RD277 - AIDS Drug Assistance Program Report – October 1, 2016
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, 2016, 6,039 clients were enrolled in VA ADAP with approximately 78% receiving medications through insurance support and 22% 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.
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 using 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.
3,610 VA ADAP clients enrolled in qualified health plans available under the Patient Protection and Affordable Care Act (ACA) in 2016, an increase of 338 clients over 2015 ACA enrollment.
• The continuing collaboration between VDH and statewide ADAP stakeholders contributed to enrollment success. VDH provided regular updates on enrollment progress through multiple communication strategies and worked proactively with partners to identify and solve challenges 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.
• Client enrollment continues to increase disproportionately to funding, and the program is increasingly reliant upon several one-time sources of funding.
• Several variables will affect future program need, including ACA carrier availability, 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 at or below 138% of the federal poverty level (FPL).
• Expanding Medicaid could result in coverage for 68% of current VA ADAP clients with substantial cost savings to VA ADAP.
• Current projections indicate a range of additional funding needs from $8.7 million to a worst-case scenario of $36 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).