Treatment Issues: Newsletter of Experimental AIDS Therapies - Volume 16, Number 4, April 2002
Lei Chou and Anne Donnelly

ADAP stands for AIDS Drug Assistance Program, although some states have different names for similar programs. ADAP provides life-sustaining and life-prolonging medications to low income individuals with HIV who have no other source of payment for these drugs.

In June of 2001, ADAP served roughly 77,000 people and national ADAP enrollments have been growing consistently at about 600 people per month.

Although an average of 80 percent of ADAP funding comes from the Federal government, individual ADAPs are administered by the states and require some additional amount of state funding if they are to offer more than bare bones drug coverage. The list of medications provided by the ADAPs varies considerably from state to state, ranging from excellent programs in California and New York to very problematic programs in much of the Southeast and other areas.

Federal ADAP funding was increased by $50 million this year — well short of the $130 million estimated need. Recent pharmaceutical price increases may push this estimated shortfall up by an additional 50 percent during 2002. This means that most, if not all, ADAPs will run out of money towards the end of this year.

Pressure on ADAP is expected to increase as new drugs such as pegylated interferon and T-20 become available next year. Access to these newer products will probably require prior authorization. Additional pressure will likely come from rising unemployment and loss of insurance; a steady level of new HIV infections and a possible rise in AIDS cases; the emergenge of long-term drug side-effects; and the tightening of state Medicaid programs.

For 2003, the President has proposed flat funding ADAP (no increases). Advocates for ADAP say a push in Congress for an Emergency Supplemental Request to increase federal funding is needed right away. If no supplemental funding is received this year, then next year's shortfall could rise to $161 million or about 14 percent of the total ADAP budget.

With the Federal shortfall, the States (already under budgetary pressure from Medicaid and other health programs) will need to contribute additional money to avoid resorting to waiting lists or other restrictions. Six ADAPs currently have waiting lists representing about 700 people who are going without treatment. This number is expected to grow. Several states currently have restrictive eligibility criteria and several more are likely to introduce new restrictions later this year. Most states will soon begin to debate increasing their own contributions to ADAP funding, but few can afford to fill the gap.

All of this means that ADAPs — and the people with HIV who depend on them — are in deep trouble.

The 2002 National ADAP Monitoring Report will be released soon by the Kaiser Family Foundation. This report will be available at www.kff.org (selecting this link will open a new browser window).

For detailed information on each state's individual ADAP, contact the AIDS Treatment Data Network/The Access Project: http://www.atdn.org/access/states/index.html (selecting this link will open a new browser window).

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