The number of patients sitting on AIDS Drug Assistance Programs (ADAP) wait lists, denied the life-saving treatment they need, have risen dramatically over the past two years. ADAPs are critical in providing HIV/AIDS treatment to low-income, uninsured, or underinsured patients within the United States and its territories. As noted in an earlier KEI blog, in January 2010, 361 individuals were on ADAP waitlists; that number grew to 7,873 across eleven states as of May 5, 2011 (a 2100% increase over less than sixteen months).
The latest ADAP watchlist, published by the National Alliance of State & Territorial AIDS Directors (NASTAD), reports that as of August 11, 2011, there were 9,217 individuals on ADAP waiting lists in 12 states, representing a 20% increase over a four month period. These states include Alabama, Arkansas, Florida, Georgia, Idaho, Louisiana, Montana, North Carolina, Ohio, South Carolina, Utah, and Virginia. Alabama and Utah are new additions to this list (since KEI’s blog on May 5, 2011), while Wyoming no longer reports patients on ADAP waiting lists though it is considering re-instituting a wait list.
In addition to these waiting lists, six states, including Arkansas, Illinois, North Dakota, Ohio, South Carolina, and Utah have all lowered financial eligibility–some by more than 50%–as a cost-containment mechanism. Seventeen states and the territory of Puerto Rico reported instituting other cost containment strategies including, among others: reduced formularies, capped enrollment, monthly or annual expenditure caps, disenrolling clients not accessing ADAP for 90-days, discontinuing reimbursement of laboratory assays, instituting client cost sharing, and restricting eligibility criteria. These states include Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Illinois, Kentucky, Louisiana, North Carolina, North Dakota, Ohio, Utah, Virginia, Washington and Wyoming. As is evident from these lists, many states have turned to multiple cost-containment strategies; even when patients are taken off the wait lists and given treatment, they may not need the full medical care they need.
Alaska, Florida, Hawaii, Kentucky, Montana, Oregon, Tennessee, Washington, Wyoming and Puerto Rico are all considering implementing new or additional cost-containment measures before March 31, 2012. Hawaii, Washington and Wyoming are among those considering the establishment of waiting lists.
NASTAD’s latest ADAP watchlist includes interesting demographic breakdowns:
African Americans and Hispanics represent 64% (48% and 16%, respectively) of clients on ADAP waiting lists. Combined, Asians, Native Hawaiian/Pacific Islanders, and Alaskan Native/American Indians represent approximately 1% of the total ADAP waiting list population. Multi-racial ADAP clients represent 1% of the total ADAP waiting list population. Non-Hispanic whites comprise 25% of clients on ADAP waiting lists.
Almost three-quarters (71%) of ADAP clients are men. One quarter (26%) of ADAP waiting list clients are women.
ADAPs identified several elements that led to the implementation or consideration of cost-containment measures (including waiting lists). These factors included:
* Level federal funding awards (28 ADAPs)
* Higher demand for ADAP services as a result of increased unemployment (27 ADAPs)
* Increased demand for ADAP services due to comprehensive HIV testing efforts (23 ADAPs)
* Escalating drug costs (20 ADAPs)
* Decreases in state general funding for ADAPs (16 ADAPs)
As these numbers–of both individuals placed on waiting lists and the number of states who have resorted to cost-containment mechanisms–continue to grow, it is evident that solutions must be found. One important area to address is the high monopoly pricing of life-saving medicines. 20 ADAPs reported escalating drug costs as a reason for implementing waiting lists or other cost-containment strategies. As previously noted, one solution to these high prices may be found through the reforms contained in S.1138, the Prize Fund for HIV/AIDS Act, introduced by Senator Sanders (I-VT) which would lower the overall costs of treatment for HIV/AIDS, increase access to these life-saving drugs, and increase innovation.
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