AIDS Drug Assistance Program Crisis Summit July 5, 2010

1. AIDS Drug Assistance Program Crisis Summit July 5, 2010 Kevin Dedner, MPH Section Chief HIV/AIDS & Hep C Section Center for Health Protection Arkansas Department of Health

2. Analogy of ADAPs

3. Analogy of ADAP • What fuels the faucet? • Funding • Client utilization: • Based on trust • Well-targeted testing • What causes leaks in the faucet? • Clients transitioning out of care • Clients lost to care • Clients incarcerated • Clients transitioning to other payers (i.e. – • Medicaid and Medicare) • Clients gaining employment and • employer sponsored insurance • Clients moving our of state

4. Status of State ADAPs

5. ADAP Clients Served, by Race/Ethnicity, June 2008

6. ADAP Clients Served, by Gender,June 2008

7. ADAP Clients Served, by Age,June 2008

8. ADAP Clients Served, by Income Level,June 2008

9. ADAP Clients Served, by Insurance Status,June 2008

10. ADAP Budget

11. National ADAP Budget, by Source, FY2003 – FY2008

12. ADAP Client Utilization

13. ADAP Client Utilization, June 2003 – June 2008

14. Trends in ADAP Client Utilization, June 2003 – June 2008

15. From the State Level • What Happen? • Tremendous Growth in the Program • 2006 to 2007 = 2% increase in clients enrolled (346 to 354) • 2007 to 2008 = 22% increase in clients enrolled (354 to 433) • 2008 to 2009 = 54% increase in clients enrolled (433 to 667) • State Budgets under strain- Reduced Funding from States • Downturn in the Economy • People lost their jobs and healthcare insurance

16. Growth in Arkansas

17. Growth in Arkansas

18. Cost Containment Goals Provide care to those who need it most • Ensure consistency in services available to clients • Provide a stable funding stream to providers and clients • Stabilize the program

19. Cost Containment Measures Implemented (AR) • Reduced income eligibility from 500% to 200% FPL effective May 26, 2009. • Curtailed outreach activities • Reviewed and reduced dental treatment plans. • Implemented weekly monitoring report of expenditures, commitments, and caseload. • Reviewed the formulary. The following changes were made. • 56 drugs are being removed. • 12 drugs will require prior authorization. • A Patient Assistance Program was developed. • Established an Advisory Group that has met two times. • Conducted 11 focus group sessions statewide: 5 with patients and 6 with providers. Results are being compiled.

20. Cost Containment Measures cont.. Required Medicare Part D clients with incomes <150% FPL to apply for Low Income Subsidy. • Sought Patient Assistance for Hepatitis C patients. The state has 10 slots available. Medications cost $16,000 per year. • Dismissed clients with incomes >200% FPL. • Notify October 1. • Effective January 1. • Strengthen the policy on payments of insurance premiums and drug co-pays to assure it is cost effective.

21. ADAP Waiting Lists and Cost-Containment

22. ADAP Waiting Lists ADAPs with Waiting Lists (2,090 individuals, as of July 1, 2010) Florida: 523 individuals Hawaii: 10 individuals Idaho: 26 individuals Iowa: 97 individuals Kentucky: 198 individuals Louisiana: 112 individuals* Montana: 20 individuals North Carolina: 783 individuals South Carolina: 187 individuals South Dakota: 22 individuals Utah: 112 individuals

23. ADAPs with Other Cost-containment Strategies (instituted since April 1, 2009) • Arizona: reduced formulary • Arkansas: reduced formulary, lowered financial eligibility to 200% of FPL • Colorado: reduced formulary • Georgia: waiting list as of July 1, 2010 • Illinois: reduced formulary • Iowa: reduced formulary • Kentucky: reduced formulary • Louisiana: capped enrollment, discontinued reimbursement of laboratory assays • Missouri: reduced formulary • North Carolina: reduced formulary • North Dakota: capped enrollment, cap on Fuzeon, lowered financial eligibility to 300% FPL • Utah: reduced formulary, lowered financial eligibility to 250% FPL • Washington: client cost sharing, reduced formulary (for uninsured clients only)

24. ADAPs Considering New/Additional Cost-containment Measures (before March 31, 2011**) • Arizona: waiting list • California: proposed elimination of ADAP services in city and county jails • Florida: reduced formulary, lowered financial eligibility • Illinois: reduced formulary, lowered financial eligibility, monthly expenditure cap • Ohio: reduced formulary, lowered financial eligibility, capped enrollment, client cost sharing, annual and monthly • expenditure caps • Oregon: reduced formulary, client cost sharing, annual expenditure cap • Wyoming: reduced formulary

25. Barriers and Challenges

26. Barriers/Challenges • Funding • Co-infections • Unmet Need • Lost to Care • Late Testers (Targeted Testing) • Access to Care • Homophobia/Stigma/Discrimination

27. Acknowledgments • National Alliance of State & Territorial AIDS Directors • Southern AIDS Coalition • Arkansas Department of Health

28. Thank you! Kevin Dedner, MPH HIV/STD/Hepatitis C Section Arkansas Department of Health 4815 West Markham, Slot 33 Little Rock, AR 72205 Direct Dial: 501-661-2408 Toll Free: 1-888-499-6544 Fax: 501-661-2082 kevin.dedner@arkansas.gov