AEGiS-ATDN: Is ADAP Closing? In some states, including New York, there is big trouble! Congress could easily solve it.

Important note: Information in this article was accurate in 2002. The state of the art may have changed since the publication date.

Is ADAP Closing? In some states, including New York, there is big trouble! Congress could easily solve it.

Information Bulletin #16 - August 2002

Research has shown that preventative medicine can dramatically reduce the costs of medical care in this nation. As patients and providers take proactive steps to stave-off declines in patients' overall health, the need for more aggressive and expensive acute care, such as hospitalizations, is reduced. The results benefit the health of the patients and reduce overall costs involved in medical care.

We know that this is no less true for persons living with HIV/AIDS. As Highly Active Anti-retroviral Therapy (HAART) continues to evolve with our understanding of this complex disease, HAART's ability to prevent HIV from destroying people's immune systems and to keep people healthy and free from opportunistic infections (OIs) has had a multi-fold effect: helping individuals to live longer and more productive lives and reducing medical costs associated with treating Ols (typically costly to treat).

A recent study revealed some interesting statistics regarding medical costs for healthy AIDS patients verses those in advanced stage AIDS. According the research, which looked at patients receiving care between 2000 and 2001, the average medical costs for a relatively healthy HIV positive person who is on HAART was approximately $14,000 annually while the medical care of a person with advanced AIDS typically cost $34,000 a year. This annual difference can be attributed to hospitalizations and other medications used to treat Ols.

Another study observed the continued benefit from HAART as measured by reduced hospitalization. The NY Presbyterian Hospital found that the rate of hospitalization declined from a high of 95 per 100 patient year in 1995 down to 25 per patient year in 2001.

Furthermore, the 2001 AIDS Drug Assistance (ADAP) Monitoring Report noted that the monthly per capita spending for an ADAP client was $831, or $9,972 per year, nearly 29% less than the Average Whole Sale Price paid for a typical HAART combination. In fact, ADAPs pays 15% less for Antiretrovirals than Medicaid, according to a July 2001 report by the Office of Inspector General of the Department Health and Human Services.

This year, the struggles we face are more daunting because AIDS programs did not receive the $82 million additional dollars needed to accommodate the expected increase in demand. Despite the fact that there will be no new money going into ADAP programs nationally until the start of next fiscal year, April of 2003, the program will continue to grow. More people who need more drugs. Thus, by the end of this year, most ADAPs in the United States will have to not be able to take new enrolments, having just enough money to assist the clients already in the program through the fiscal year.

ADAP was designed to fill the gap between people who qualify for Medicaid and those who can afford private insurance. This gap is widening. The majority of ADAP clients make less than 200% for the Federal Poverty Level, the group of people most affected during an economic downturn.

Since we have not experienced this kind of economic climate since ADAP's inception, it remains to be seen if the steady trend of enrollment increase will remain the same. Already we are seeing enrollment spikes unlike previous years in several states. Compound this situation with Medicaid cuts caused by state budget shortfalls throughout the nation and we see that ADAPs are being squeezed from both ends.

T-20, a new HIV drug expected to be approved by the FDA this year, will become the dividing line between the 'haves' and the 'have-nots' in the U.S. Due to the expected high cost, most ADAPs will not be able to cover the drug, a drug needed by people for whom existing therapies no longer work. It is the end of line in HIV therapy. Thus, persons living with HIV/AIDS will be placed in a vice where life and death will be defined by their ability to pay for medication.

Call Your U.S. House of Representatives and Senators today and tell them how important these programs are to you, your family, friends, and those you care for. Ask them why they voted for or against fully funding ADAP this year - Congress didn't come up with $82 million of the money needed for ADAP, and states all over the country are either closing enrollment in their programs, or cutting back on services. Call Lei Chou at 212-260-8868, ext.21 to find out how you can help.

1. "HIV/AIDS Treatment and Care in the New Century" Plenary Session from the XIV International AIDS Conference, Michael Saag M.D. Ph.D., University of Alabama AIDS Center.

2. "Impact of Antiretroviral Therapy on Decreasing Hospitalization Rates of HIV-Infected Patients in 2001", AIDS Research and Human Retroviruses 2002, May1;18(7):501-6

3. National ADAP Monitoring Project Annual Report, April 2002

4. "Cost Containment of Medicaid HIV/AIDS Drug Expenditures", Department of Health and Human Services, Office of Inspector General, July 2001

020810
TR020811

AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, iMetrikus, Inc., John M. Lloyd Foundation, the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2002. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2002. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .