RD315 - AIDS Drug Assistance Program Report


Executive Summary:
The following Report was developed in response to the directive under the VIRGINIA ACTS OF ASSEMBLY – CHAPTER 890, Item 284:

"G. The Commissioner of Health shall monitor patients who have been removed or diverted from the Virginia AIDS Drug Assistance Program due to budget considerations. At a minimum the Commissioner shall monitor patients to determine if they have been successfully enrolled in a private Pharmacy Assistance Program or other program to receive appropriate anti-retroviral medications. The Commissioner shall also monitor the program to assess whether a waiting list has developed for services provided through the ADAP program. The Commissioner shall report findings to the Chairmen of the House Appropriations and Senate Finance Committees annually beginning October 1, 2011."

Background

The Virginia AIDS Drug Assistance Program (ADAP), administered by the Virginia Department of Health’s (VDH’s), Division of Disease Prevention (DDP), provides life-saving medications for treatment of HIV and related illnesses for low-income clients without medication coverage. The program is primarily supported with federal Ryan White (RW) Treatment Extension Act Part B grant funding which is distributed by formula based on living HIV and AIDS cases to all states and U.S. territories. ADAP also receives significant support from state funding. Other funding sources include Medicaid reimbursements for clients who receive retroactive eligibility and rebates from pharmaceutical manufacturers.

The ADAP formulary includes antiretroviral medications indicated for the treatment of HIV, selected vaccines, and selected medications to treat or prevent Opportunistic Infections (OIs). Eligible clients must have incomes at or below 400% of the federal poverty level (FPL); however, the majority of enrolled clients (81%) have incomes below 200% FPL. Enrolled clients are assessed twice yearly to ensure eligibility for the program.

During RW Part B Grant Year 2009 (April 2009-March 2010) (*1), 3,952 clients received 63,959 prescriptions, representing a steep increase in program utilization compared to the prior grant year. Additionally, pharmaceutical expenditures reached a historic high of $26,290,325, a $3.2 million increase from the prior year.

Subsequently, in RW GY2010 (April 2010-March 2011), 3,958 clients received 66,076 prescriptions and pharmaceutical expenditures decreased to $23,787,093. This expenditure reduction was due to aggressive cost containment measures including implementation of an ADAP waiting list in November 2010 and transition of clients to other sources for medications, as described in this report.
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(*1) The RW Part B Grant Year (GY) runs from April 1 to March 31 and is named for the year in which it begins.