1. The State of ADAPs Update on the ADAP Crisis and the ADAP Crisis Task Force Murray Penner National Alliance of State & Territorial AIDS Directors April 2, 2012

2. Presentation Agenda  The ADAP Year in Review  The ADAP Crisis  The ADAP Crisis Task Force  Questions and Answers

3. The ADAP Year in Review

4. ADAP Waiting Lists and Other Unmet Need  ADAP waiting lists reached their highest point on September 1, 2011 at 9,298 individuals. –The number of individuals on waiting lists has decreased 62 percent since that time.  ADAPs continue to focus on establishing program efficiencies to create long-term program sustainability including: –Implementing effective cost-containment measures. –Coordinating with other payers to ensure Ryan White Program payer of last resort requirements.

5. FY2011 ADAP Emergency Funding  In September 2011, ADAPs received $40 million in emergency federal funding through the Ryan White Program to address ADAP waiting lists and other unmet ADAP needs. –Allocations were made to 30 states. –As a result of receipt of this funding, Alabama, Florida, Georgia, Idaho, Louisiana, Montana, North Carolina, Ohio, South Carolina, Utah, and Virginia were able to reduce the overall number of individuals on or eliminate their waiting lists.

6. December 1, 2011: New ADAP Resources  On World AIDS Day, President Obama announced $35 million in new resources for ADAPs.  HRSA is developing a distribution methodology that will require a competitive application by ADAPs.  A second component of the application will be continuation of the $40 million from September 2011.  The funding announcement is expected to be released in April and awards for both components are expected to be made by July 1, 2012.

7. FY2012 and FY2013 ADAP Budget  New ADAP awards for FY2012, which will include an additional $15 million appropriated by Congress, are anticipated by April 1, 2012.  President Obama’s FY2013 budget proposal includes a $67 million increase for ADAP over FY2012 levels, for a total of $1 billion.  The FY2012 ADAP earmark included in the FY2013 budget includes the $35 million announced on World AIDS Day.

8. Outlook for the Future  Impact of additional federal funding and enhanced pharmaceutical company agreements.  State funding generally begins July 1, 2012.  Continued ADAP waiting lists and cost-containment measures expected; decreases expected as new funding is received.  Need for additional state and federal funding for the program remains.  Requires collaboration from all stakeholders.

9. ADAP Cost-containment Measures

10. Factors Leading to Implementation of Cost-containment Measures  As of February 1, 2012, ADAPs reported the following factors contributing to consideration or implementation of cost containment measures: –Level federal funding awards (16 ADAPs). –Higher demand for ADAP services as a result of increased unemployment (16 ADAPs). –Increased demand for ADAP services due to comprehensive HIV testing efforts (15 ADAPs). –High drug costs (12 ADAPs).

11. ADAPs with (and anticipating) Cost-containment Measures  Examples of cost-containment measures currently in place or anticipated: –Reduced formulary –Reduced eligibility criteria –Expenditure caps –Client cost-sharing –Capped enrollment  Once the enrollment cap is reached, ADAP will establish a waiting list. –Waiting lists

12. ADAP Waiting Lists

13. NASTAD ADAP Watch  ADAP waiting list update contains individuals who have: –Completed the application process for their state ADAP. –Been deemed eligible for the ADAP in their state. –Been placed on the state’s ADAP waiting list or unmet need list.  Information based on state reports is distributed weekly.

14. What the ADAP Watch Does Not Capture  Individuals who have not presented to ADAP.  Individuals who have presented but were not eligible.  Individuals who may have been disenrolled.  Individuals who have “fallen out” of ADAP (e.g., no longer taking drugs, moved, obtained other coverage).  Individuals who may be in one or more of the above categories and accessing a PAP for medications.

15. ADAP Waiting List Update

16. ADAP Waiting Lists (3,666 individuals in 11 states), as of March 29, 2012 State Number of Individuals on ADAP Waiting List Percent of the Total ADAP Waiting List Increase/Decrease from Previous Reporting Period Date Waiting List Began Florida 60716%+101 June 2010 Georgia 86123%-26 July 2010 Idaho 70.2%-2 February 2011 Louisiana 39411%+16 June 2010 Montana 60.2%0 January 2008 Nebraska 2176%+10 October 2011 North Carolina 1705%+9 January 2010 Ohio 00%0 July 2010 South Carolina 44012%+24 March 2010 Utah 00%0 May 2011 Virginia 96426%- November 2010

17. Waiting List Organization  Of the 11 states with ADAP waiting lists, six ADAPs utilize a first-come, first-served model for prioritizing clients.  Of the 11 states with ADAP waiting lists, five ADAPs utilize a medical criteria model for prioritizing clients.

18. Access to Medications  Case management services are being provided to clients on ADAP waiting lists in 11 states through: –ADAP (2 ADAPs) –Ryan White Part B (9 ADAPs) –Contracted agencies (6 ADAPs) –Other agencies, including other Parts of Ryan White (5 ADAPs).  States with case management services report individuals on waiting lists are receiving medications through Welvista or company PAPs.

19. The ADAP Crisis Task Force

20. Overview  Comprised of eight state AIDS/ADAP directors.  Negotiates with drug companies for supplemental discounts/rebates to benefit all ADAPs equally.  Arguments for special pricing for ADAPs: –ADAPs are unlike other health care payors. –ADAPs are not entitlement programs with guaranteed funding. –ADAPs are not insurers and therefore unable to raise revenues with premiums. –ADAPs do not receive the “cost-effectiveness” benefits of drugs (i.e., reduced hospitalizations and long term care).

21. ADAP Crisis Task Force Agreements  In December 2011, the ACTF announced that it reached enhanced agreements with six of the eight major antiretroviral manufacturers.  To date, these negotiations have resulted in an additional $142 million in savings to ADAPs from January 2012 through December 2013.  The cumulative savings of the Task Force agreements from 2003 to 2011 is estimated at more than $1.3 billion.

22. ADAP Crisis Task Force – Agreements and Future Efforts  Most agreements expire on December 31, 2013.  Continued negotiations with Abbott Laboratories.  Several negotiations continue related to anticipated new medications and new formulations.  Continued discussion with companies regarding the ongoing ADAP crisis and the impact of health reform.  Continued discussions and coordination with Fair Pricing Coalition and other stakeholders related to streamlining access to PAPs and co-pay programs.

23. Questions and Answers

24. Resources  For an electronic copy of the 2012 National ADAP Monitoring Project Annual Report, please visit www.NASTAD.org. www.NASTAD.org

25. Contact Information Murray Penner Deputy Executive Director NASTAD Phone: (202) 434.8090 mpenner@NASTAD.org www.NASTAD.org