AIDS Drug Assistance Monitoring Project

DESPITE FUNDING INCREASES IN RECENT YEARS, MANY STATES LIMITING AIDS DRUG ASSISTANCE PROGRAMS (ADAPs)IN RESPONSE TO GROWING DEMAND AND COSTS

Drugs Covered, Eligibility, and State Contribution Vary Widely Across State ADAPs

WASHINGTON, D.C. -- As expensive new drug therapies prove more promising in treating people living with HIV/AIDS, a survey of the nation's 52 state AIDS Drug Assistance Programs, or ADAPs, finds that despite an 85 percent increase in total program spending between 1996 and 1997, more than half imposed limits to cope with growing demand and costs. Thirty-five ADAPs enacted at least one emergency measure in the last year:

Seventeen transferred funds from other AIDS-specific services or other discretionary health department funds;

Sixteen instituted waiting lists for access to the program or protease inhibitors;

Fifteen capped or restricted access to protease inhibitors;

Thirteen capped the number of people served;

Eleven reduced the number of drugs covered; and

Seven restricted eligibility by lowering the income levels covered.

As of this month, 23 ADAPs continue to have an emergency cost-containment measure in place.

The study, which was conducted for the Kaiser Family Foundation by the National Alliance of State and Territorial AIDS Directors and the AIDS Treatment Data Network, also found wide variation across the nation's ADAPs in terms of income and medical eligibility criteria, state contribution to the program, and drugs covered:

Income eligibility ranges from coverage for people with incomes up to 100% of poverty ($7890 or less for one person) in Arkansas and Utah to a high of 400% above the federal poverty level in California, Hawaii, Idaho and Rhode Island.

In 1997, 30 ADAPs supplemented federal funding of the program with state money and 22 provided no additional contribution.

Most ADAPs cover at least some of the drugs that can be used in the combination drug therapies that are recommended for the treatment of HIV-positive individuals by the federal Public Health Service. Two states -- New York and North Carolina --currently cover all available antiretrovirals. Only four ADAPs -- Arkansas, Nevada, Oregon, and South Dakota -- do not cover any of the approved protease inhibitors.

"At a time when new guidelines are calling for expanded access to AIDS drugs, state and federal policy makers face difficult decisions about how to meet the growing demand on state AIDS Drug Assistance Programs," said Sophia Chang, M.D., Director, HIV Programs, Kaiser Family Foundation.

In June of this year, the Public Health Service (PHS), part of the federal Department of Health and Human Services, released draft guidelines for HIV antiretroviral therapy that recommend patients start on a combination drug treatment earlier in the course of the disease. The report concluded that the guidelines would put further pressure on state programs to finance needed drugs: "Although the implications of implementing these new guidelines have not been establish, pressure on state ADAPs to expand drug coverage and keep pace with expected client growth. Unfortunatunprepared to offer this standard of care to eligible patients who may be candidates for triple combination therapy," the researchers said.

Budget and Demand: What's Been Happening Recently to ADAP?

Between 1996 and 1997, the overall ADAP budget including both federal and state contributions increased 85 percent from $208 million to $385 million. Over the last two years, ADAP budgets nationally grew three-fold.

National ADAP Funding Source Changes Between 1996 and 1997
Funding Source	FY 1996 (in millions)	FY 1997 (in millions)	Percent Change
Federal*	$136.1	$ 249.6	+ 83%
State	$ 53.7	$109.0	+ 103%
Other (includes Drug Rebates, Insurance Recovery)	$ 17.7	$ 26.4	+ 50%
Total	$207.5	$385.0	+ 85%

* Includes both Title I and II funds

The report notes that while states may be reluctant to report ADAP budget shortfalls, at least in part because some state laws prohibit overspending of federal or state resources, in this survey eleven ADAPs did indicate anticipating shortfalls in 1997: Alabama, Arizona, Arkansas, Colorado, Montana, New Mexico, Puerto Rico, Texas, Vermont, Washington State, and West Virginia. In addition, three others -- Florida, Mississippi, and South Dakota -- reported having had to severely limit services already this year in response

"While there has been a significant increase in both federal and state support to ADAP in the last year, states are spending their funds almost as soon as they receive them due to growing client demand and the costly new standard of treatment. In many states, this translates into restricted access to AIDS drugs," said Joseph Kelly, Deputy Director, National Alliance of State and Territorial AIDS Directors.

Forty-two of the 52 ADAPs reported increases in the number of low-income HIV-positive people served in the last six months of 1996, the most recent period for which information is available. Nationally, the number of clients served in December 1996 was 23 percent higher than in the previous July -- an average increase of approximately 1,000 clients per month. Monthly program spending during the same six month period increased overall by 37 percent, from $14.9 million to $20.4 million.

During the calendar year 1996, the national estimate of the total number of people served by ADAP was 80,000. The report's authors find that "in spite of very limited data, an estimate of those persons with HIV who would be eligible for the program range between 140,000 and 280,000 nationally," a range that would imply a "two- to four-fold increase in potential ADAP clients."

AIDS Drug Assistance Program, or ADAP, is a state-administered program that provides access to the drugs used to treat HIV and prevent the onset of related opportunistic infections for low-income people living with HIV/AIDS who do not have adequoate private or public health insurance. The program forms one link in the continuum of publicly-funded HIV care and services that includes the Ryan White CARE Act, Medicaid, Medicare, and local indigent health care programs. The 52 ADAPs -- fifty states plus the District of Columbia -- receive federal funds through the Ryan White CARE Act. In 1997, thirty states contributed supplementary funding. In 1997 total federal and state ADAP spending was $385 million. States set the income and medical eligibility, determine which drugs will be covered and how they will be purchased and distributed.

The Kaiser Family Foundation, based in Menlo Park, California, is a non-profit, independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries. The Foundation's work is focused on four main areas: health policy, reproductive health, and HIV in the United States, and health and development in South Africa.

The National Alliance of State and Territorial AIDS Directors (NASTAD) represents the chief HIV/AIDS program managers in every U.S. state and territorial health department responsible for administering federally-funded HIV/AIDS prevention surveillance, health care, supportive service and housing programs, including Title II of the Ryan White CARE Act. Established in 1992, NASTAD provides a forum for technical assistance and dissemination of information about effective HIV prevention and continuum of care programs among state AIDS directors.

The AIDS Treatment Data Network (ATDN) operates the Access Project, a nationwide database of AIDS Drug Assistance Programs, Medicaid Programs and pharmaceutical industry-sponsored drug access programs, as well as provides information about drugs used to treat HIV/AIDS.

Copies. State AIDS Drug Assistance Programs: A National Report on Access can be ordered by calling the Kaiser Family Foundation's toll-free publications request line at 1- (Ask for report #1275).

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Last modified: 7/12/97
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