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AIDS Issues Update: Features:

To save ADAP, universal health reform needed

Thanks to the current financial crisis, the AIDS Drug Assistance Program (ADAP), an already tenuous treatment access safety net for people living with HIV/AIDS, is becoming even less secure. Twenty-two states are imposing waiting lists or cost containment measures. But problems with ADAP, the “payer of last resort for people with HIV/AIDS,” is symbolic of larger problems that won’t go away until there is universal health care.

“This is a symptom of a fractured health care system,” said Ryan Clary, director of public policy at Project Inform. “We’re lucky we’ve built this, but it’s indicative of a health care system failure.”

As of March 5, there were 662 individuals on ADAP waiting lists in ten states. According to NASTAD’s ADAP Watch, that is a 58 percent increase from the 418 individuals in December 2009, and a complete shift for the worse from single person on a waiting list as of March 2008. In addition, there are 12 states that have instituted cost-containment measures and 11 states are considering implementing such measures, which include limiting the number of drugs on the formulary or raising the CD4 counts of people who can qualify.

While those who know how to work through the system can usually get antiretrovirals through pharmaceutical patient assistance programs, using these programs is a major stressor that relies on individuals to jump through hoops. In 2005, four people with AIDS in South Carolina died while on waiting lists.

ADAPs received an increase of $20 million through the FY2010 Congressional appropriations process. However, this number falls far short of what is necessary for ADAPs to fully serve everyone in need. Advocates are asking President Barack Obama to sign a $126 million emergency Fiscal Year 2010 supplemental increase in ADAP.

The immediate cause for the most recent crisis is the global economic meltdown and various state budget crises. Many people who had private health insurance through their employers lost their jobs. And the increase in the cost of health insurance in recent years caused employers to drop health insurance. Also, some states have cut back on eligibility and drugs for their Medicaid programs, pushing people into ADAP. In addition, although ADAP directors negotiate collectively with drug companies, the cost of drugs continues to go up.

Even in California, which has a very strong ADAP program, a proposed change to Medicaid would limit recipients to receiving three drugs. This policy would bring people to ADAP, which fortunately is very strong in California.

“A lot of states are looking at significant budget shortfalls. In many states things are getting tighter and tighter, and we’re worried about the situation getting worse,” said Ann Lefert, associate director of government relations at NASTAD.

But while the latest crisis was precipitated by the financial crisis, it’s a bigger problem than that. Because ADAP relies on both state and federal funding, states that don’t allocate enough resources—such as many in the South and the Great Plains region—are constantly going in and out of crisis-mode. States that have less barriers for access to Medicaid have ADAP programs under less stress.

In New York, for instance, childless adults with HIV/AIDS have access to Medicaid, access that isn’t available in many states. And partially because of high eligibility for Medicaid that allows 50 percent of all people with HIV/AIDS to have access, ADAP programs have enough funding to serve everyone in need. But states that don’t have the political will or resources find themselves constantly facing shortfalls.

What can be done

In the short-term, getting sates to increase funding for ADAP means putting pressure on state legislatures and on the federal government. There is currently a petition on change.org urging President Barack Obama to sign $126 million emergency Fiscal Year 2010 supplemental appropriation for ADAP. You can go to the Save America’s ADAPs facebook page for more information.

“All people living with HIV in this country have a right to the medications they need and a responsibility to be active in the political process that will ultimately increase ADAP funding,” Lanny Cross, the former program director of the New York State ADAP wrote in the Positively Aware newsletter last month. “Letter-writing campaigns and visits to elected officials can make a difference in funding levels, and coordinated efforts can have the most impact.”

But in the longer-term, we need universal health insurance so that everyone is covered by health insurance. Passing the Early Treatment for HIV Act (ETHA) would allow people with HIV to have access to Medicaid.

And if Medicaid were expanded to 133 percent of the poverty level in health care reform, many of the pressure on ADAPs would go away. Forty-two percent of people on ADAP are below 100 percent of the poverty level, and 75 percent are below 200 percent of the poverty level.

“We believe that health reform will really help ADAP. Medicaid expansion will be huge. We are in many ways looking at this as bridge to health reform,” Lefert said. “Then it’s a whole new ballgame.”

• Categorized as: AIDS Issues Update, Features
• Posted by Diana Scholl , March 11, 2010 at 4:20pm