ADAP funding still fails to meet the growing need

Waiting list near 1,000

Nearly 1,000 people were on waiting lists for AIDS Drug Assistance Programs (ADAPs) at the beginning of 2006, and this number is expected to jump at least 10% when the 118 people who receive medication through the President’s ADAP Initiative join the ranks since the initiative’s funding ran out in March.

Fiscal year 2006 money became available on April 1, but that funding is the same as last year, which was insufficient by more than $200 million, says Bill Arnold, executive director of Title II Community AIDS National Network and director of the National ADAP Working Group, both in Washington, DC.

"Some states have stepped in with meaningful increases," Arnold says. "And the drug manufacturers are throwing back in close to $100 million a year."

Still, these measures cannot entirely solve ADAP’s budgetary shortfall, which is why the waiting lists have grown in 10 states and another seven states and a territory have added new cost-containment measures.

The new Medicare drug benefit is making the problem worse for ADAPs because it has eliminated Medicaid’s role in providing medication to many who need HIV antiretroviral drugs, Arnold says. "A lot of people who were on Medicaid before and had no co-pays or deductibles now have co-pays and deductibles under the Medicare drug program, and ADAPs are paying for some of those," Arnold says.

"Some people will be eligible for low-income subsidy, and some will have incomes that are too high for that," he says.

The new Medicare drug prescription program has a catastrophic coverage clause that limits how much of these co-pays and deductibles an individual has to pay, but there is no limit on how much of these are paid by ADAP, Arnold explains.

"Catastrophic coverage does not kick in because you can’t count the ADAP expenditure towards it," he says. "If 10 percent of our people’s co-pays could be paid by ADAP and counted toward the catastrophic coverage, then we could open up another ADAP treatment slot to an HIV-positive person on the waiting list."

Two other factors that could greatly increase the ADAP rolls are the CDC’s extra push into outreach and testing programs and the new scientific research suggesting that HIV antiretroviral therapy should begin soon after a person becomes infected, Arnold notes.

"Ethically, it’s a real problem because you tell me how anyone can say that if someone tests positive they can guarantee them treatment," Arnold says. "We have cases where we know that can’t happen."

The president’s budget proposal calls for $70 million to be directed toward providing health care and treatment services to individuals in the greatest need, including those who were newly diagnosed because of increased HIV testing, says Laura Hanen, director of government relations at the National Alliance of State & Territorial AIDS Directors of Washington, DC.

"But we don’t really know what that means," Hanen says. "We’ll be advocating for the $70 million to go through the ADAP formula to address our ADAP crisis."