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ADAP Cuts
 
 
 
 
ADAP Watch from NASTAD
 
As of December 7, 2009, there were 418 individuals on AIDS Drug Assistance Program (ADAP) waiting lists in nine states. This is an increase of 167 percent from the 157 individuals on the previous ADAP Watch published in September 2009. Seven ADAPs, four with current waiting lists, have instituted additional cost-containment measures since April 1, 2009.* Seven ADAPs, including three with current waiting lists, are considering implementing new or additional cost-containment measures by the end of March 2010.* Among cost containment measures being considered, reductions in services provided by ADAP are most apparent, including reducing ADAP formularies and instituting waiting lists. Factors cited by states contributing to cost containment measures include:
 
· Level federal funding awards (12 ADAPs)
· Higher demand for ADAP services as a result of higher unemployment (11 ADAPs)
· Increased drug costs (10 ADAPs)
· Higher demand for ADAP services due to increased testing efforts (9 ADAPs)
· Increased insurance/Medicare Part D wrap-around costs (5 ADAPs)
· Decreases in state general funding for ADAPs (4 ADAPs)
· Higher demand for ADAP services due to neighboring states waiting list or cost-containment
measures (4 ADAPs)
· State Medicaid or other state program budget cuts (3 ADAPs)
· Reduced contributions from Part B into ADAP (3 ADAPs)
· Reduced contributions from Part A into ADAP (2 ADAPs)
· Higher demand for ADAP services in general (2 ADAP)
 
The national economic crisis coupled with a myriad of other factors requires increased federal funding to maintain current clients and serve new clients seeking ADAP and other Ryan White services. Additionally, the recent revisions to the Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents which moderately support the initiation of ARV treatment at higher CD4 levels than previously recommended, will also likely result in additional client utilization and ultimately require greater funding levels for ADAP.
 
The FY2010 Omnibus Appropriations bill provides ADAPs with an increase of $20 million for a total of $835 million and a $10 million increase for the Part B base for a total of $419 million. ADAPs needed an increase of $269 million for a total of $1 billion and the Part B Base required an increase of $113 million for a total of $514 million to meet the increased demand for the comprehensive array of life-saving therapies, outpatient medical care and support services.
 
ADAPs provide life-saving HIV treatments to low income, uninsured, and underinsured individuals living with HIV/AIDS in all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, the Federated States of Micronesia, American Samoa, and the Republic of the Marshall Islands. In addition, some ADAPs provide insurance continuation and Medicare Part B wrap-around services to eligible individuals. Ryan White Part B programs provide necessary medical and support services to low income, uninsured, and underinsured individuals living with HIV/AIDS in all states, territories and associated jurisdictions.
 
The following ADAPs reported cost containment strategies to NASTAD in its most recent survey. Other ADAPs may need to consider changes but due to unfinished state budget processes, political factors and other considerations, have not reported them.
 
ADAPs with Waiting Lists (418 individuals, as of December 7, 2009)
Arkansas: 9 individuals
Iowa: 27 individuals
Kentucky: 128 individuals
Montana: 18 individuals
Nebraska: 30 individuals
South Dakota: 14 individuals
Tennessee: 142 individuals
Utah: 37 individuals
Wyoming: 13 individuals
 
ADAPs with Other Cost-containment Strategies (instituted since April 1, 2009)
Arizona: reduced formulary
Arkansas: reduced formulary, lowered financial eligibility
Iowa: reduced formulary
Nebraska: reduced formulary
North Dakota: cap on Fuzeon
Utah: reduced formulary, lowered financial eligibility
Washington: client cost sharing, reduced formulary (for uninsured clients only)
 
ADAPs Considering New/Additional Cost-containment Measures (before March 31, 2010*)
Idaho: waiting list
Indiana: capped enrollment, waiting list
Kentucky: reduced formulary, client cost sharing
Missouri: reduced formulary
North Dakota: capped enrollment, waiting list, reduced formulary, annual expenditure cap
South Dakota: reduced formulary
Wyoming: lowered financial eligibility, annual expenditure cap
* March 31, 2010 is the end of ADAP FY2009. ADAP fiscal years begin April 1 and end March 31.
 
 
 
 
 
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