NATIONAL ADAP MONITORING PROJECT - AIDS United

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e low-income and uninsured, and most are men. • The number of clients served and the monthly program expenditures of state and territorial ADAPs have continued to grow over time, although at slower rates. Expenditure growth outpaced the growth in client utilization between 1996 and 2001. During this period, ADAP client utilization increased by 144%; ADAP monthly drug expenditures increased by 320%. Growth in the number of clients may reflect several factors including: increases in the number of people living with HIV/AIDS; increasing client demand; and increases in funding for ADAPs, enabling them to serve more people. Expenditure growth is attributable to several factors including: increases in client utilization; rising drug prices; and the increasing complexity of treatment regimens. • The national ADAP budget has also continued to grow over time, although, like clients and expenditures, at slower rates. Between FY 1996 and FY 2001, the national ADAP budget increased by 329%. The federal ADAP earmark continues to represent the core of the national ADAP budget. Slightly more than two-thirds of states provide state general revenue funds to their ADAP programs. In the remaining states, ADAPs must rely solely on federal funding. • Despite the overall growth in the national ADAP budget, access to ADAPs continues to vary greatly depending upon where one lives, as indicated by wide variations in income eligibility criteria and formulary coverage across states, and the continued use of waiting lists and other access restrictions by some jurisdictions. Variations in access are the result of both the availability of other resources—and therefore the size of the gap that ADAPs are asked to fill—as well as state discretion over ADAP program design. • While different states have faced restrictions over time, a subset repeatedly struggles with lower ADAP income eligibility, more limited formularies, and other program restrictions. In at least four of the last six fiscal years (FY 1996–2001), the following 13 states—primarily southeastern and frontier states— have capped/limited client enrollment and/or restricted access to antiretrovirals: Alabama, Arkansas, Georgia, Idaho, Kentucky, Maine, Montana, North Carolina, Oklahoma, South Carolina, South Dakota, Texas, and Wyoming. 6 • Finally, all states take advantage of the most costeffective drug discount mechanisms available to their ADAPs—primarily the 340B Drug Discount Program. Given the rapidly rising costs of prescription drugs, however, many states are continuing to explore other options to obtain more significant drug discounts/rebates on state-purchased pharmaceuticals. Detailed Findings from the Current Survey In addition to these overall themes, findings from the most recent survey period of June 2001 include: Clients, Expenditures, and Prescriptions • The number of clients served by ADAPs grew to 76,743 in June 2001. The overall growth rate for ADAPs reporting complete client and expenditure data between 1996 and 2001, the entire period of the National ADAP Monitoring Project, was 144%, including a 10% increase over the last year alone, a rate of growth smaller than in prior periods (see Charts 1 and 3). • ADAP drug expenditures grew to almost $64 million in June 2001. The overall expenditure growth rate for ADAPs reporting complete client and expenditure data between 1996 and 2001 was 320%, including a 16% increase in the last year. Antiretrovirals continue to represent the bulk of drug expenditures (87%) (see Charts 2, 4, and 6). • Per capita drug expenditures were $831 in June 2001 (see Chart 5). • State ADAPs filled a total of 246,062 prescriptions in June 2001 (see Chart 7). ADAP Client Demographics • The demographic makeup of ADAP clients has remained fairly constant since 1996. The majority of ADAP clients in June 2001 were people of color, with African Americans representing approximately onethird (34%) and Hispanics representing about onequarter (24%) of the national ADAP population. Asian/Pacific Islanders and American Indians/Alaska Natives accounted for less than 1% each. White non- Hispanics represented 38% of ADAP clients in June 2001 (see Chart 8). • Eight in ten (80%) ADAP clients in June 2001 were men, and almost all (99%) ADAP clients were over the age of 18 (see Chart 9).
• ADAPs continue to serve a low-income population, with almost 80% of June 2001 ADAP clients reporting incomes at or below 200% of FPL, 8 including slightly less than half (44%) reporting incomes less than 100% FPL (see Chart 10). • The majority of ADAP clients are uninsured. Six percent of June 2001 ADAP clients were reported to have Medicaid coverage and 10% percent were reported to have Medicare coverage (the number of dually covered among this group is unknown). Eleven percent of clients were reported to have some level of private insurance coverage (see Chart 11). The National ADAP Budget • The national ADAP budget grew to $810 M in FY 2001, an increase of approximately $86 million over FY 2000. The national ADAP budget has increased by 329% since FY 1996, including a 12% increase since last year, compared to a 9% increase over the prior reporting period (see Chart 14). • The core of the national ADAP budget continues to be federal ADAP funding allocated under Title II of the Ryan White CARE Act (the ADAP earmark). The federal ADAP earmark accounted for nearly threequarters of the national ADAP budget in FY2001 (see Chart 15). • Much of the national ADAP budget increase in FY 2001 was due to increases in Title I Eligible Metropolitan Area (EMA) contributions 9 and state general revenue funding of ADAP (see Charts 18 and 19). Eight ADAPs received contributions from Title I EMAs within their jurisdictions compared to 9 in FY 2000, although the dollar amount was higher in FY 2001. Thirty-eight states provided state general revenue support to ADAPs in FY 2001, compared to 37 in FY 2000 (see Appendix X). Funding from these sources has been highly variable due to other factors such as needs within the Title I EMA and state budget fiscal constraints. ADAP Restrictions • Ten states/territories—Alabama, Georgia, Idaho, Kentucky, Maine, North Carolina, South Dakota, Texas, Wyoming, and Guam—reported having one or more program restrictions such as capped enrollment, limited antiretroviral access, and expenditure caps in response to fiscal constraints, as of February 2002 (see State-by-State Summary ADAP Profile). All of these states, except Guam, have reported restrictions 7 in four of the last six fiscal years. 10 The three states reporting capped or restricted access to antiretroviral drugs were Maine, Texas and Guam. • The state ADAPs that consistently report program restrictions such as limited formularies, low financial eligibility criteria and/or additional clinical eligibility criteria, confront unique state level concerns that prevent ADAP expansion. Common issues include few state resources to direct toward ADAP, relatively less generous Medicaid programs and no state indigent/uninsured care program. In some jurisdictions, the state legislative body must approve various aspects of ADAP expansion. Client Eligibility Criteria and State Formularies • Financial eligibility for ADAPs ranged from a low of 125% FPL in North Carolina to a high of 500% FPL or more in Massachusetts, New Jersey, and New York. In addition to financial eligibility requirements, seven states reported additional clinical criteria for clients to access ADAP (e.g., specific CD4 or viral load ranges). Some ADAPs have implemented additional clinical criteria specifically for access to antiretroviral drugs (see State-by-State Summary ADAP Profile). • ADAP formularies ranged from a low of 18 drugs covered in two states, Louisiana and Utah, to 471 drugs covered in New York. Two state ADAPs, Massachusetts and New Jersey, moved to an open formulary 11 since the previous National ADAP Monitoring Project report (see Appendix XI). • Almost all state ADAPs cover all FDA-approved antiretrovirals. South Dakota continues to be the only ADAP that does not provide coverage for protease inhibitors due to lack of resources. Coverage of drugs to prevent and treat opportunistic infections is increasing, but remains uneven. Ten states currently offer all 16 highly recommended drugs for the prevention and treatment of opportunistic infections according to Public Health Service/Infectious Disease Society of America (PHS/IDSA) Guidelines, up from 8 last year. 12 A total of 36 states now cover 10 or more of these recommended OI drugs, up from 31 states last year. Only 2 states do not cover any of the recommended OI drugs, compared to 4 last year (see State-by-State Summary ADAP Profile). Other Issues Last year’s report identified several issues that could
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: Introduction Spending on prescripti
Page 11 and 12: State-by-State Summary ADAP Profile
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
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ADAP Budget FY 2001: Federal and St
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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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