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AIDS Drug Assistance Program Crisis Summit July 5, 2010. Kevin Dedner, MPH Section Chief HIV/AIDS & Hep C Section Center for Health Protection Arkansas Department of Health. Analogy of ADAPs. Analogy of ADAP. What fuels the faucet? Funding Client utilization: Based on trust - PowerPoint PPT Presentation
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Kevin Dedner, MPHSection Chief
HIV/AIDS & Hep C SectionCenter for Health Protection
Arkansas Department of Health
Analogy of ADAPs
What fuels the faucet?•Funding•Client utilization:
•Based on trust•Well-targeted testing
What causes leaks in the faucet?•Clients transitioning out of care•Clients lost to care•Clients incarcerated•Clients transitioning to other payers
(i.e. – Medicaid and Medicare)•Clients gaining employment and employer sponsored insurance•Clients moving our of state
Status of State ADAPs
ADAP Budget
ADAP Client Utilization
What Happen?◦ Tremendous Growth in the Program
2006 to 2007 = 2% increase in clients enrolled (346 to 354) 2007 to 2008 = 22% increase in clients enrolled (354 to 433) 2008 to 2009 = 54% increase in clients enrolled (433 to 667)
◦ State Budgets under strain- Reduced Funding from States
◦ Downturn in the Economy People lost their jobs and healthcare insurance
Provide care to those who need it most Ensure consistency in services available to
clients Provide a stable funding stream to providers
and clients Stabilize the program
Reduced income eligibility from 500% to 200% FPL effective May 26, 2009. Curtailed outreach activities Reviewed and reduced dental treatment plans. Implemented weekly monitoring report of expenditures, commitments, and
caseload. Reviewed the formulary. The following changes were made.
◦ 56 drugs are being removed.◦ 12 drugs will require prior authorization.
A Patient Assistance Program was developed. Established an Advisory Group that has met two times. Conducted 11 focus group sessions statewide: 5 with patients and 6 with
providers. Results are being compiled.
Required Medicare Part D clients with incomes <150% FPL to apply for Low Income Subsidy.
Sought Patient Assistance for Hepatitis C patients. The state has 10 slots available. Medications cost $16,000 per year.
Dismissed clients with incomes >200% FPL.◦ Notify October 1.◦ Effective January 1.
Strengthen the policy on payments of insurance premiums and drug co-pays to assure it is cost effective.
ADAP Waiting Lists and Cost-Containment
ADAPs with Waiting Lists (2,090 individuals, as of July 1, 2010)Florida: 523 individualsHawaii: 10 individualsIdaho: 26 individualsIowa: 97 individuals
Kentucky: 198 individualsLouisiana: 112 individuals*
Montana: 20 individualsNorth Carolina: 783 individualsSouth Carolina: 187 individualsSouth Dakota: 22 individuals
Utah: 112 individuals
Arizona: reduced formulary Arkansas: reduced formulary, lowered financial eligibility to 200% of FPL Colorado: reduced formulary Georgia: waiting list as of July 1, 2010 Illinois: reduced formulary Iowa: reduced formulary Kentucky: reduced formulary Louisiana: capped enrollment, discontinued reimbursement of laboratory
assays Missouri: reduced formulary North Carolina: reduced formulary North Dakota: capped enrollment, cap on Fuzeon, lowered financial
eligibility to 300% FPL Utah: reduced formulary, lowered financial eligibility to 250% FPL Washington: client cost sharing, reduced formulary (for uninsured clients
only)
Arizona: waiting list California: proposed elimination of ADAP services in city and
county jails Florida: reduced formulary, lowered financial eligibility Illinois: reduced formulary, lowered financial eligibility, monthly
expenditure cap Ohio: reduced formulary, lowered financial eligibility, capped
enrollment, client cost sharing, annual and monthly expenditure caps Oregon: reduced formulary, client cost sharing, annual
expenditure cap Wyoming: reduced formulary
Funding Co-infections Unmet Need Lost to Care Late Testers (Targeted Testing) Access to Care Homophobia/Stigma/Discrimination
National Alliance of State & Territorial AIDS Directors
Southern AIDS Coalition Arkansas Department of Health
Kevin Dedner, MPHHIV/STD/Hepatitis C Section
Arkansas Department of Health4815 West Markham, Slot 33
Little Rock, AR 72205
Direct Dial: 501-661-2408Toll Free: 1-888-499-6544
Fax: [email protected]