiting list. • Several ADAPs decreased income eligibility requirements and disenrolled clients from ADAP in order to address shortfalls. • In FY2010, some ADAPs began transitioning clients off of ADAP and onto PAPs as a means of cost-containment. These clients were directed to seek access to medications through PAPs.
ADAP Waiting Lists, as of June 30, 2011 8,615 individuals in 13 states* Alabama: 73 individuals Arkansas: 40 individuals Florida: 3,562 individuals Georgia: 1,630 individuals Idaho: 20 individuals Louisiana: 824 individuals** Montana: 29 individuals North Carolina: 292 individuals Ohio: 485 individuals South Carolina: 810 individuals Utah: 25 individuals Virginia: 817 individuals Wyoming: 8 individuals *As a result of ADAP emergency funding, Hawaii, Idaho, Iowa, Kentucky, South Dakota, and Utah eliminated their waiting lists; Idaho reinstituted a waiting list in February 2011 and Utah reinstituted a waiting list in May 2011. **Louisiana has a capped enrollment on their program. This number represents their current unmet need.
ADAPs with Cost-containment, as of April 13, 2011 Arizona: reduced formulary Arkansas: reduced formulary, lowered financial eligibility to 200% FPL (disenrolled 99 clients in September 2009) Colorado: reduced formulary Florida: reduced formulary, transitioned 5,403 clients to Welvista from February 15, 2011 to March 31, 2011 Georgia: reduced formulary, implemented medical criteria, participating in the Alternative Method Demonstration Project (AMDP) Idaho: capped enrollment Illinois: reduced formulary, instituted monthly expenditure cap ($2,000 per client per month) Kentucky: reduced formulary Louisiana: discontinued reimbursement of laboratory assays North Carolina: reduced formulary
ADAPs with Cost-containment, as of April 13, 2011 (continued) North Dakota: capped enrollment, instituted annual expenditure cap, lowered financial eligibility to 300% FPL (grandfathered in current clients above 300%FPL) Ohio: reduced formulary, lowered financial eligibility to 300% FPL (disenrolled 257 clients in July 2010) Puerto Rico: reduced formulary South Carolina: lowered financial eligibility to 300% FPL (grandfathered in current clients above 300% FPL) Utah: reduced formulary, lowered financial eligibility to 250% FPL (disenrolled 89 clients in FY2010) Virginia: reduced formulary, transitioned 207 clients onto waiting list and PAPs, only distributing 30-day prescription refills Washington: instituted client cost sharing, reduced formulary (for uninsured clients only), only paying insurance premiums for clients currently on antiretrovirals Wyoming: reduced formulary, instituted client cost sharing
Coordinated Strategy to Save America’s ADAPs • Secure additional resources for ADAP from the federal government: • The HIV/AIDS community is advocating for an increase of $106 million for ADAPs for a total funding of $991 million in FY2012. • Maintain, restore and increase resources for ADAPs from state governments. • Continue agreements between ADAPs and pharmaceutical manufacturers to provide financial stability and augment existing agreements, when possible.
The Outlook for the Future • A bridge to 2014 is slowly being built and will require much construction before ADAPs can fully take advantage of health reform provisions. • Weathering the current storm to reach 2014 will take collaboration from all stakeholders involved in the administration of the program.
Contact Information Britten Pund Manager, Health Care Access NASTAD Phone: (202) 434.8044 bpund@NASTAD.org www.NASTAD.org