Murray C. Penner, BSW, Care and Treatment Programs, National Alliance of State and Territorial AIDS Directors, 444 N. Capitol St., NW, Suite 339, Washington, DC 20001, 202-434-8090, mpenner@nastad.org

Issue: AIDS Drug Assistance Programs (ADAPs) are state-run pharmaceutical assistance programs for low income, uninsured, and underinsured People Living With HIV/AIDS (PLWH) in the U.S. and its territories. Funded under Title II of the Ryan White CARE Act, ADAPs serve approximately 90,000 individuals monthly. ADAPs are funded approximately 80 percent through federal appropriations and 20 percent through state revenues. Funding in recent years has not kept pace with demand.

Description: The National Alliance of State and Territorial AIDS Directors (NASTAD), the Kaiser Family Foundation (KFF), and the AIDS Treatment Data Network (ATDN) conduct a survey of all ADAP programs annually. The survey examines utilization, enrollment, expenditure and other ADAP trends. Survey results are published annually in the National ADAP Monitoring Project Report.

Lessons Learned: Utilization, enrollment, and expenditure trends are presented in the 2004 National ADAP Monitoring Project Report. ADAP utilization has increased substantially since inception of the program although funding increases have slowed in recent years. ADAPs face fiscal crises and access to care in at least 15 states has been restricted due to fiscal concerns. Waiting lists exist in up to ten states, with nearly 800 individuals waiting for access to antiretroviral therapies (as of February 2004).

Recommendations: With inadequate increases expected in federal or state funding for ADAPs, ADAPs continue to implement cost-containment measures affecting access to care for PLWH. Reauthorization of the CARE Act in 2005 provides opportunities for adjustments to ADAP legislation. These adjustments should increase access to antiretroviral therapies for PLWH in the U.S.

Learning Objectives: At the conclusion of this session, the participant in this session will be able to

• Describe the structure of state-run AIDS Drug Assistance Programs (ADAPs) in the United States.
• Understand trends in utilization, expenditures, and other trends associated with ADAPs.
• Describe the fiscal crisis and other challenges that many state ADAPs face.
• Identify steps that state ADAPs have taken to overcome fiscal challenges.
• List potential changes to ADAPs during reauthorization of the Ryan White CARE Act that may address fiscal and other challenges that ADAPs currently face.

Keywords: HIV/AIDS, Ryan White

Related Web page: www.nastad.org/adap.asp

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: National Alliance of State and Territorial AIDS Directors (NASTAD) employee