The State of ADAPs Update on the ADAP Crisis and the ADAP Crisis Task Force Murray Penner National...
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Transcript of The State of ADAPs Update on the ADAP Crisis and the ADAP Crisis Task Force Murray Penner National...
The State of ADAPsUpdate on the ADAP Crisis and the ADAP Crisis Task ForceMurray PennerNational Alliance of State & Territorial AIDS DirectorsApril 2, 2012
Presentation Agenda
The ADAP Year in Review
The ADAP Crisis
The ADAP Crisis Task Force
Questions and Answers
The ADAP Year in Review
ADAP Waiting Lists and Other Unmet Need
ADAP waiting lists reached their highest point on September 1, 2011 at 9,298 individuals.– The number of individuals on waiting lists has
decreased 62 percent since that time.
ADAPs continue to focus on establishing program efficiencies to create long-term program sustainability including:– Implementing effective cost-containment measures. – Coordinating with other payers to ensure Ryan White
Program payer of last resort requirements.
FY2011 ADAP Emergency Funding
In September 2011, ADAPs received $40 million in emergency federal funding through the Ryan White Program to address ADAP waiting lists and other unmet ADAP needs. – Allocations were made to 30 states. – As a result of receipt of this funding, Alabama, Florida,
Georgia, Idaho, Louisiana, Montana, North Carolina, Ohio, South Carolina, Utah, and Virginia were able to reduce the overall number of individuals on or eliminate their waiting lists.
December 1, 2011:New ADAP Resources
On World AIDS Day, President Obama announced $35 million in new resources for ADAPs.
HRSA is developing a distribution methodology that will require a competitive application by ADAPs.
A second component of the application will be continuation of the $40 million from September 2011.
The funding announcement is expected to be released in April and awards for both components are expected to be made by July 1, 2012.
FY2012 and FY2013 ADAP Budget
New ADAP awards for FY2012, which will include an additional $15 million appropriated by Congress, are anticipated by April 1, 2012.
President Obama’s FY2013 budget proposal includes a $67 million increase for ADAP over FY2012 levels, for a total of $1 billion.
The FY2012 ADAP earmark included in the FY2013 budget includes the $35 million announced on World AIDS Day.
Outlook for the Future
Impact of additional federal funding and enhanced pharmaceutical company agreements.
State funding generally begins July 1, 2012.
Continued ADAP waiting lists and cost-containment measures expected; decreases expected as new funding is received.
Need for additional state and federal funding for the program remains.
Requires collaboration from all stakeholders.
ADAP Cost-containment Measures
Factors Leading to Implementation of Cost-containment Measures
As of February 1, 2012, ADAPs reported the following factors contributing to consideration or implementation of cost containment measures:– Level federal funding awards (16 ADAPs).– Higher demand for ADAP services as a result of
increased unemployment (16 ADAPs).– Increased demand for ADAP services due to
comprehensive HIV testing efforts (15 ADAPs).– High drug costs (12 ADAPs).
ADAPs with (and anticipating) Cost-containment Measures
Examples of cost-containment measures currently in place or anticipated:– Reduced formulary– Reduced eligibility criteria– Expenditure caps– Client cost-sharing– Capped enrollment
Once the enrollment cap is reached, ADAP will establish a waiting list.
– Waiting lists
ADAP Waiting Lists
NASTAD ADAP Watch
ADAP waiting list update contains individuals who have:– Completed the application process for their state
ADAP.– Been deemed eligible for the ADAP in their state.– Been placed on the state’s ADAP waiting list or unmet
need list.
Information based on state reports is distributed weekly.
What the ADAP Watch Does Not Capture
Individuals who have not presented to ADAP.
Individuals who have presented but were not eligible.
Individuals who may have been disenrolled.
Individuals who have “fallen out” of ADAP (e.g., no longer taking drugs, moved, obtained other coverage).
Individuals who may be in one or more of the above categories and accessing a PAP for medications.
ADAP Waiting List Update
ADAP Waiting Lists (3,666 individuals in 11 states),
as of March 29, 2012State
Number of Individuals on ADAP Waiting List
Percent of the TotalADAP Waiting List
Increase/Decrease from Previous Reporting Period
Date Waiting List Began
Florida 607 16% +101 June 2010
Georgia 861 23% -26 July 2010
Idaho 7 0.2% -2 February 2011
Louisiana 394 11% +16 June 2010
Montana 6 0.2% 0 January 2008
Nebraska 217 6% +10 October 2011
North Carolina 170 5% +9 January 2010
Ohio 0 0% 0 July 2010
South Carolina 440 12% +24 March 2010
Utah 0 0% 0 May 2011
Virginia 964 26% - November 2010
Waiting List Organization
Of the 11 states with ADAP waiting lists, six ADAPs utilize a first-come, first-served model for prioritizing clients.
Of the 11 states with ADAP waiting lists, five ADAPs utilize a medical criteria model for prioritizing clients.
Access to Medications
Case management services are being provided to clients on ADAP waiting lists in 11 states through:– ADAP (2 ADAPs)– Ryan White Part B (9 ADAPs)– Contracted agencies (6 ADAPs)– Other agencies, including other Parts of Ryan White
(5 ADAPs). States with case management services report
individuals on waiting lists are receiving medications through Welvista or company PAPs.
The ADAP Crisis Task Force
Overview
Comprised of eight state AIDS/ADAP directors. Negotiates with drug companies for supplemental
discounts/rebates to benefit all ADAPs equally. Arguments for special pricing for ADAPs:
– ADAPs are unlike other health care payors.– ADAPs are not entitlement programs with
guaranteed funding. – ADAPs are not insurers and therefore unable to
raise revenues with premiums.– ADAPs do not receive the “cost-effectiveness”
benefits of drugs (i.e., reduced hospitalizations and long term care).
ADAP Crisis Task Force Agreements
In December 2011, the ACTF announced that it reached enhanced agreements with six of the eight major antiretroviral manufacturers.
To date, these negotiations have resulted in an additional $142 million in savings to ADAPs from January 2012 through December 2013.
The cumulative savings of the Task Force agreements from 2003 to 2011 is estimated at more than $1.3 billion.
ADAP Crisis Task Force – Agreements and Future Efforts
Most agreements expire on December 31, 2013.
Continued negotiations with Abbott Laboratories.
Several negotiations continue related to anticipated new medications and new formulations.
Continued discussion with companies regarding the ongoing ADAP crisis and the impact of health reform.
Continued discussions and coordination with Fair Pricing Coalition and other stakeholders related to streamlining access to PAPs and co-pay programs.
Questions and Answers
Resources
For an electronic copy of the 2012 National ADAP Monitoring Project Annual Report, please visit www.NASTAD.org.
Contact Information
Murray PennerDeputy Executive Director
NASTADPhone: (202) 434.8090 [email protected]
www.NASTAD.org