Part B: Continued
ADAP Comes of Age
Efforts to expand access to antiretroviral medications continued unabated, and in 1996, for the first time, ADAP was funded as a specific line item within the Title II appropriation. In the ensuing 14 years, funding for the ADAP program grew from $52 million to $835 million (see chart).
Yet implementing ADAPs at the State level presented many challenges, particularly in the early years. Beth Scalco, Director of HIV/AIDS Program, Louisiana Office of Public Health, arrived in her position in 1996 as Louisiana was receiving its first ADAP award. “There was very little guidance [on setting up a distribution mechanism],” she remembers, “so each State had to figure it out on their own.”8 Louisiana first used a State pharmacy to distribute drugs but ran into numerous shipping delays and logistical challenges. After determining the need for a better, more efficient distribution mechanism, the program turned to Louisiana’s 10 State-run public hospitals, which all have an ambulatory HIV clinic and were collectively treating 75 percent of people living with HIV/AIDS in the State.
Challenges to ADAP Access Persist
Even with steadily increasing resources, State ADAPs have faced challenges providing access to drugs for all who need them. Over the years, some States have been forced to implement waiting lists, limit the drugs available, or raise eligibility criteria to save money. Stakeholders at all levels have worked to find solutions to these challenges.
The National Alliance of State and Territorial AIDS Directors ADAP Crisis Task Force, formed in 2003, played an important role in negotiating lower drug prices for ADAPs, resulting in an estimated $425 million in savings since its formation.9 In 2004, the President’s ADAP Initiative allocated $20 million in one-time funding from outside the ADAP system to reduce waiting lists in 10 states.8 Because ADAPs operate as Federal–State partnerships and contributions from the States vary, community advocates have also worked at the State level to increase funding commitments in States with waiting lists and other limits on access. “Much of the success came when advocates carried the simple message that people should not be on a waiting list for a life-saving treatment,” says Project Inform’s Ryan Clary.10
The 2006 reauthorization for the first time included a minimum drug formulary for State ADAPs along with a new formula for determining ADAP awards that includes both HIV and AIDS living cases. As in Part A and Part C, the new law also requires States to spend 75 percent of Part B funds on core medical services and created a new supplemental awards program in Part B.
In 2008, HAB distributed medications to more than 175,000 patients through ADAP, continuing its commitment to extending life-saving medications to the underserved. General economic decline in the context of shrinking State budgets, however, continued to place strain on the program. To address this, in 2010 an additional $25 million was reallocated for ADAP to States with waiting lists or who have implemented strategies to contain costs and delay or prevent a waiting list.