October 12, 2012

As of October 11, 2012, there were 104 individuals on AIDS Drug Assistance Program (ADAP) waiting lists in five (5) states. This is a 91 percent decrease from the 1,125 individuals on the August 2012 ADAP Watch. Twenty ADAPs, including five with current waiting lists, have instituted additional costcontainment measures since April 1, 2009 (reported as of September 26, 2012). In addition, two ADAPs reported considering implementing new or additional cost-containment measures by the end of ADAPs current fiscal year (March 31, 2013). At this time, three states have determined an enrollment cap for their program and anticipate reaching this cap and thus, beginning wait lists during the fiscal year. ADAPs with Current or Anticipated Cost-Containment Measures, Including Waiting Lists, September 26, 2012

Waiting List Client Demographics: African Americans and Hispanics represent 49% (32% and 17%, respectively) of clients on current ADAP waiting lists. Combined, Asians, Native Hawaiian/Pacific Islanders and Alaskan Native/American Indians represent approximately 5% of the total ADAP waiting list population. Multi-racial ADAP clients represent 1% of the total ADAP waiting list population. Non-Hispanic whites comprise 41% of clients on ADAP waiting lists. Unknown is currently 1% of the total ADAP waiting list. Almost two-thirds (67%) of ADAP clients on waiting lists are men. Approximately one third (32%) of ADAP waiting list clients are women. Transgender are only 1% of the ADAP waiting list.
ADAP waiting list clients, by Race/Ethnicity, as of September 26, 2012
32% 41% 17% 1% 4% 1%

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Non-hispanic Black/African American (32%) Hispanic (17%) Native Hawaiian/Pacific Islander (0%) Multi-racial (1%)

Non-hispanic White (41%) Asian (1%) American Indian/Alaskan Native (4%)

ADAP waiting list clients, by Gender, as of September 26, 2012

67% 32% 1%

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Male (67%)

Female (32%)

Transgender (1%)

Access to Medications: Case management services are being provided to ADAP waiting list clients through Part B (5 ADAPs), contracted agencies (2 ADAPs) and other agencies, including other Parts of Ryan White (3 ADAPs). For clients on ADAP waiting lists who are currently on or in need of medications, all five ADAPs with waiting lists confirm that ADAP waiting list clients are receiving medications through either pharmaceutical company patient assistance programs (PAPs), Welvista, or other mechanisms available within the state. Waiting List Organization: An ADAP waiting list using a first-come, first-served model is structured to place any individual applying to ADAP on the waiting list in order of receipt of a completed enrollment application and eligibility confirmation. Of the five states with ADAP waiting lists, three utilize a firstcome, first-served model for prioritizing clients to join the active client roll. An ADAP waiting list using a medical criteria model is structured based on a hierarchical criteria typically established by the state based on recommendations from its ADAP Advisory Committee. Of the five states with ADAP waiting lists, two utilize a medical criteria model for prioritizing clients to join the active client roll.

Factors Leading to Implementation of Cost-containment Measures: ADAPs reported the following factors contributing to consideration or implementation of cost containment measures: Higher demand for ADAP services as a result of increased unemployment (12 ADAPs) Level federal funding awards (11 ADAPs) Increased demand for ADAP services due to comprehensive HIV testing efforts (9 ADAPs) Escalating drug costs (8 ADAPs) State budget decreases (5 ADAPs) ADAPs with Active Waiting Lists (104 individuals in 5 states*, as of October 11, 2012) State Florida Georgia Louisiana** North Carolina South Dakota Number of Individuals on ADAP Waiting List 58 0 30 0 16 Percent of the Total ADAP Waiting List 56% 0% 29% 0% 15% Increase/Decrease from Previous Reporting Period 36 0 -26 0 6 Date Waiting List Began June 2010 July 2010 June 2010 January 2010 August 2012

*As a result of FY2012 ADAP emergency funding, Alabama, Florida, Georgia, Idaho, Louisiana, Montana, Nebraska, North Carolina, and Virginia were able to reduce the overall number of individuals on their waiting lists. **Louisiana has a capped enrollment on their program. This number represents their current unmet need.

ADAPs with Capped Enrollment (as of October 11, 2012) State Idaho Utah Wyoming Enrollment Cap 197 450 direct medication clients, 100 insurance clients 135

ADAPs with Other Cost-containment Strategies: Financial Eligibility (instituted since September 2009, as of September 26, 2012) Since September 2009, six ADAPs previously lowered their financial eligibility as part of their costcontainment plans. Illinois, North Dakota, Ohio and South Carolina lowered their eligibility level to 300 % FPL. Utah lowered its eligibility level to 250% FPL. Arkansas lowered its eligibility level to 200% FPL. Previously, income eligibility for the states noted above was 400% FPL or higher. As a result of these measures, a total of 445 individuals in three states (Arkansas - 99, Ohio - 257, and Utah 89) were disenrolled. Illinois, North Dakota, and South Carolina grandfathered clients that were previously eligible based on their income level into their programs. No other ADAPs currently report anticipating further changes to their financial eligibility.

ADAPs with Other Cost-containment Strategies (instituted since April 1, 2009, as of September 26, 2012) Alabama: reduced formulary Alaska: reduced formulary Arkansas: reduced formulary Florida: reduced formulary, transitioned 5,403 clients to Welvista from February 15 to March 31, 2011 Georgia: reduced formulary, implemented medical criteria, participating in the Alternative Method Demonstration Project Illinois: reduced formulary, instituted monthly expenditure cap ($2,000 per client per month) Kentucky: reduced formulary Louisiana: discontinued reimbursement of laboratory assays Nebraska: reduced formulary North Carolina: reduced formulary North Dakota: capped enrollment, instituted annual expenditure cap Puerto Rico: reduced formulary South Dakota: annual expenditure cap ($10,500 per client per month) Tennessee: reduced formulary Utah: reduced formulary Virginia: restricted eligibility criteria Washington: instituted client cost sharing, reduced formulary, only paying insurance premiums for clients currently on antiretrovirals Wyoming: reduced formulary, instituted client cost sharing ADAPs Considering New/Additional Cost-containment Measures (before March 31, 2013***) Maine: reduced formulary Montana: waiting list ***March 31, 2013 is the end of ADAP FY2012. ADAP fiscal years begin April 1 and ends March 31. About ADAP: ADAPs provide life-saving HIV treatments to low income, uninsured, and underinsured individuals living with HIV/AIDS in all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, the Federated States of Micronesia, American Samoa, and the Republic of the Marshall Islands. In addition, some ADAPs provide insurance continuation and Medicare Part D wrap-around services to eligible individuals. Ryan White Part B programs provide necessary medical and support services to low income, uninsured, and underinsured individuals living with HIV/AIDS in all states, territories and associated jurisdictions. About NASTAD: Founded in 1992, NASTAD is a nonprofit national association of state and territorial health department HIV/AIDS program directors who have programmatic responsibility for administering HIV/AIDS and viral hepatitis health care, prevention, education, and supportive services programs funded by state and federal governments. For more information, visit www.NASTAD.org.
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