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AIDS Drug Plans Vary Widely by State
Associated Press
May 19, 2004
Mark Sherman
Government AIDS Drug Assistance Programs (ADAPs) are the last resortfor many HIV-infected patients with little or no prescription drug coverage,but the assistance can vary greatly from state to state, a report releasedWednesday finds. For instance, North Carolinians who earn more than $11,000do not qualify for the state's ADAP. Meanwhile, income limits are at leastfour times as high in Delaware, Massachusetts, New Jersey and New York,noted the annual report released by the Kaiser Family Foundation and stateAIDS directors.
Only about three in 10 HIV patients have private insurance. Nearly halfof AIDS patients rely on Medicaid, the health program for the poor. Somehave Medicare, and about 20 percent have no health insurance at all.Patients in ADAPs are mostly poor and minorities; 80 percent are men; and 60percent are ages 25-44, the report said.
Budget constraints are causing "an upswing in the number of stateslooking at and instituting cost-containment measures," said Jennifer Kates,Kaiser's director for HIV policy. North Carolina and a dozen other stateshave imposed measures to contain costs, from capping enrollment to reducingthe number of drugs covered. The number of patients on waiting lists hasincreased in recent months, said Kates. Indicating a willingness to findcreative ways to pay for the drugs, 24 states are using AIDS drug assistancemoney to purchase health insurance or continue COBRA coverage obtained whena person leaves a job.
Because state budget shortfalls and confusing eligibility requirementsleave thousands of HIV patients with inadequate care, the Institute ofMedicine recently recommended that the federal government pick up more ofthe tab for treating poor Americans with HIV.
To view "The National ADAP Monitoring Project Annual Report - May 2004"visit http://www.kff.org/.
State One of 10 with Waiting List for Free Drugs for HIV, AIDS
Associated Press
May 20, 2004
Of the 1,472 people who were on waiting lists for free HIV/AIDS drugsin 10 states as of May 3, 115 were in Kentucky, according to the eighthannual AIDS Drug Assistance Monitoring Report released yesterday. SinceKentucky's list began in February 2000, five people who were waiting died.However, all deaths were from illnesses other than those "specificallyrelated to HIV," said Lisa Daniel, administrator of Kentucky's AIDS DrugAssistance Program (ADAP).
There were about 2,150 people with AIDS in Kentucky in 2002. Because oflimited funding, Kentucky's ADAP has an enrollment cap of 700 patients peryear. The program cost more than $4.9 million last year. An eligibleKentucky resident must have an income at or below 300 percent of the federalpoverty level (about $27,000 annually for a single person), no cash assetsover $10,000, and no insurance or Medicaid coverage.
People on the list are given assistance in applying for free ordiscount medications from pharmaceutical companies, but not all of thementered such programs, said Daniel. The longest waits are six to ninemonths, Daniel estimated.
"It's a very bad situation," said Cathy Cox, executive director ofLexington-based AIDS Volunteers Inc., which serves people with HIV/AIDS in72 Kentucky counties. "When people with HIV and AIDS can't accessmedications, it nullifies all the other advances. Access to medication isthe only reason people are living longer and healthier. ...People here aregoing without medication and dying in this country." For information onKentucky's ADAP, telephone 800-420-7431.
State AIDS Drug Assistance Programs (ADAPs) Continue to FaceDifficult Funding Challenges
(press release from Kaiser Family Foundation, NASTAD)
11 States Close Enrollment—9 Have Waiting Lists to Receive HIV Drugs
Wide Variation in Access to HIV Medications Across States
WASHINGTON, DC -- Despite a nine percent increase in the overall ADAP budget between FY 2002 and 2003, an increasing number of people living longer with HIV/AIDS, the rising costs of HIV medications, and continuing fiscal pressures at the Federal and state levels have led some state AIDS Drug Assistance Programs (ADAPs) to implement cost-saving measures such as capping enrollment and reducing the number of HIV-medications offered. The eighth annual National ADAP Monitoring Report reveals wide variation in the eligibility criteria and drugs offered by ADAPs in the 50 states, the District of Columbia, territories, and associated jurisdictions. The report was prepared by the Kaiser Family Foundation, the National Alliance of State and Territorial AIDS Directors (NASTAD) and the AIDS Treatment Data Network (ATDN).
ADAPs serve as "payer of last resort" for prescription medications to people with HIV/AIDS -- meaning that to qualify for the program, individuals must have no other funding source available to them. In the month of June 2003 alone, more than 85,000 people were served by these programs, most of whom were low-income and minority Americans, and each year, approximately 136,000 people receive services from ADAPs, representing about 30% of people estimated to be living with HIV/AIDS in care in the U.S.
ADAPs are a discretionary grant program funded through the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, which is administered by the U.S. Department of Health and Human Services. Because ADAPs are not entitlement programs, funding levels are not conditioned on the number of people who need prescription drugs or the cost of medications. In addition to federal funding, ADAPs may also receive state general revenue support and other funding, but these other sources are highly variable and dependent on local decisions and resource availability. Each state administers its own ADAP with broad latitude over program design, including determining who is eligible and what drugs are offered.
"ADAPs continue to be in a difficult situation with the need for HIV/AIDS medications exceeding available resources," said Jennifer Kates, M.A., M.P.A, Director of HIV Policy, Kaiser Family Foundation. "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."
"Many states are struggling to continue to provide these life-saving medications to people in need," said Julie Scofield, Executive Director, NASTAD. "The difficult decisions state ADAPs are being forced to make to keep programs solvent are contrary to good public health."
Key findings from the survey reveal:
Waiting Lists and Other Cost Containment Measures Affect Client Access. As of April 2004, 13 ADAPs—Alabama, Alaska, Arkansas, Colorado, Idaho, Indiana, Kentucky, Montana, North Carolina, Oklahoma, South Dakota, Washington, and West Virginia—had cost containment measures in place, including:
--Eleven states have closed enrollment to new clients; nine of these states reported 1,263 people on waiting lists for medications.
--Two states reduced the number of drugs offered.
--Three states have monthly or annual per capita expenditure limits.
--One state increased client cost-sharing.
--Ten ADAPs anticipate the need to implement additional cost containment measures before the end of the current fiscal year (which ends March 31, 2005).
While waiting lists provide one measure of unmet need for ADAP services, they do not reflect the full level of need; some people who need ADAP services may not be on waiting lists and others who receive medications from ADAPs may not get the full level of treatment needed, especially in a state with a limited drug formulary.
What You Get Depends on Where You Live. Due to limited funding and state discretion over ADAP program design, there are significant differences in scope and availability of coverage across the country. Some examples of variation include:
--Eligibility criteria for ADAPs ranges from 125% of the Federal Poverty Level (FPL) in North Carolina (this is approximately $11,000 in annual income for a single person) to 500% FPL or higher in Delaware, Massachusetts, New Jersey, and New York.
--The number of drugs on ADAP formularies range from 18 in Colorado to 474 in New York, and open formularies in Massachusetts, New Hampshire, New Jersey, and the Northern Mariana Islands.
--Sixteen states do not cover all FDA-approved antiretroviral medications, including one state (South Dakota) that does not provide any protease inhibitors.
--Only seventeen states provide the full set of 14 drugs highly recommended by the Public Health Service/Infectious Disease Society of American (PHS/IDSA) Guidelines for the prevention and treatment of opportunistic infections. Two states (Colorado and Louisiana) do not provide any of these drugs or drugs for other HIV-related conditions.
--Thirty-three states provide Fuzeon, the first drug approved by the FDA in a new class of HIV medications (fusion inhibitors).
Some State ADAPs Experienced Budget Decreases. While the overall ADAP budget increased by 9% between FY 2002 and FY 2003, largely driven by increases in the federal ADAP earmark (the federal ADAP earmark, the main component of the ADAP budget, increased by 12% over this period), five state ADAPs (Colorado, Delaware, Indiana, Minnesota, and Oklahoma) experienced net decreases in their budgets. ADAPS receive funding from several sources -- the federal ADAP earmark went up for each state, but other sources did not and in some cases were cut, which means that a state's overall ADAP budget may be less than in the prior year. Although 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.
ADAP Client Profile. The majority of ADAP clients are low-income, people of color, male, and uninsured.
--Eight in ten (81%) report incomes at or below 200% of FPL, including about half (49%) falling at or below 100% of FPL.
--The majority are people of color, with African Americans representing one-third (33%), Hispanics one-quarter (25%), and Asian/Pacific Islanders, Alaskan Native and American Indians combined representing approximately 2%.
--More than three-quarters (79%) of ADAP clients are men and six in 10 were between the ages of 25 and 44.
--Most ADAP clients are uninsured, with only small percentages reporting some other source of coverage (13% private, 8% Medicare, and/or 7% Medicaid).
The Centers for Disease Control and Prevention (CDC) estimates that there are approximately 850,000-950,000 people living with HIV/AIDS in the U.S., and more the 380,000 are estimated to be living with AIDS, the most advanced form of HIV disease. Each year, an estimated 40,000 new HIV infections occur in the U.S.
The survey is sent to states on an annual basis. It requests data and other program information for the month of June of that year, for the fiscal year, and for other periods as specified. After the survey is sent out, extensive follow-up is conducted by NASTAD to ensure completion by as many ADAPs as possible. Fifty-four of 57 ADAPs responded to the current survey. Data used in this report are from June 2003 and FY 2003, unless otherwise noted (for example, some data are supplemented through other NASTAD data collection efforts, such as its bi-monthly ADAP Funding Watch survey).
All states receiving ADAP earmark funding through the Ryan White CARE Act are surveyed (the number of states receiving such funding has increased over the course of the project).
The Kaiser Family Foundation is a non-profit, private operating foundation dedicated to providing information and analysis on health care issues to policymakers, the media, the health care community, and the general public. The Foundation is not associated with Kaiser Permanente or Kaiser Industries.
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