627 People on ADAP Waiting Lists in 11 States; 10 Other States Taking Steps to Limit Coverage, Control Costs, Report Says

Eleven states have implemented waiting lists for their AIDS Drug Assistance Programs, as funding for the programs "falls short," and a total of 627 HIV-positive people were on those lists as of last month, according to a report released on Wednesday by the Kaiser Family Foundation and the National Alliance of State and Territorial AIDS Directors, Reuters reports. In addition, 10 other states have had to limit drug coverage under the program or make other cost-cutting measures, according to the report, titled "National ADAP Monitoring Project 2005 Annual Report" (Reuters, 4/20). ADAPs are federal- and state-funded programs that provide HIV/AIDS-related medications to low-income, uninsured and underinsured HIV-positive individuals (Kaiser Daily HIV/AIDS Report, 4/12). As of March, 11 states -- Alabama, Alaska, Arkansas, Idaho, Iowa, Kentucky, Montana, Nebraska, North Carolina, West Virginia and Wyoming -- had waiting lists, and 10 other states had implemented other measures, including three states that capped ADAP enrollment and four states that reduced or restricted ADAP drug formularies (Kaiser Family Foundation release, 4/20).

Funding
Overall, ADAP budgets rose 11% in fiscal year 2004 over FY 2003 levels, which allowed 38 states to provide more HIV-positive people with medication, according to Reuters (Reuters, 4/20). Approximately 32% of the funding increase is attributable to increases in state budgets, 33% came from drug manufacturers' rebates and 5% came from an increase in the federal earmark, according to the release. ADAP funding levels are not determined based on the number of people who need prescription drugs or the cost of medications because ADAPs are a discretionary program funded through the federal Ryan White CARE Act (Kaiser Family Foundation release, 4/20). An additional $20 million in federal money was made available in June 2004. The funding helped to provide medications directly to HIV-positive people living in the 10 states that had waiting lists at that time -- Alabama, Alaska, Colorado, Idaho, Iowa, Kentucky, Montana, North Carolina, South Dakota and West Virginia (Kaiser Daily HIV/AIDS Report, 4/12).

Reaction
About 136,000 HIV-positive people -- or about 30% of people estimated to be living with the disease nationwide -- receive ADAP services, according to the report (CQ HealthBeat, 4/20). Most states with the greatest number of HIV-positive residents currently do not have waiting lists and tend to have "more generous" access to their programs, according to a Kaiser Family Foundation release (Kaiser Family Foundation release, 4/20). "The states have really had to step up in the last year to keep the doors open," NASTAD Executive Director Julie Scofield said (CQ HealthBeat, 4/20). "The growing number of people who need HIV medications and rising drug costs continue to exceed available resources," Jennifer Kates, a vice president and director of HIV policy at the Kaiser Family Foundation, said (Reuters, 4/20). According to CDC data, 42% to 59% of the nearly one million HIV-positive people in the United States are not accessing health care, and approximately 40,000 new HIV infections occur annually in the country, CQ HealthBeat reports.

Other Findings
Other findings from the report include:

• ADAP formularies range from 25 drugs offered in Louisiana to nearly 500 drugs in New York. Massachusetts, New Hampshire and New Jersey offer "open formularies," according to CQ HealthBeat;
  
  
• 17 ADAPs do not offer all FDA-approved antiretroviral drugs; and
  
  
• 15 ADAPs offer fewer than 10 of the 16 drugs "highly recommended" by the U.S. Public Health Service and Infectious Diseases Society of America for the prevention of opportunistic infections, CQ HealthBeat reports (CQ HealthBeat, 4/20).