PI Action alerts & updates ... 1997

Fiscal Crisis for ADAP:
Funding for the AIDS Drug Assistance Program

AIDS Drug Assistance Programs (ADAPs) provide HIV/AIDS treatments at low or no cost to people living with HIV and AIDS on a limited income in all fifty states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. This treatment access program is intended to serve the low-income HIV positive person who has no other source of prescription reimbursement. The programs are generally funded by a combination of federal (Ryan White CARE Act) and state funds. ADAPs provide a life-saving, cost-effective, and essential service for people living with HIV/AIDS. The majority of uninsured people are also working. For many ADAP consumers, the assistance offered by the program allows them to continue to work and be productive while still affording necessary HIV treatment.

ADAPs across the country are facing difficulty delivering appropriate services due to a number of factors, including inadequate federal and state funding. The Food and Drug Administration (FDA) approval of several promising but costly anti-HIV drugs has placed a financial burden on these programs. Clinical study results and drastically improved health for some individuals has renewed hope regarding HIV treatment. As one consequence, state ADAP enrollment is increasing significantly. In addition, since protease inhibitors are approved for use in combination with one or two other antivirals and the efficacy of combination therapy has been well established, the overall yearly cost for an individual&$8217;s HIV treatment regimen has doubled or tripled in the last year.

In response to this problem, The National ADAP Working Group, a coalition of community advocates and pharmaceutical industry representatives, was formed to devise a strategy for dealing with this problem. In 1996, through the hard work of advocates, some elected officials, including Representative Nancy Pelosi (D-SF), Representative John Porter (R-IL) and Senator Arlen Spector (R-PA), and the Clinton administration, a total of $167M in new federal funding was targeted specifically for the AIDS Drug Assistance Program. In addition, many state advocates convinced their state officials to increase state contributions to the program. This amount of money still fell $81M short of the estimated need for the program.

Since then, the crisis in many state ADAPs has continued. There are still some states which offer no coverage for protease inhibitors. There are other states which offer only one or two protease inhibitors, sometimes including Saquinavir (Invirase), the least effective protease, as the only option. Other states have enacted strict criteria which may not be justified by the current standard of HIV care. For example, Georgia offers protease inhibitors only to individuals who have a CD4 count of less than 100 and 3TC to those with CD4 counts below 350. Additionally, ADAP recipients must have a letter from their physician stating consistent compliance. Each individual is allowed only two prescriptions per month. Some states experiencing severe funding crunches have placed caps on the numbers of people served and/or the amount they spend on each individual, or tightened eligibility requirements. Colorado is one example of a worst case scenario in which its ADAP is closed down due to lack of funding. Additionally, while the focus has been on the addition of protease, many states continue to make very few drugs available only to those with the most limited incomes, sometimes less than $8,000 per year, making the program virtually useless to those who may need it. Other ADAPs, particularly those with significant state funding, are delivering much more to their clientele.

If the current ADAP crisis is to be dealt with seriously, both the federal and state governments must support significant increases in funding so that every HIV positive individual can benefit from the successes of government-funded HIV/AIDS research, regardless of income. The Clinton administration’s proposed budget for 1998 includes no new money specifically for ADAP, with a very small increase in Title II of the Ryan White CARE Act (the title which provides the majority of federal funding to ADAP).

The administration can and should announce support for a supplemental increase to 1997 funding. It is important that at least $81M in supplemental funding be passed for the 1997 budget in order to solve some of the most immediate problems the programs are facing. The government is about to announce a new standard of care document for people living with HIV/AIDS based on the recent treatment developments. In light of that document, Congress should increase the President’s 1998 request to $297.6 M, an increase of $130.6 M over current 1997 funding, in order to begin to deliver an adequate standard of care through this important program. It is cost-effective and humane to increase funding now, so that individuals can access promising treatments, remain productive and stay off other costly government programs.

Your help to make that possible will be essential. Elected officials at the federal and state level need to hear about the importance of ADAP and the difference this program can make in your life and the lives of those you love.