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ADAP: SECURING HIV/AIDS DRUGS for the NATION’S POOR and UNINSURED. Early Treatment of HIV Summit Washington DC July 20, 2009. William McColl Political Director AIDS Action Council. Carl Schmid Deputy Executive Director The AIDS Institute. GOALS & METHODS. - PowerPoint PPT Presentation
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Early Treatment of HIV Summit
Washington DC
July 20, 2009
Carl Schmid
Deputy Executive Director
The AIDS Institute
William McColl
Political Director
AIDS Action Council
ADAP: SECURING HIV/AIDS DRUGS
for theNATION’S POOR and UNINSURED
GOALS & METHODSGOALS & METHODS
Joint project by The AIDS Institute & AIDS Action Council
Analyze ADAPs & how well they are meeting goal of providing medications
Conducted 30 Interviews Offered an Overall Assessment & 25 Policy
Recommendations Use for Health Reform, Appropriations, NAS &
Future Ryan White Reauthorization
OVERALL ASSESSMENTOVERALL ASSESSMENT
Despite a budget of $1.4 billion in federal and state funds
ADAP is not fully meeting the needs of people living with HIV/AIDS
45 percent of people needing medications not receiving them
Great disparities between the states in their ADAP coverage.
HOW DID WE GET HERE?HOW DID WE GET HERE?
Ryan White HIV/AIDS Program– Impact of Treatment Modernization Act
Medicare Part D – Impact on ADAP
TREATMENT MODERNIZATION TREATMENT MODERNIZATION ACTACT
Formula Changes– Move from AIDS to HIV/AIDS
Increase in ADAP Supplemental– From 3% to 5% of ADAP
Drug Formulary RequirementCore Medical Services Carry-over Funds/Unobligated Balances
Redistribution
Medicare Part DMedicare Part D
Picked up ADAP Clients– Savings $73-89 million in FY06
ADAPs Wrap Around Part D– But not all states do so
Cost Burden on some BeneficiariesAdministrative HeadacheCreation of SPAPs
FACTORS INFLUENCING ADAP FACTORS INFLUENCING ADAP GROWTHGROWTH
New infectionsIncreased costsIncreased testing effortsLoss of insurance coverage
OTHER FACTORS OTHER FACTORS INFLUENCING ADAP GROWTHINFLUENCING ADAP GROWTH
New MedicationsChanging Treatment
GuidelinesCoverage of Additional
Services
FACTORS INFLUENCING ADAP FACTORS INFLUENCING ADAP BUDGETSBUDGETS
Federal Annual Appropriation– Small Annual Growth– Much less than required
State Budgets– Current Fiscal Crisis in many States
Price of MedicationsDrug Company Rebates
State ADAP FundingState ADAP Funding
LIMITATIONS ON ACCESS TO LIMITATIONS ON ACCESS TO THE PROGRAMTHE PROGRAM
Need for adherence servicesNeed for Medical Care and Support
ServicesState Service Variability & Cost
Containment MeasuresDistribution of Funds
OTHER ISSUESOTHER ISSUES
Patient Assistance ProgramsLimited New Drugs &
ResearchUnobligated Balance Rule
POSSIBLE SOLUTIONSPOSSIBLE SOLUTIONS
Increased Federal Appropriations– By President & Congress
State Actions– Work at State Level, particularly states that
make no or little contribution to ADAP– Review Current State match requirements– Encourage States to use ADAP Dollars for
Insurance Programs
POSSIBLE SOLUTIONSPOSSIBLE SOLUTIONS
Drug Prices– Continue Current Price Negotiations– Access to DOD Prices
Medicare Part D– Allow ADAP Expenditures to count toward True Out-
of-Pocket Expenses– Encourage States to Wrap Around Drug Benefit with
ADAP dollars– Encourage States to Create State Pharmacy Assistance
Programs
POSSIBLE SOLUTIONSPOSSIBLE SOLUTIONS
Medicaid Expansion– Early Treatment for HIV Act– Ensure states enact at state level
Create an ADAP Entitlement, along with all Ryan White Services
Increase Access to ADAP Drugs & Services– Greater Use of ADAP Dollars for Adherence &
Outreach– Greater Use of Minority AIDS Initiative Dollars for
Outreach– Increased Funding for all Ryan White Programs
POSSIBLE SOLUTIONSPOSSIBLE SOLUTIONS
Addressing State Variability– Establish a floor for eligibility (350% of FPL)– Require all Antiretrovirals & OI Drugs on
Formularies– Greater Portability– Adjust Hard Harmless, while Increase
Appropriations– Develop a Severity of Need Index– HRSA Review ADAP Supplemental Criteria
POSSIBLE SOLUTIONSPOSSIBLE SOLUTIONS
Unobligated Balances– HRSA Review Current Policy– Increase Amount Allowed to Carry-over from
2-5% and relax one or both penalties
ADAP Rebate Dollars– Clarify it is not program income
POSSIBLE SOLUTIONSPOSSIBLE SOLUTIONS
Congress Investigate Number of Patients on Pharmacy Assistance Programs & Address ways to meet their needs
Public Policies that encourage companies to research and develop new drugs
CONCLUDING THOUGHTSCONCLUDING THOUGHTS
FY10 Budget & AppropriationsRyan White ExtensionHealth ReformFuture Review of Ryan White
Program, including ADAP
THE FULL REPORT CAN BE THE FULL REPORT CAN BE ACCESSED AT:ACCESSED AT:
www.theaidsinstitute.org/downloads/ADAPReportMarch2009TheAIDSInstitute.pdf
orwww.aidsaction.org/images/pdf/aids_drug_assistance_program.pdf
