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ADAP 102:

ADAP 102: . National ADAP TA Meeting Beth Crutsinger-Perry, Ann Lefert, Lynne Greabell, Angela Seegars, Britten Ginsburg July 9, 2008. NASTAD – Everything You Need To Know, but . . . NASTAD mission and vision

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ADAP 102:

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  1. ADAP 102: National ADAP TA Meeting Beth Crutsinger-Perry, Ann Lefert, Lynne Greabell, Angela Seegars, Britten Ginsburg July 9, 2008

  2. NASTAD – Everything You Need To Know, but . . . • NASTAD mission and vision • The mission of NASTAD is to strengthen state and territory-based leadership, expertise and advocacy and bring them to bear on reducing the incidence of HIV infection and on providing care and support to all who live with HIV/AIDS. • The vision of NASTAD is a world free of HIV/AIDS. • Programs • Care and Treatment • Prevention • Viral Hepatitis • Government Relations • Racial and Ethnic Health Disparities • Operations • Global

  3. NASTAD (continued) • Care and Treatment Team Mission • NASTAD’s Care and Treatment program partners with state health departments to improve HIV care services through information dissemination, peer-based education and technical assistance, public policy and advocacy, and resource development. • Care and Treatment Staff • Beth Crutsinger-Perry • Angela Seegars • Britten Ginsburg

  4. Major Projects • Major Projects • ADAP TA Cooperative Agreement • TA Briefs • Medicare Part D (survey and TA) • Emergency Preparedness Guide • On site TA/Peer Mentoring • Drug Pricing TA • National ADAP Monitoring Report • ADAP/HIV Care Watch • NASTAD News • Reauthorization Implementation/Planning • Part B TA • MAI Brief • ADAP TA Meeting • ADAP Crisis Task Force • ADAP Advisory Committee

  5. National ADAP Monitoring Project Annual Survey and Report – Purpose • The project documents new developments and challenges facing ADAPs, assesses key trends over time, and provides the latest available data on the status of ADAPs. • Questions in the survey address topics including monthly and annual snapshots of ADAP budgets; prescription utilization and expenditures; formulary composition; current and programmatic cost-containment measures; program eligibility criteria; and program demographics. • The data collected from the survey will be compiled into the National ADAP Monitoring Project Annual Report which will be released in spring 2009 and will report state specific information on all of the topics addressed in the survey.

  6. National ADAP Monitoring Project Annual Survey and Report – Report • The National ADAP Monitoring Project Annual Report is used by states and the community to advocate for ADAP programs and funding. • States can use the completed report to seek out similar programs across the county or to inform their program questions. • Community members, including legislators, use the completed report to understand the use of ADAP funding. • NASTAD staff use the report to respond to inquiries related to ADAP and to inform the work that NASTAD does on behalf of ADAP.

  7. National ADAP Monitoring Project Annual Survey and Report – Data Collection • Survey released – August 20, 2008 • Survey returned – September 17, 2008 • Report released – Spring 2009 • Data from the survey is used in the report and in NASTAD’s daily work representing ADAP’s. • All of the questions in they survey should be responded to.

  8. ADAP Watch Surveys • Bi-monthly survey on current cost-containment and waiting list status in states. • Collects information on the addition of new medications (if applicable) to ADAP formularies. • Identifies program expansion efforts in ADAPs. • At the start of the fiscal year, ascertains if Part B funds were shifted to ADAP to maintain program. • Data is collected and released within two weeks, resulting in an up-to-date reflection of ADAP across the country.

  9. Member Services: NASTAD Website NASTAD Website Features…. • Program Info, including ADAP • Advocacy Info • Publications • State-based Resources • State-by-state Directory • NASTAD Positions • TA Info

  10. NASTAD Website • For health department staff, NASTAD website… • Provides access to health department-only content (e.g. NASTAD News) • Allows you to upload resource materials • Ability to request NASTAD TA and apply to become a peer TA provider • Allows you to subscribe/unsubscribe to NASTAD various NASTAD listservs

  11. NASTAD Website Access this information by logging in: Login: email address Password: first name (all lower case) Questions, Problems, Log-in Issues? Contact…. • Lynne Greabell: lgreabell@NASTAD.org • Ashley Garner: agarner@NASTAD.org (202) 434-8090

  12. ADAP New Coordinator Welcome Page Accessible via NASTAD’s main page. Contains information pertinent to ADAPs. Links to all NASTAD documents related to ADAP.

  13. ADAP Glossary The ADAP Glossary and Frequently Asked Questions (FAQ) were created to serve as an overview for new/ incoming ADAP coordinators.

  14. ADAP FAQ The ADAP FAQ contains a series of frequently asked questions and provides feedback that is succinct and easily understood.

  15. ADAP Peer Technical Assistance • Process to request TA: TA is requested through self-identification by ADAP, responses to surveys, and referrals • Types of TA: TA is delivered through information exchange and skills building from self identification • Forms of TA: Telephonic/conference calls, emails, ADAP and Part B listservs, TA publications, shared peer based materials, written reports on site visits/ face to face and web based • Who does the TA: TA is conducted by Health Department peers; expert NASTAD staff; and NASTAD consultants

  16. ADAP Peer Technical Assistance (continued) • Timeframe of TA: TA is provided either on a one-time, short-term, or long term basis, depending on specific need • Results of TA: TA is aimed at increasing: • Individual/organizational capacity of ADAP/ DOH staff • Developing leadership • Establish peer relationships

  17. Medicare Prescription Drug Coverage • Prescription drug benefit (Part D) began January 1, 2006 • Drugs provided through private prescription drug plans or Medicare Advantage • Majority of HIV-positive Medicare beneficiaries are dual-eligibles • 1st years filled with implementation challenges for all Part D beneficiaries

  18. Medicare Part D Benefit Design Source: Centers for Medicare and Medicaid Services http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/07_PartDBenefitParameters.asp#TopOfPage

  19. Out-of-Pocket Spending Medicare Part D Benefit Catastrophic CoverageEnrollee Pays 5% 5% $5,726 (equivalent to $4,050 in out-of-pocket spending) No CoverageEnrollee Pays 100% $3,216Coverage Gap“Doughnut Hole” $2,510 in Total Drug Costs Partial Coverage up to Limit 25% $275 Deductible Deductible Medicare Part D – Standard Benefit, 2008 Plan Pays 75% SOURCES: Kaiser FamilyFoundation, Fact Sheet: The Medicare Prescription Drug Benefit, October 2007.

  20. Medicare Part D – Low Income Subsidies

  21. Medicare Part D – Key Points • With the standard benefit, beneficiaries can only change plans once per year – during open enrollment periods • All beneficiaries who qualify for Low-Income Subsidy (LIS) can change plan once a month with effective date the 1st of the next month. • All plans must cover all antiretrovirals (ARVs) in all formulations • If find that plan does not cover an ARV, need to report to CMS Medicare Part D “trouble contact” • Prior authorization not allowed on ARVs • Plans have complete control over tier placement of drugs • If it is felt that a drug is not placed on right tier, can go through exceptions and appeals process to try to lower its cost

  22. Relationship to Ryan White Programs • Medicare Part D adds another “piece” to the quilt that individuals use to get comprehensive HIV care • As “payer of last resort” Medicare Part D coverage is to be used before services are provided through CARE Act • ADAPs are particularly affected by Part D • Many ADAPs provide wrap-around services to Medicare eligible clients • In some areas, Part A drug purchasing programs and Part C clinics may also play a role in providing wrap-around services to Medicare beneficiaries • ADAPs are allowed to provide wrap-around services by paying premiums, deductibles, co-insurance and co-payments

  23. Policies Affecting ADAPs • ADAP spending (federal or state funds) will not count toward true-out-of-pockets costs (TrOOP) • Clients should be required to enroll in Medicare prescription drug plan (PDP) before accessing ADAP services (HRSA requirement) • HRSA is requiring a cost-benefit analysis to justify ADAPs’ wrap-around coverage policy • although haven’t heard if they are checking on this • ADAPs have been unable to access LIS information in data exchanges with CMS • ADAPs must coordinate with TrOOP facilitator to track payments

  24. Implementation Challenges for Clients • Choosing right plan can be overwhelming and difficult • Most regions have over 40 available plans • Tremendous range in monthly premiums • Many clients who are dual-eligible are not used to paying co-payments and other associated costs • Past has shown that plans are often not complying with CMS regulations • Some using prior authorization on ARVs • Disenrollment challenges

  25. Implementation Challenges for ADAPs • Policy differs from state to state, due to varying structure of ADAPs and different distribution systems • Available resources – financial and personnel to deal with implementation and ongoing counseling • Many ADAPs not set up to pay premiums or co-payments • Pharmacy issues – for best coordination of benefits, ADAPs and clients must ensure that ADAP pharmacy and PDP pharmacies are able to coordinate • ADAPs may choose to work with limited number of PDPs for this purpose • Seeing increased co-payments and other costs

  26. Implementation Challenges for ADAPs • Consider different groups of beneficiaries when developing policies (low-income subsidy groups) – policies may differ between populations • ADAP policy will continue to change as benefit is implemented and issues/solutions are identified and resources gain or drain is determined • Need ongoing one-on-one benefits counseling for clients; brochure or training not sufficient: • Need to be sure clients choose best plan for them • Requires coordination with ADAP

  27. Impact on ADAPS • In 2007, NASTAD surveyed all jurisdictions regarding Medicare Part D and its impact on ADAPs • 38 jurisdictions completed the survey • 17% of ADAP clients are eligible for Medicare Part D (18,346) • 69% of ADAP clients also eligible for Part D qualified for low-income subsidy • NASTAD estimates that Part D saved between $73 and $89 million in calendar year 2006

  28. Medicare-Eligible ADAPs Clients NOTE: Chart 1 includes responses from 25 states.

  29. Contact Information Care and Treatment Program Staff: • Beth Crutsinger-Perry, Associate Director, Care and Treatment Program - b crutsinger-perry@nastad.org • Ann Lefert, Associate Director, Government Relations - alefert@nastad.org • Angela Seegars, Manager, Care and Treatment Program - aseegars@nastad.org • Britten Ginsburg, Senior Associate, Care and Treatment Program - bginsburg@nastad.org National Alliance of State and Territorial AIDS Directors 444 N. Capitol Street, NW Suite 339 Washington, DC  20001 Phone (202) 434-8042  Fax (202) 434-8092

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