Status of ADAP Waiting Lists and Other Cost-Containment Measures - PowerPoint PPT Presentation

Status of ADAP Waiting Lists and Other Cost-Containment Measures Jennifer Kates Kaiser Family Foundation and Murray Penner National Alliance of State and Territorial AIDS Directors December 15, 2004

Figure 1 What are ADAP Waiting Lists? • Faced with increasing numbers of clients and demand, rising drug costs, and limited funding, ADAPs need to contain costs • ADAPs establish waiting lists as one tool for containing costs • Other cost containment measures include: - Lowering financial eligibility - Limiting or reducing ADAP formularies - Establishing monthly or annual expenditure caps - Using drug purchasing strategies - Using other Ryan White CARE Act funds (Title II base), often at the expense of other services

Figure 2 What are ADAP Waiting Lists - continued • ADAP eligible individuals join waiting lists and do not receive medications from ADAP until they move into the program • Those on waiting lists may access state- or manufacturer-operated Pharmacy Assistance Programs while on ADAP waiting lists • States face challenges in managing waiting lists – some states choose other cost containment measures instead

Figure 3 Current Status of ADAP Waiting Lists The Administration’s $20 million ADAP Initiative is now underway and waiting list numbers have begun to decrease As of November 22, 2004: • 9 ADAPs reported a waiting list - 4 of those were not eligible for the Administration’s Initiative • 813 individuals were on waiting lists in those states, with 758 of those clients due to be enrolled in the Initiative • 13 ADAPs have instituted cost containment measures (other than waiting lists) since April ‘03 • 6 ADAPs anticipate new or additional cost containment measures before March 31, 2005 Source: National Alliance of State and Territorial AIDS Directors, ADAP Watch , December 2004.

Figure 4 ADAPs Eligible for Administration’s Initiative, June 2004 NH VT ME WA MT ND NY MN MA OR ID WI SD RI MI CT WY PA IA NJ OH NE IN NV DE IL WV UT VA CO KY MD KS MO CA NC TN DC OK SC AZ NM AR GA MS AL AK LA Puerto Rico TX FL Virgin Islands Guam HI Source: National Alliance of State and Territorial AIDS Directors, ADAP Watch , December 2004.

Figure 5 ADAPs with Waiting Lists by Eligibility Status for President’s Initiative, November 2004 NH VT ME WA MT ND NY MN MA OR ID WI SD RI MI CT WY PA IA (2) NJ OH NE (12) IN NV DE (15) IL WV UT VA (5) CO KY MD KS MO CA NC (493) TN DC OK SC AZ NM AR (31) GA MS AL (244) AK LA (4) Puerto Rico TX FL Virgin Islands Guam HI (7) Eligible ADAPs with Waiting Lists (5 states – 758 individuals) Not-Eligible ADAPs with Waiting Lists (4 states – 55 individuals) Source: National Alliance of State and Territorial AIDS Directors, ADAP Watch , December 2004.

Figure 6 ADAPs With Additional Cost Containment Measures, Current & Planned, November 2004 NH VT ME WA ND NY MN MT MA OR WI ID SD RI MI CT WY PA IA NJ OH NE IN NV DE IL WV UT VA CO KY MD KS MO CA NC TN DC OK SC AZ NM AR GA MS AL AK LA Puerto Rico TX FL Virgin Islands Guam HI Current Current & Anticipated None in Place, but Anticipated Source: National Alliance of State and Territorial AIDS Directors, ADAP Watch , December 2004.

Figure 7 Implementation of the Administration's $20 Million ADAP Initiative: Enrollment Status as of 11/04 900 758 591 600 300 55 0 Eligible & Eligible - Not Eligible - Enrolled Yet to be Enrolled Currently on Waiting Lists Sources: National Alliance of State and Territorial AIDS Directors, ADAP Watch , December 2004; Kaiser Family Foundation and National Alliance of State and Territorial AIDS Directors, National ADAP Monitoring Project Data Analysis, December 2004.

Figure 8 Analysis of ADAP Waiting List Trends • First analysis of trends over time • ADAPs surveyed regularly between July 2002 November 2004 (18 survey periods total) • Data on waiting lists and other cost containment measures collected and verified – Whether waiting list in place – Number of people on waiting list – Whether other cost containment measures in place and/or anticipated • Implementation of Administration’s $20 Million ADAP Initiative included in survey periods

Figure 9 Key Findings • Fluctuation across states: – Number of people on waiting lists ranged from low of 537 to high of 1629; average was 862. – Number of states with waiting lists ranged from low of 6 to high of 11 • Fluctuation within states – Number of people went up and down, sometimes eliminated, then reinstated • Eighteen states had a waiting list at some point between 7/02 – 11/04 – Most of these states had them in place for more than one survey period – 1 had a waiting list throughout, in all 18 periods – 7 had waiting lists in at least 10 of the periods Source: Kaiser Family Foundation and National Alliance of State and Territorial AIDS Directors, National ADAP Monitoring Project Data Analysis, December 2004.

Figure 10 Number of States with ADAP Waiting Lists by Survey Period, 7/02 – 11/04 12 11 11 10 9 9 9 9 9 9 9 9 9 9 8 8 7 7 7 7 6 6 4 Jul- Oct- Dec- Jan- Feb- Mar- Apr- May- Jun- Aug- Sep- Nov- Jan- Mar- May- Jul- Sep- Nov- 02 02 02 03 03 03 03 03 03 03 03 03 04 04 04 04 04 04 2 0 Source: Kaiser Family Foundation and National Alliance of State and Territorial AIDS Directors, National ADAP Monitoring Project Data Analysis, December 2004.

Figure 11 Number of People with HIV/AIDS on ADAP Waiting Lists, by Survey Period, 7/02 – 11/04 1,800 1,629 1,518 1,500 1,307 1,263 1,200 1,108 1,110 900 791 813 726 622 630 552 626 628 568 600 541 537 552 300 0 Jul- Oct- Dec- Jan- Feb- Mar- Apr- May- Jun- Aug- Sep- Nov- Jan- Mar- May- Jul- Sep- Nov- 02 02 02 03 03 03 03 03 03 03 03 03 04 04 04 04 04 04 Source: Kaiser Family Foundation and National Alliance of State and Territorial AIDS Directors, National ADAP Monitoring Project Data Analysis, December 2004.

Figure 12 Number of People with HIV/AIDS on ADAP Waiting Lists, by State & Survey Period, 7/02 – 11/04 1,000 Alabama Alaska Arkansas 800 Colorado Guam Hawaii Idaho 600 Indiana Iowa Kentucky Montana 400 Nebraska North Carolina Oregon 200 South Dakota Utah West Virginia Wyoming 0 Jul- Oct- Dec- Jan- Feb- Mar- A pr- May- Jun- A ug- Sep- Nov- Jan- Mar- May- Jul- Sep- Nov- 02 02 02 03 03 03 03 03 03 03 03 03 04 04 04 04 04 04 Source: Kaiser Family Foundation and National Alliance of State and Territorial AIDS Directors, National ADAP Monitoring Project Data Analysis, December 2004.

Figure 13 Conclusions Administration’s $20 Million ADAP Initiative has helped to • alleviate waiting lists in FY 2004 – Reaching almost half of those eligible in short time – Outstanding questions/issues • How to address those on waiting lists in non-eligible states? • Looking ahead to FY 2005 and beyond • Overall challenge: “capped funding” affects number of clients who can be served and amount of services provided • ADAPs have limited set of tools for managing program costs and demand • Waiting lists most visible example of this – but only one measure of unmet need • Waiting lists fluctuate regularly – Hard to predict and plan for – States face challenges in managing those on waiting lists