February 19, 2013

As of February 14, 2013, there were 63 individuals on AIDS Drug Assistance Program (ADAP) waiting lists in four (4) states. Sixteen ADAPs, including four with current waiting lists, have had costcontainment measures in place since April 1, 2012 (reported as of February 6, 2013). In addition, one ADAP reported considering implementing new or additional cost-containment measures by the end of ADAPs current fiscal year (March 31, 2013). One ADAP reported being able to eliminate or improve previous cost-containment measures in the last quarter. ADAPs with Current or Anticipated Cost-Containment Measures, Including Waiting Lists, as of February 6, 2013

Factors Leading to Consider or Implementation of Cost-containment Measures ADAPs reported the following factors contributing to consideration or implementation of cost containment measures: Increased clients/demand due to job loss/unemployment (11 ADAPs) Increased HIV testing leading to higher client enrollment (9ADAPs) Reduced or insufficient federal ADAP funding (8 ADAPs) Escalating drug costs (7 ADAPs) Increased utilization from already enrolled clients (6 ADAPs)

ADAPs with Waiting Lists (63 individuals in 4 states, as of February 14, 2013) State Florida Idaho Louisiana* South Dakota Number of Individuals on ADAP Waiting List 0 26 0 37 Percent of the Total ADAP Waiting List 0% 41% 0% 59% Increase/Decrease from Previous Reporting Period 0 5 0 7 Date Waiting List Began June 2010 October 2012 June 2010 August 2012

*Louisiana has a capped enrollment on their program. This number represents their current unmet need.

Waiting List Client Demographics:

ADAP waiting list clients, by Race/Ethnicity, as of February 6, 2013

19%

54%

17%

2% 2%

6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Non-hispanic Black/African American (19%) Hispanic (17%) Native Hawaiian/Pacific Islander (2%) Multi-racial (0%) Unknown (0%)

Non-hispanic White (54%) Asian (2%) American Indian/Alaskan Native (6%) Other (0%)

ADAP waiting list clients, by Gender, as of February 6, 2013

79% 21%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Male (79%)

Female (21%)

Transgender (0%)

Unknown (0%)

Access to Medications: All four ADAPs with waiting lists confirm that case management services assist clients in obtaining medications through either pharmaceutical company patient assistance programs (PAPs) (3 ADAPs) or Welvista (1 ADAP) while clients are on the waiting list. Case management services are provided to ADAP waiting list clients through Part B (1 ADAP) and other agencies, including other Parts of Ryan White (3 ADAPs). Waiting List Organization: Waiting list clients are prioritized by one of two models: First-come, first-served model: placing individuals on the waiting list in order of receipt of a completed application and eligibility confirmation (3 ADAPs). Medical criteria model: based on hierarchical medical criteria based on recommendations by the ADAP Advisory Committee (1 ADAP).

ADAPs with Other Cost-containment Strategies (since April 1, 2012**, as of February 6, 2013) Enrollment Cap: Idaho Indiana Utah Wyoming Expenditure Cap: Illinois: (monthly) Kentucky: (annual) New Mexico: (monthly) South Dakota: (annual) Formulary Reduction: Florida Illinois Puerto Rico Tennessee Utah Virgin Island (U.S.) Other: Montana: elimination of all support services Washington: pay insurance premiums only if client is prescribed and taking ARVs

** ADAPs may have other cost-containment strategies that were instituted prior to April 1, 2012.

ADAPs Considering New/Additional Cost-containment Measures (before March 31, 2013***) Formulary Reduction: Maine ***March 31, 2013 is the end of ADAP FY2012. ADAP fiscal years begin April 1 and ends March 31. ADAPs that Eliminated/Modified Cost-containment Measures (since December 17, 2013****) Formulary Increase: North Carolina **** ADAPs may have eliminated/modified other cost-containment strategies prior to December 17, 2013. About ADAP: ADAPs provide life-saving HIV treatments through directly purchasing medications or providing insurance coverage and wrap-around services to low income, uninsured, and underinsured individuals living with HIV/AIDS in all states, territories and associated jurisdictions. About NASTAD: NASTAD strengthens state and territory-based leadership, expertise, and advocacy and brings them to bear on reducing the incidence of HIV and viral hepatitis on providing care and support to all who live with HIV and viral hepatitis. NASTADs vision is a world free of HIV/AIDS and viral hepatitis. For more information, visit www.NASTAD.org.
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