1. The State of ADAPs Update on the ADAP Crisis Britten Pund National Alliance of State & Territorial AIDS Directors July 7, 2011

2. National Alliance of State & Territorial AIDS Directors (NASTAD)  Represents the nation’s chief health agency HIV/AIDS and viral hepatitis staff in all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands and the U.S. Pacific Islands –Provides technical assistance and other support to health department HIV/AIDS and viral hepatitis programs –Provides national leadership on HIV/AIDS and viral hepatitis policy and programs –Educates about and advocates for necessary federal funding

3. Year in Review

4. The “Perfect Storm”

5. Patient Protection and Affordable Care Act  Patient Protection and Affordable Care Act (PPACA) signed into law in March 2010.  Some portions of reform that will impact ADAPs specifically are: –Medicaid eligibility expansion (2014); –Increase in the number of individuals covered by insurance plans (2014); –ADAPs’ Medicare Part D expenditures counting toward True Out Of Pocket (TrOOP) expenditures (2011); –Narrowing and closing of the Medicare Part D “doughnut hole (ongoing);” –An increase in the Medicaid rebate amount for purchased drugs; and (2010) –340B pricing transparency.

6. Pharmaceutical Partners Contributions  In May 2010, pharmaceutical partners augmented current agreements with ADAPs including: –Providing deeper discounts; –Increased rebates; and/or –Price freezes to ADAP.  Pharmaceutical partners expanded the reach of Patient Assistance Programs (PAPs) and participated in Welvista for waiting list clients.

7. ADAP Waiting Lists  Over the course of 2010, 19 ADAPs reported a waiting list.  Several ADAPs decreased income eligibility requirements and disenrolled clients from ADAP in order to address shortfalls.  In FY2010, some ADAPs began transitioning clients off of ADAP and onto PAPs as a means of cost- containment. These clients were directed to seek access to medications through PAPs.

8. ADAP Waiting Lists and Cost-containment, as of May 2011

9. ADAP Waiting Lists, as of June 30, 2011 8,615 individuals in 13 states* Alabama: 73 individuals Arkansas: 40 individuals Florida: 3,562 individuals Georgia: 1,630 individuals Idaho: 20 individuals Louisiana: 824 individuals** Montana: 29 individuals North Carolina: 292 individuals Ohio: 485 individuals South Carolina: 810 individuals Utah: 25 individuals Virginia: 817 individuals Wyoming: 8 individuals *As a result of ADAP emergency funding, Hawaii, Idaho, Iowa, Kentucky, South Dakota, and Utah eliminated their waiting lists; Idaho reinstituted a waiting list in February 2011 and Utah reinstituted a waiting list in May 2011. **Louisiana has a capped enrollment on their program. This number represents their current unmet need.

10. ADAPs with Cost-containment, as of April 13, 2011 Arizona: reduced formulary Arkansas: reduced formulary, lowered financial eligibility to 200% FPL (disenrolled 99 clients in September 2009) Colorado: reduced formulary Florida: reduced formulary, transitioned 5,403 clients to Welvista from February 15, 2011 to March 31, 2011 Georgia: reduced formulary, implemented medical criteria, participating in the Alternative Method Demonstration Project (AMDP) Idaho: capped enrollment Illinois: reduced formulary, instituted monthly expenditure cap ($2,000 per client per month) Kentucky: reduced formulary Louisiana: discontinued reimbursement of laboratory assays North Carolina: reduced formulary

11. ADAPs with Cost-containment, as of April 13, 2011 (continued) North Dakota: capped enrollment, instituted annual expenditure cap, lowered financial eligibility to 300% FPL (grandfathered in current clients above 300%FPL) Ohio: reduced formulary, lowered financial eligibility to 300% FPL (disenrolled 257 clients in July 2010) Puerto Rico: reduced formulary South Carolina: lowered financial eligibility to 300% FPL (grandfathered in current clients above 300% FPL) Utah: reduced formulary, lowered financial eligibility to 250% FPL (disenrolled 89 clients in FY2010) Virginia: reduced formulary, transitioned 207 clients onto waiting list and PAPs, only distributing 30-day prescription refills Washington: instituted client cost sharing, reduced formulary (for uninsured clients only), only paying insurance premiums for clients currently on antiretrovirals Wyoming: reduced formulary, instituted client cost sharing

12. Coordinated Strategy to Save America’s ADAPs  Secure additional resources for ADAP from the federal government: –The HIV/AIDS community is advocating for an increase of $106 million for ADAPs for a total funding of $991 million in FY2012.  Maintain, restore and increase resources for ADAPs from state governments.  Continue agreements between ADAPs and pharmaceutical manufacturers to provide financial stability and augment existing agreements, when possible.

13. The Outlook for the Future  A bridge to 2014 is slowly being built and will require much construction before ADAPs can fully take advantage of health reform provisions.  Weathering the current storm to reach 2014 will take collaboration from all stakeholders involved in the administration of the program.

14. Questions and Answers

15. Contact Information Britten Pund Manager, Health Care Access NASTAD Phone: (202) 434.8044 bpund@NASTAD.org www.NASTAD.org