Kevin Dedner, MPH Section Chief HIV/AIDS & Hep C Section Center for Health Protection Arkansas Department of Health

Analogy of ADAPs

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 Analogy of ADAP

Status of State ADAPs

ADAP Budget

ADAP Client Utilization

 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

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

 Reduced income eligibility from 500% to 200% FPL effective May 26,  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.

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.

ADAP Waiting Lists and Cost-Containment

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

 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)

 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

 Funding  Co-infections  Unmet Need  Lost to Care  Late Testers (Targeted Testing)  Access to Care  Homophobia/Stigma/Discrimination

 National Alliance of State & Territorial AIDS Directors  Southern AIDS Coalition  Arkansas Department of Health

Kevin Dedner, MPH HIV/STD/Hepatitis C Section Arkansas Department of Health 4815 West Markham, Slot 33 Little Rock, AR Direct Dial: Toll Free: Fax: