December 17, 2012

As of December 13, 2012, there were 58 individuals on AIDS Drug Assistance Program (ADAP) waiting lists in four (4) states. Eighteen ADAPs, including four with current waiting lists, have cost-containment measures in place since April 1, 2012 (reported as of December 5, 2012). In addition, three ADAPs reported considering implementing new or additional cost-containment measures by the end of ADAPs current fiscal year (March 31, 2013). Three ADAPs reported they were able to eliminate or improve previous cost-containment measures as of October 1, 2012. ADAPs with Current or Anticipated Cost-Containment Measures, Including Waiting Lists, December 5, 2012

Factors Leading to Consider or Implementation of Cost-containment Measures ADAPs reported the following factors contributing to consideration or implementation of cost containment measures: Increased clients/demand due to neighboring states cost-containment measures/waiting list (22 ADAPs) Reduced or insufficient federal ADAP funding (19 ADAPs) Increased HIV testing leading to higher client enrollment (17 ADAPs) Escalating drug costs (16 ADAPs) Reduced or insufficient state ADAP funding (14 ADAPs)

ADAPs with Waiting Lists (58 individuals in 4 states, as of December 13, 2012) State Florida Idaho Louisiana* South Dakota Number of Individuals on ADAP Waiting List 0 15 19 24 Percent of the Total ADAP Waiting List 0% 26% 33% 41% Increase/Decrease from Previous Reporting Period 0 7 -39 3 Date Waiting List Began June 2010 October 2012 June 2010 August 2012

*Louisiana has a capped enrollment on their program. This number represents their current unmet need.

Waiting List Client Demographics:

ADAP waiting list clients, by Race/Ethnicity, as of December 5, 2012
8% 32% 10% 2% 12% 2% 35%

0%

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20%

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40%

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70%

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100%

Non-hispanic Black/African American (8%) Hispanic (10%) Native Hawaiian/Pacific Islander (0%) Multi-racial (2%) Unknown (35%)

Non-hispanic White (32%) Asian (2%) American Indian/Alaskan Native (12%) Other (0%)

ADAP waiting list clients, by Gender, as of December 5, 2012

68% 32%

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Male (68%)

Female (32%)

Transgender (0%)

Unknown (0%)

Access to Medications: All four ADAPs with waiting lists confirm that case management services assist clients in obtaining medications through either pharmaceutical company patient assistance programs (PAPs) (3 ADAPs) or Welvista (1 ADAP) while clients are on the waiting list. Case management services are provided to ADAP waiting list clients through Part B (1 ADAP) as well as, other agencies, including other Parts of Ryan White (3 ADAPs). Waiting List Organization: Waiting list clients are prioritized by one of two models: First-come, first-served model is to place individuals on the waiting list in order of receipt of a completed application and eligibility confirmation (3 ADAPs). Medical criteria model is based on the hierarchical medical criteria based on recommendations by the ADAP Advisory Committee (1 ADAP).

ADAPs with Other Cost-containment Strategies (since April 1, 2012**, as of December 5, 2012) Enrollment Cap: Indiana Utah Wyoming Expenditure Cap: Illinois: (monthly) Kentucky: (annual) New Mexico: (monthly) South Dakota: (annual) Formulary Reduction: Alabama Florida Illinois North Carolina Puerto Rico Tennessee Utah Virgin Island (U.S.) Other: Washington: pay insurance premiums only if client is prescribed and taking ARVs

** ADAPs may have other cost-containment strategies that were instituted prior to April 1, 2012.

ADAPs Considering New/Additional Cost-containment Measures (before March 31, 2013***) Capped Enrollment: Alabama Formulary Reduction: Maine Waiting List: Montana ***March 31, 2013 is the end of ADAP FY2012. ADAP fiscal years begin April 1 and ends March 31. ADAPs that Eliminated/Modified Cost-containment Measures (as of October 1, 2012****) Formulary Increase: Kentucky Virginia Increased Financial Eligibility: North Carolina **** ADAPs may have eliminated/modified other cost-containment strategies prior to October 1, 2012. About ADAP: ADAPs provide life-saving HIV treatments through directly purchasing medications or providing insurance coverage and wrap-around services to low income, uninsured, and underinsured individuals living with HIV/AIDS in all states, territories and associated jurisdictions. About NASTAD: NASTAD strengthens state and territory-based leadership, expertise, and advocacy and brings them to bear on reducing the incidence of HIV and viral hepatitis on providing care and support to all who live with HIV and viral hepatitis. NASTADs vision is a world free of HIV/AIDS and viral hepatitis. For more information, visit www.NASTAD.org.
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