PART B - AIDS DRUG ASSISTANCE PROGRAM

The AIDS Drug Assistance Program (ADAP) provides medications for the treatment of HIV disease. Program funds may also be used to purchase health insurance for eligible clients and for services that enhance access to, adherence to, and monitoring of drug treatments. The program is funded through Part B of the Ryan White HIV/AIDS Treatment Modernization Act (formerly known as the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act) which provides grants to States and Territories.

• Grants are awarded to all 50 States, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, and the Pacific Jurisdictions.
• Congress “earmarks” funds that must be used for the ADAP, an important distinction because other Part B spending decisions are made locally. The ADAP earmark grew from $52 million in 1996 to $789.005 million in 2006 and $789.546 million in 2007. The FY 2008 appropriation is $808.500 million. Total ADAP spending is even higher, however, because State ADAPs also receive money from their respective States, from other Ryan White HIV/AIDS Program components, and through cost-saving strategies.
• A formula based on the most recent calendar year of living HIV/AIDS cases is used to award ADAP funds to States and Territories. However, 5 percent of the total earmark is reserved for supplemental grants to States and Territories with demonstrated severe need that prevents them from providing medications consistent with Public Health Service guidelines. In previous years, estimated living cases of AIDS were used in determining the formula and 3 percent was reserved for supplemental grants.

• Many States and Territories provide medications through a pharmacy reimbursement model. Patients show enrollment cards at participating pharmacies to receive their medications, and the pharmacy invoices the ADAP for payment.
• Some ADAPs use pharmacies located within public health clinics to distribute drugs.
• A few ADAPs purchase drugs and mail them to clients directly.

Each State and Territory establishes its own client clinical and income eligibility criteria. All States and Territories are required to implement an ADAP recertification process every 6 months to ensure that only eligible clients are served. All grantees must document HIV status of program participants.

In 2006, all ADAPs reported a positive HIV diagnosis as a criterion for receiving service. Ten States required a CD4 count, although a few of these States required a threshold number. The median income eligibility was 300 percent of the Federal Poverty Level (FPL), and more than 6 in 10 States used between 200 and 400 percent of FPL as their criterion for eligibility.

• Highly active antiretroviral therapy (HAART) is the standard of care for the majority of people living with HIV disease. Its cost may be $12,000 or more per year, in addition to the costs of addressing opportunistic infections, side effects, and other treatment issues.
• AIDS mortality has decreased dramatically in the United States since 1995, but estimated HIV incidence has not. Therefore, the total number of people living with HIV disease continues to climb.
• The epidemic is growing rapidly among minorities, who have historically experienced higher risk for poverty, lack of health insurance, comorbidity, and disenfranchisement from the health care system. The result is a growing number of people living with HIV disease who require public support.