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The AIDS Drug Assistance Program (ADAP) benefit formulary in New York reads like a five-star restaurant menu: Uninsured HIV-infected people who earn less than $44,000 per year, which is more than 500% of the federal poverty level (FPL), may choose from six protease inhibitors (PIs), three non-nucleosides, 16 opportunistic infection (OI) prophylaxis drugs, and 408 other medications, according to the 2001 National ADAP Monitoring Project Report.
Suppose the same HIV-infected person grew tired of cold winters and moved south to North Carolina. The formulary in that state includes five PIs, three non-nucleosides, 11 OI prophylaxis, and 22 other medications. But it’s only available to people earning 125% FPL or less, which basically means the average client would have an income lower than the $10,000-$15,000 annual cost of an HIV antiretroviral regimen.
The amount of money that states contribute to ADAPs also varies widely. About 60% of the ADAP budget in New Mexico comes from the state’s contribution. By contrast, Rhode Island, Wyoming, Montana, North Dakota, Arkansas, Delaware, Iowa, Indiana, Kansas, Louisiana, and Michigan contributed no money to the total ADAP budget in fiscal year 2000, the ADAP report says. The report is the fifth in a series of annual reports about ADAP and is published by The National Alliance of State and Territorial AIDS Directors of Washington, DC, the AIDS Treatment Data Network, and Henry J. Kaiser Family Foundation of Menlo Park, Calif.
Here are some of the report’s major findings:
• The population receiving help from ADAP is 40% white, 30% African-American, and 25% Hispanic.
• ADAP programs with inadequate funding will add restrictions and limitations, including lower financial eligibility criteria, smaller formularies, enrollment caps, and restricted access to antiretroviral medications.
• ADAP formulary coverage varies from states that cover no OI treatments to 16 OI prophylaxis treatments covered in California, Alaska, Hawaii, New Jersey, New York, and Oregon.
• The number of clients served by ADAPs more than doubled between July 1996 and June 2000. The change reflects a growth in the number of people living with HIV/AIDS, increasing client demand due to the availability of more effective therapies, and increases in funding available to ADAPs.
• Monthly program expenditures increased more than threefold between July 1996 and June 2000. This increase was caused by rising drug costs and the increasing complexity of treatment regimens.
• In June 2000, 46% of ADAP program expenditures paid for nucleoside analogues; 29% paid for protease inhibitors; 12% went to non-nucleoside reverse transcriptase inhibitors; and 13% went for other medications.
• Expenditures for OI medications and other drugs rose overall by 19% between July 1997 and June 2000 among the 32 ADAPs that cover these drugs and provide complete data.
• Most ADAP clients are uninsured, with only 10% receiving some prescription drug coverage through private insurance in June 2000.
• The fiscal year 2000 budget for ADAP was approximately $724.5 million, an increase of 9% over the previous fiscal year.
• The federal contribution to ADAP increased in 2000 to 73%, compared with 69% of the national ADAP budget in fiscal year 1999 and 27% in fiscal year 1996.
• Ten states reported having capped enrollment to their ADAPs, and 17 states reported one or more current and/or projected program limitations.
• Six ADAPs increased their financial eligibility levels since the last report, and almost two-thirds of ADAPs now have financial eligibility set at or above 300% of the federal poverty level.
• Eight states offer all 16 category A1 drugs recommended under the Public Health Service/ Infectious Disease Society of America guidelines.
• Nine states reported implementing or expanding insurance continuation and insurance purchasing programs using Title II base, ADAP, and state funding. Indiana will move all ADAP clients into the state’s high-risk insurance pool and pay for client premiums, deductibles, and pharmacy co-pays.