TITLE II: AIDS DRUG ASSISTANCE PROGRAM
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AIDS Drug Assistance Program (ADAP) provides medications for the treatment
of HIV disease. Program funds may also be used to purchase health insurance
for eligible clients. Amendments to the Ryan White Comprehensive
AIDS Resources Emergency (CARE) Act in October 2000 added language
allowing ADAP funds to be used for services that enhance access to,
adherence to, and monitoring of drug treatments. The program is funded
through Title II of the CARE Act, which provides grants to States and
Territories.
FUNDING
- Grants are awarded to all 50 States, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands. In FY 2002, two additional jurisdictions in the Pacific, the Marshall Islands and North Marianas, received funds.
- Congress “earmarks” funds that must be used for the ADAP, an important distinction because other Title II spending decisions are made locally. The ADAP earmark is by far the fastest growing component of CARE Act appropriations. It was $52 million in 1996 and $790 million in 2006. But total ADAP spending is even higher, because State ADAPs also receive money from their respective States, from other CARE Act programs, and through cost-saving strategies.
- A formula based on AIDS prevalence is used to award ADAP funds to States and Territories. However, 3 percent of the total earmark is reserved for supplemental grants to States and Territories with demonstrated severe need that prevents them from providing medications consistent with Public Health Service guidelines.
CLIENTS
- Approximately 142,653 people received medications through ADAP in FY 2004.
- None had adequate health insurance or the financial resources necessary to cover the cost of medications.
- Many clients are enrolled in ADAP only temporarily while they await acceptance into other insurance programs, such as Medicaid. On average, 73,000 clients are served each month.
IMPLEMENTATION
The ADAP in each State and Territory is unique in that it decides which medications will be included in its formulary and how those medications will be distributed.
- Many States and Territories provide medications through a pharmacy reimbursement model. Patients show enrollment cards at participating pharmacies to receive their medications, and the pharmacy invoices the ADAP for payment.
- Some
ADAPs use pharmacies located within public health clinics to distribute
drugs.
- A few ADAPs purchase drugs and mail them to clients directly.
ELIGIBILITY
Each State and Territory establishes its own eligibility criteria. All require that program participants document their HIV status. Nine programs require a CD4 count of 500 or less. Fifteen States have established income eligibility at 200 percent or less of the Federal Poverty Level (FPL). Nationally, more than 80 percent of ADAP clients have incomes at 200 percent or less of the FPL.
INCREASING DEMAND
Pressure on ADAP resources has increased substantially.
- Highly active antiretroviral therapy (HAART) is the standard of care for the majority of people living with HIV disease. Its cost may be $12,000 or more per year, in addition to the costs of addressing opportunistic infections, side effects, and other treatment issues.
- AIDS mortality has decreased dramatically in the United States since 1995, and HIV incidence remains constant at approximately 40,000 new infections annually. Therefore, the total number of people living with HIV disease continues to climb.
- The epidemic is growing rapidly among minorities, who have historically experienced higher risk for poverty, lack of health insurance, comorbidity, and disenfranchisement from the health care system. The result is a growing number of people living with HIV disease who require public support.
ADDITIONAL RESOURCES
Additional fact sheets on ADAP eligibility, formularies, and cost-saving mechanisms are available on the HIV/AIDS Bureau Web site, http://hab.hrsa.gov.
