ADAPS: WAITING LISTS NEARLY ELIMINATED IN 2007, BUT WHAT’S AHEAD?

Volume 29, Issue 514 April 28, 2008

Matthew Gever

There’s some good news regarding the long-beleaguered AIDS Drug Assistance Programs (ADAPs). The latest yearly survey of the 58 state-run programs found that ADAPS—which provide prescription medications to mostly very low-income, uninsured clients with HIV/AIDS—were so were well-funded in 2007 that, at least during the one month of September, all waiting lists for the program were eliminated. Those lists were eradicated even though the ADAP client caseload grew to its highest level in 2007 since the program began—with 102,000 people served in the month of June 2007 alone.

But the picture isn’t all bright. Since September, Montana has built a new list of six people. And experts worry that the current economic downturn could again force people to wait for life-saving drugs.

All 50 states and 8 territories run ADAPs, supplementing federal funds with their own to provide medications or purchase health insurance for the patients. About 146,000 individuals are enrolled in ADAPs, which help approximately 3 out of every 10 people with the virus, according to the report, produced by the National Association of State and Territorial AIDS Directors and the Henry J. Kaiser Family Foundation.

Authors of the report attribute the elimination of waiting lists to the fact that some states, whose economies were recovering from an earlier downturn, provided additional funds to the ADAPs from their general revenues. Other factors include the President’s ADAP initiative (which provided additional one-time funding to 10 states with waiting lists); the one-time impact of switching patients to Medicare Part D; increasing sophistication on the part of ADAPs in obtaining pharmaceutical rebates; and reauthorization of the Ryan White Act, which provided supplemental grants to states with significant needs.

States institute waiting lists as one of a series of cost-control measures. In March of 2007, 571 people in four states were on such lists. The majority of them were in South Carolina, which at times had wait lists numbering up to 600 people. Two actions helped the state eliminate this list. "The first and in some ways most important thing that happened was that a group of community-based organizations in the state that serve people living with HIV and AIDS came together to form a grass roots advocacy organization, and they advocated the ADAP with our state legislature," said Noreen O'Donnell, the state's ADAP director. In response to this, the state appropriated an additional $3 million in recurring funds to the program, allowing it to serve all eligible comers.

Nevertheless, the experts are watchful. “We’re hearing things about the state economic downturn and we don’t know what that’s going to mean for ADAP’s,” said Jennifer Kates, vice president and director of HIV policy at the Kaiser Foundation…And so from a planning perspective it’s a little bit of a challenge for states, I think.”