RD308 - AIDS Drug Assistance Program Report - October 1, 2015


Executive Summary:
The Virginia Department of Health (VDH) eliminated the Virginia (VA) Acquired Immuno-deficiency Syndrome (AIDS) Drug Assistance Program (ADAP) waiting list in August 2012. As of March 31, 2015, 5,634 clients were enrolled in VA ADAP, with approximately 75% receiving medications through insurance support and 25% directly receiving medications through local health departments (LHDs) or other distribution sites. Providing medication access through purchasing insurance plays a key role in ADAP sustainability.

Background

VA ADAP provides access to life-saving medications for the treatment of Human Immunodeficiency Virus (HIV) and related illnesses for low-income clients through the provision of medications or through assistance with insurance costs. The program is primarily supported with federal Ryan White (RW) Treatment Extension Act Part B grant funding, which is distributed by a formula based on living HIV and AIDS cases to all states and territories in the United States. ADAP also receives support from state general funds. Other funding sources include Medicaid reimbursements for clients who receive retroactive eligibility and rebates from pharmaceutical manufacturers.

Accomplishments

3,272 VA ADAP clients enrolled in qualified health plans available under the Patient Protection and Affordable Care Act (ACA), an increase of 962 clients over 2014 ACA enrollment. Based on National Alliance of State & Territorial AIDS Directors (NASTAD) data, 27% of all ADAP clients are enrolled in ACA plans nationally, compared to 57% of VA ADAP clients.

• A high degree of collaboration among statewide ADAP stakeholders contributed to enrollment success. Regular meetings and multiple communication strategies allowed VDH to provide updates on enrollment progress, identify challenges and work collaboratively to maximize insurance enrollment.

• VDH is collaborating with state-supported HIV/AIDS Resource and Consultation Centers and federally-supported AIDS Education and Training Centers to provide insurance education programs to community partners and consumers.

Challenges

• Client enrollment continues to increase, but funding has not proportionately risen, with the program increasingly reliant upon several one-time sources of funding.

• Several variables will affect future program need, including ACA plan premium costs and formulary composition, geographic coverage of plans, availability of rebates from the pharmaceutical industry, and whether VA will expand Medicaid to provide coverage for all persons with incomes under 138% of the federal poverty level (FPL).

Conclusions

• Expanding Medicaid would result in coverage for 70.4% of current VA ADAP clients and substantial cost savings to VA ADAP.

• Current projections indicate a range of additional funding needs from $2 million to a worst case scenario of $23 million for April 2017 to March 2018. Careful monitoring of all variables and immediate reassessment will be necessary to determine if resources are adequate to serve all eligible clients in the next grant year (GY).