State AIDS Drug Programs Have Huge Waiting Lists

There is nothing new or surprising that fewer government funds are available for state AIDS Drug Assistance Programs, or ADAPs. But the crisis is growing. As of May 12, there were 8,100 people on AIDS Drug Assistance Program, or ADAP, waiting lists in 13 states, which is a whopping 706 percent increase from 1,004 individuals in 10 states who were on ADAP waiting lists exactly a year ago.

Meanwhile, 16 more state ADAPs have undertaken various cost containment strategies, such as reducing formularies and capping enrollment, over the past two years. This is up from 10 states at this time last year, according to the latest report from the National Alliance of State & Territorial AIDS Directors. And five other states are considering the same measures (see here and here).

For those who may not recall, the federal share of the national ADAP budget has declined from a high of 68 percent in 2000 to the current share of 45 percent. At the same time, the recession is prompting some states to decrease their own contributions. Yet the ADAPs are estimated to need an increase of $360 million in funding Fiscal Year 2012.

Why? In June 2010, the average expenditure per prescription was $325, compared to $302 in June 2009, amounting to an 8 percent increase, according to NASTAD. And the average expenditure per prescription for antiretrovirals, or ARVs, was $491, a significantly higher cost than for other meds, which averaged between $64 and $67 (read more here).

Not surprisingly, the combined effect of the recession and rising prices are taking a toll. Between June 2009 and June 2010, drug expenditures grew 16 percent, due to increasingly complex drug regimens, AIDS patients remaining enrolled in ADAPs longer than in the past and those patients who are transitioning to more costly drug regimens and treating co-morbidities.

To compensate, ADAPs are trying to relying more heavily on state contributions, but also on increased rebates and discounts from drugmakers. The ADAP Crisis Task Force, in fact, has agreements with 12 drugmakers, although the process has not always been smooth. Recently, for instance, California implored several drugmakers to lower their prices (read here).

Many of those agreements, by the way, expire at the end of 2013. But NASTAD notes that, as agreements expire or when market conditions for specific drugs change, the ACTF will seek additional pricing concessions and price freezes (see here).