NATIONAL ADAP MONITORING PROJECT - AIDS United

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affect state ADAPs over the coming years, each of which was assessed by the current survey: • New antiretroviral treatment guidelines released last year, suggesting delaying the initiation of antiretroviral therapy until later in illness. 13 State ADAP programs reported that this clinical change has yet to have a significant impact on ADAPs given that ADAP clients generally enter the program late in disease progression, with very low CD4 counts, at which point, antiretroviral therapy would generally be indicated. • Ryan White CARE Act Amendments of 2001 (reauthorizing the CARE Act). The CARE Act Amendments contained provisions allowing ADAPs more flexibility, such as allowing ADAP funds to be used for medical monitoring and adherence programs. Many states reported, however, that the demand for medications prevented them from taking advantage of this flexibility over the last year. More importantly, the reauthorized CARE Act also allowed for the 1 Kaiser Family Foundation, Prescription Drug Trends: A Chartbook Update, November 2001. 2 Steinbrook, R., “The Prescription Drug Problem,” New England Journal of Medicine, Vol. 346, No. 11, March 2002. 3 Health Resources and Services Administration, The ADAP Manual: AIDS Drug Assistance Program of the Ryan White CARE Act, 1999. 4 A regimen used after a person develops resistance to the majority of available therapies is sometimes referred to as “salvage” therapy. These therapies often involve four or more drugs. 5 Kaiser Family Foundation, Financing HIV/AIDS Care: A Quilt with Many Holes, October 2000. 6 The Federated states of Micronesia and the Marshall Islands, two Pacific U.S. territories, will receive federal ADAP earmark funding for the first time in FY 2002. 7 Health Resources and Services Administration, ADAP Fact Sheet. Available: www.hab.hrsa.gov/programs/factsheets/ adap1.htm. 8 In 2001, the FPL was $8,590 per year (slightly higher in Alaska and Hawaii) for a household of 1. 8 provision of supplemental grants to states with severe ADAP needs. 14 While this “ADAP supplemental” has begun to help some states expand their programs and ease restrictions, a core group of states continues to have limited or restricted programs. The continued program restrictions and limitations in these states may be indicative of less generous Medicaid programs or lack of other indigent care programs. The State-by-State ADAP Summary Profile that begins on the next page provides a synopsis of each ADAPs eligibility criteria, coverage of specific drug classes, budget information, client utilization and expenditures, and reported program limitations/restrictions that were in place as of February 2002. Maps showing current or planned program restrictions and coverage of OI drugs across the country are also presented. These are followed by charts showing current data and trends over time. Detailed tables with data by state are contained in the Appendices. 9 Under the Ryan White CARE Act, an EMA’s Ryan White HIV Services Planning Council can decide to allocate Title I dollars to their state ADAP program. 10 This was the first year in which Guam provided data for the National ADAP Monitoring Project. 11 An open formulary provides access to any FDA-approved HIVrelated prescription drug. 12 USPHS/IDSA, Guidelines for the Prevention of Opportunistic Infections in Persons Infected with Human Immunodeficiency Virus, November 2001. Available: www.hivatis.org/guidelines/ other/OIs/OIGNov27.pdf. 13 Department of Health and Human Services/The Henry J. Kaiser Family Foundation, Guidelines for the Use of Antiretroviral Agents in HIV infected Adults and Adolescents, February 2002. Available: www.hivatis.org/trtgdlns.html#Adult. 14 Three percent of the ADAP earmark is set aside for supplemental grants to states with severe needs such as low financial eligibility, program restrictions, or limited formularies. These grants were first issued in FY 2001.
State-by-State Summary ADAP Profile 9 1 In 2001, the FPL was $8,590 per year (slightly higher in Alaska and Hawaii) for a household of 1. 2 Refers to additional medical criteria to access ADAP such as a specified CD4 count, viral load, or both. All states require individuals to be HIV positive to access ADAP. 3 Additional medical criteria applies to ARV drug access only. 4 Virginia financial eligibility at 333% FPL for Northern Virginia only. 5 MA and NJ have an open formulary; see formulary for specific exclusions. 6 The following classes of drugs are covered as groups: Antidepressants, Antilipidemia, Bipolar Medications, Oral Analgesics, Oral Antidiabetics, Topical Steroids. Bold indicates changes from the 2000 survey reported in the 2001 survey. Italics indicate data from the 2000 survey. Shaded areas indicate restrictions lifted since 2000 survey.
Page 1 and 2: NATIONAL ADAP MONITORING PROJECT AN
Page 3 and 4: NATIONAL ADAP MONITORING PROJECT AN
Page 5 and 6: National ADAP Monitoring Project: A
Page 7 and 8: Introduction Spending on prescripti
Page 9: • ADAPs continue to serve a low-i
Page 13 and 14: States/Territories with Current or
Page 15 and 16: Charts
Page 17 and 18: Chart 2 ADAP Drug Expenditures and
Page 19 and 20: Millions of Dollars Chart 4 Trends
Page 21 and 22: Chart 6 ADAP Drug Expenditures, by
Page 23 and 24: Chart 8 ADAP Clients, by Race/Ethni
Page 25 and 26: Unknown >400% FPL 301-200% FPL 201-
Page 27 and 28: Chart 12 Health Status of ADAP Clie
Page 29 and 30: Millions of Dollars Milions of Doll
Page 31 and 32: Millions in Dollars Millions in Dol
Page 33 and 34: Millions in Dollars Millions in Dol
Page 35 and 36: Chart 20 ADAP Cost Recovery Resourc
Page 37 and 38: Serving almost 77,000 largely unins
Page 39 and 40: Appendices
Page 41 and 42: Total Clients Served, Expenditures
Page 43 and 44: Appendix II ADAP Expenditures, By C
Page 45 and 46: ADAP Expenditures, By Class, June 2
Page 47 and 48: Prescriptions Filled, by Class, Jun
Page 49 and 50: Appendix IV Race/Ethnicity of June
Page 51 and 52: Appendix V Gender and Age of June 2
Page 53 and 54: Appendix VI Income Level and Insura
Page 55 and 56: Income Level and Insurance Status o
Page 57 and 58: Health Status of ADAP Clients Enrol
Page 59 and 60: ADAP Budget FY 2001: Federal and St
Page 61 and 62:
Appendix IX ADAP Budgets for FY 200
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Appendix X Major FY 2001 Budget Cat
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Major FY 2001 Budget Categories Com
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Alabama ADAP FORMULARIES ANTIRETROV
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Connecticut ADAP FORMULARIES ANTIRE
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Distric of Columbia ADAP FORMULARIE
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Illinois ANTIRETROVIRALS NRTIs- aba
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Maine ADAP FORMULARIES ANTIRETROVIR
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Mississippi ANTIRETROVIRALS NRTIs-
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New Hampshire ADAP FORMULARIES ANTI
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New York ADAP FORMULARIES ANTIRETRO
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Oklahoma ADAP FORMULARIES ANTIRETRO
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Rhode Island ADAP FORMULARIES ANTIR
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Vermont ADAP FORMULARIES ANTIRETROV
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Wisconsin ADAP FORMULARIES ANTIRETR
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NATIONAL ADAP MONITORING PROJECT - AIDS United

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