The State of ADAPsUpdate on the ADAP Crisis and the ADAP Crisis Task ForceMurray PennerNational Alliance of State & Territorial AIDS DirectorsApril 2, 2012

Presentation Agenda

The ADAP Year in Review

The ADAP Crisis

The ADAP Crisis Task Force

Questions and Answers

The ADAP Year in Review

ADAP Waiting Lists and Other Unmet Need

ADAP waiting lists reached their highest point on September 1, 2011 at 9,298 individuals.– The number of individuals on waiting lists has

decreased 62 percent since that time. 

ADAPs continue to focus on establishing program efficiencies to create long-term program sustainability including:– Implementing effective cost-containment measures. – Coordinating with other payers to ensure Ryan White

Program payer of last resort requirements.

FY2011 ADAP Emergency Funding

In September 2011, ADAPs received $40 million in emergency federal funding through the Ryan White Program to address ADAP waiting lists and other unmet ADAP needs. – Allocations were made to 30 states. – As a result of receipt of this funding, Alabama, Florida,

Georgia, Idaho, Louisiana, Montana, North Carolina, Ohio, South Carolina, Utah, and Virginia were able to reduce the overall number of individuals on or eliminate their waiting lists.

December 1, 2011:New ADAP Resources

On World AIDS Day, President Obama announced $35 million in new resources for ADAPs.

HRSA is developing a distribution methodology that will require a competitive application by ADAPs.

A second component of the application will be continuation of the $40 million from September 2011. 

The funding announcement is expected to be released in April and awards for both components are expected to be made by July 1, 2012. 

FY2012 and FY2013 ADAP Budget

New ADAP awards for FY2012, which will include an additional $15 million appropriated by Congress, are anticipated by April 1, 2012. 

President Obama’s FY2013 budget proposal includes a $67 million increase for ADAP over FY2012 levels, for a total of $1 billion. 

The FY2012 ADAP earmark included in the FY2013 budget includes the $35 million announced on World AIDS Day.   

Outlook for the Future

Impact of additional federal funding and enhanced pharmaceutical company agreements.

State funding generally begins July 1, 2012.

Continued ADAP waiting lists and cost-containment measures expected; decreases expected as new funding is received.

Need for additional state and federal funding for the program remains.

Requires collaboration from all stakeholders.

ADAP Cost-containment Measures

Factors Leading to Implementation of Cost-containment Measures

As of February 1, 2012, ADAPs reported the following factors contributing to consideration or implementation of cost containment measures:– Level federal funding awards (16 ADAPs).– Higher demand for ADAP services as a result of

increased unemployment (16 ADAPs).– Increased demand for ADAP services due to

comprehensive HIV testing efforts (15 ADAPs).– High drug costs (12 ADAPs).

ADAPs with (and anticipating) Cost-containment Measures

Examples of cost-containment measures currently in place or anticipated:– Reduced formulary– Reduced eligibility criteria– Expenditure caps– Client cost-sharing– Capped enrollment

Once the enrollment cap is reached, ADAP will establish a waiting list.

– Waiting lists

ADAP Waiting Lists

NASTAD ADAP Watch

ADAP waiting list update contains individuals who have:– Completed the application process for their state

ADAP.– Been deemed eligible for the ADAP in their state.– Been placed on the state’s ADAP waiting list or unmet

need list.

Information based on state reports is distributed weekly.

What the ADAP Watch Does Not Capture

Individuals who have not presented to ADAP.

Individuals who have presented but were not eligible.

Individuals who may have been disenrolled.

Individuals who have “fallen out” of ADAP (e.g., no longer taking drugs, moved, obtained other coverage).

Individuals who may be in one or more of the above categories and accessing a PAP for medications.

ADAP Waiting List Update

ADAP Waiting Lists (3,666 individuals in 11 states),

as of March 29, 2012State

Number of Individuals on ADAP Waiting List

Percent of the TotalADAP Waiting List

Increase/Decrease from Previous Reporting Period

Date Waiting List Began

Florida 607 16% +101 June 2010

Georgia 861 23% -26 July 2010

Idaho 7 0.2% -2 February 2011

Louisiana 394 11% +16 June 2010

Montana 6 0.2% 0 January 2008

Nebraska 217 6% +10 October 2011

North Carolina 170 5% +9 January 2010

Ohio 0 0% 0 July 2010

South Carolina 440 12% +24 March 2010

Utah 0 0% 0 May 2011

Virginia 964 26% - November 2010

Waiting List Organization

Of the 11 states with ADAP waiting lists, six ADAPs utilize a first-come, first-served model for prioritizing clients.

Of the 11 states with ADAP waiting lists, five ADAPs utilize a medical criteria model for prioritizing clients.

Access to Medications

Case management services are being provided to clients on ADAP waiting lists in 11 states through:– ADAP (2 ADAPs)– Ryan White Part B (9 ADAPs)– Contracted agencies (6 ADAPs)– Other agencies, including other Parts of Ryan White

(5 ADAPs). States with case management services report

individuals on waiting lists are receiving medications through Welvista or company PAPs.

The ADAP Crisis Task Force

Overview

Comprised of eight state AIDS/ADAP directors. Negotiates with drug companies for supplemental

discounts/rebates to benefit all ADAPs equally. Arguments for special pricing for ADAPs:

– ADAPs are unlike other health care payors.– ADAPs are not entitlement programs with

guaranteed funding. – ADAPs are not insurers and therefore unable to

raise revenues with premiums.– ADAPs do not receive the “cost-effectiveness”

benefits of drugs (i.e., reduced hospitalizations and long term care).

ADAP Crisis Task Force Agreements

In December 2011, the ACTF announced that it reached enhanced agreements with six of the eight major antiretroviral manufacturers.

To date, these negotiations have resulted in an additional $142 million in savings to ADAPs from January 2012 through December 2013.

The cumulative savings of the Task Force agreements from 2003 to 2011 is estimated at more than $1.3 billion.

ADAP Crisis Task Force – Agreements and Future Efforts

Most agreements expire on December 31, 2013.

Continued negotiations with Abbott Laboratories.

Several negotiations continue related to anticipated new medications and new formulations.

Continued discussion with companies regarding the ongoing ADAP crisis and the impact of health reform.

Continued discussions and coordination with Fair Pricing Coalition and other stakeholders related to streamlining access to PAPs and co-pay programs.

Questions and Answers

Resources

For an electronic copy of the 2012 National ADAP Monitoring Project Annual Report, please visit www.NASTAD.org.

Contact Information

Murray PennerDeputy Executive Director

NASTADPhone: (202) 434.8090  mpenner@NASTAD.org

www.NASTAD.org