August 10, 2012

As of August 9, 2012, there were 1,125 individuals on AIDS Drug Assistance Program (ADAP) waiting lists in seven (7) states. This is a 63 percent decrease from the 3,079 individuals on the April 2012 ADAP Watch. Twenty-one ADAPs, including seven with current waiting lists, have instituted additional costcontainment measures since April 1, 2009 (reported as of August 2, 2012). In addition, two ADAPs reported they are considering implementing new or additional cost-containment measures by the end of ADAPs current fiscal year (March 31, 2013). ADAPs with Current or Anticipated Cost-Containment Measures, Including Waiting Lists, August 2012

Waiting List Organization: An ADAP waiting list using a first-come, first-served model is structured to place any individual applying to ADAP on the waiting list in order of receipt of a completed enrollment application and eligibility confirmation. Of the seven states with ADAP waiting lists, four ADAPs utilize a first-come, first-served model for prioritizing clients to join the active client roll. An ADAP waiting list using a medical criteria model is structured based on a hierarchical criteria typically established by the state based on recommendations from its ADAP Advisory Committee. Of the seven states with ADAP waiting lists, three ADAPs utilize a medical criteria model for prioritizing clients to join the active client roll. Waiting List Client Demographics: African Americans and Hispanics represent 52% (47% and 5%, respectively) of clients on current ADAP waiting lists. Combined, Asians, Native Hawaiian/Pacific Islanders and Alaskan Native/American Indians represent approximately 1% of the total ADAP waiting list population. Multi-racial ADAP clients represent 0% of the total ADAP waiting list population. Non-Hispanic whites comprise 19% of clients on ADAP waiting lists. Unknown is currently 28% of the total ADAP waiting list. Almost three-quarters (71%) of ADAP clients on waiting lists are men. Approximately one quarter (28%) of ADAP waiting list clients are women.
ADAP waiting list clients, by Race/Ethnicity, as of August 2, 2012
61% 0% 10% 20% 30% 40% Non-hispanic Black/African American (47%) Hispanic (5%) Native Hawaiian/Pacific Islander (0%) Multi-racial (0.5%) Unknown (28%) 50% 25% 6% 5% 100%

60% 70% 80% 90% Non-hispanic White (19%) Asian (1%) American Indian/Alaskan Native (0.1%) Other (1%)

ADAP waiting list clients, by Gender, as of August 2, 2012

71% 28%

0%

10%

20%

30%

40% Female (28%)

50%

60%

70%

80%

90%

100%

Male (71%)

Transgender (0.4%)

Unknown (1%)

Access to Medications: Case management services are being provided to ADAP waiting list clients through ADAP (1 ADAP), Part B (7 ADAPs), contracted agencies (4 ADAPs) and other agencies, including other Parts of Ryan White (2 ADAPs). For clients on ADAP waiting lists who are currently on or in need of medications, seven ADAPs with waiting lists confirm that ADAP waiting list clients are receiving medications through either pharmaceutical company patient assistance programs (PAPs) Welvista, or other mechanisms available within the state. Factors Leading to Implementation of Cost-containment Measures: ADAPs reported the following factors contributing to consideration or implementation of cost containment measures: Higher demand for ADAP services as a result of increased unemployment (19 ADAPs) Level federal funding awards (18 ADAPs) Increased demand for ADAP services due to comprehensive HIV testing efforts (15 ADAPs) Escalating drug costs (15 ADAPs) Increased insurance/Medicare Part D wrap around costs (11 ADAPs)

ADAPs with Waiting Lists (1,125 individuals in 7 states*, as of August 9, 2012) State Alabama Florida Georgia Louisiana** North Carolina South Dakota Virginia Number of Individuals on ADAP Waiting List 102 31 223 285 3 4 477 Percent of the Total ADAP Waiting List 9% 3% 20% 25% .2% .4% 42% Increase/Decrease from Previous Reporting Period -20 0 -32 -41 3 4 -12 Date Waiting List Began April 2012 June 2010 July 2010 June 2010 January 2010 August 2012 November 2010

*As a result of FY2012 ADAP emergency funding, Alabama, Florida, Georgia, Idaho, Louisiana, Montana, Nebraska, North Carolina, and Virginia were able to reduce the overall number of individuals on their waiting lists. **Louisiana has a capped enrollment on their program. This number represents their current unmet need.

ADAPs with Other Cost-containment Strategies: Financial Eligibility (instituted since September 2009, as of August 2, 2012) Six ADAPs have previously lowered their financial eligibility as part of their cost-containment plans since September 2009. Illinois, North Dakota, Ohio and South Carolina lowered their eligibility level to 300 % FPL. Utah lowered its eligibility level to 250% FPL. Arkansas lowered its eligibility level to 200% FPL. Previously, income eligibility for the states noted above was 400% FPL or higher. As a result of these measures, a total of 445 individuals in three states (Arkansas - 99, Ohio - 257, and Utah 89) were disenrolled. Illinois, North Dakota, and South Carolina grandfathered clients that were previously eligible based on their income level into their programs. No other ADAPs currently anticipate further changes to their financial eligibility.

ADAPs with Other Cost-containment Strategies (instituted since April 1, 2009, as of August 2, 2012) Alabama: reduced formulary, capped enrollment Alaska: reduced formulary Arizona: reduced formulary Arkansas: reduced formulary Florida: reduced formulary, transitioned 5,403 clients to Welvista from February 15 to March 31, 2011 Georgia: reduced formulary, implemented medical criteria, participating in the Alternative Method Demonstration Project Illinois: reduced formulary, instituted monthly expenditure cap ($2,000 per client per month) Kentucky: reduced formulary Louisiana: discontinued reimbursement of laboratory assays Montana: reduced formulary Nebraska: reduced formulary North Carolina: reduced formulary North Dakota: capped enrollment, instituted annual expenditure cap Puerto Rico: reduced formulary South Dakota: annual expenditure cap ($10,500) Tennessee: reduced formulary Utah: reduced formulary Virginia: reduced formulary, restricted eligibility criteria Washington: instituted client cost sharing, reduced formulary, only paying insurance premiums for clients currently on antiretrovirals Wyoming: capped enrollment, reduced formulary, instituted client cost sharing ADAPs Considering New/Additional Cost-containment Measures (before March 31, 2013***) Maine: reduced formulary Wyoming: institute waiting list ***March 31, 2013 is the end of ADAP FY2012. ADAP fiscal years begin April 1 and ends March 31. About ADAP: ADAPs provide life-saving HIV treatments to low income, uninsured, and underinsured individuals living with HIV/AIDS in all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, the Federated States of Micronesia, American Samoa, and the Republic of the Marshall Islands. In addition, some ADAPs provide insurance continuation and Medicare Part D wrap-around services to eligible individuals. Ryan White Part B programs provide necessary medical and support services to low income, uninsured, and underinsured individuals living with HIV/AIDS in all states, territories and associated jurisdictions. About NASTAD: Founded in 1992, NASTAD is a nonprofit national association of state and territorial health department HIV/AIDS program directors who have programmatic responsibility for administering HIV/AIDS and viral hepatitis health care, prevention, education, and supportive services programs funded by state and federal governments. For more information, visit www.NASTAD.org.
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