1. Early Treatment of HIV Summit Washington DC July 20, 2009 Carl Schmid Deputy Executive Director The AIDS Institute William McColl Political Director AIDS Action Council ADAP: SECURING HIV/AIDS DRUGS for the NATION’S POOR and UNINSURED

2. GOALS & METHODS Joint project by The AIDS Institute & AIDS Action Council Analyze ADAPs & how well they are meeting goal of providing medications Conducted 30 Interviews Offered an Overall Assessment & 25 Policy Recommendations Use for Health Reform, Appropriations, NAS & Future Ryan White Reauthorization

3. OVERALL ASSESSMENT Despite a budget of $1.4 billion in federal and state funds ADAP is not fully meeting the needs of people living with HIV/AIDS 45 percent of people needing medications not receiving them Great disparities between the states in their ADAP coverage.

4. HOW DID WE GET HERE? Ryan White HIV/AIDS Program – Impact of Treatment Modernization Act Medicare Part D – Impact on ADAP

5. TREATMENT MODERNIZATION ACT Formula Changes – Move from AIDS to HIV/AIDS Increase in ADAP Supplemental – From 3% to 5% of ADAP Drug Formulary Requirement Core Medical Services Carry-over Funds/Unobligated Balances Redistribution

6. Medicare Part D Picked up ADAP Clients – Savings $73-89 million in FY06 ADAPs Wrap Around Part D – But not all states do so Cost Burden on some Beneficiaries Administrative Headache Creation of SPAPs

7. FACTORS INFLUENCING ADAP GROWTH New infections Increased costs Increased testing efforts Loss of insurance coverage

8. OTHER FACTORS INFLUENCING ADAP GROWTH New Medications Changing Treatment Guidelines Coverage of Additional Services

9. FACTORS INFLUENCING ADAP BUDGETS Federal Annual Appropriation – Small Annual Growth – Much less than required State Budgets – Current Fiscal Crisis in many States Price of Medications Drug Company Rebates

11. State ADAP Funding

12. LIMITATIONS ON ACCESS TO THE PROGRAM Need for adherence services Need for Medical Care and Support Services State Service Variability & Cost Containment Measures Distribution of Funds

13. OTHER ISSUES Patient Assistance Programs Limited New Drugs & Research Unobligated Balance Rule

14. POSSIBLE SOLUTIONS Increased Federal Appropriations – By President & Congress State Actions – Work at State Level, particularly states that make no or little contribution to ADAP – Review Current State match requirements – Encourage States to use ADAP Dollars for Insurance Programs

15. POSSIBLE SOLUTIONS Drug Prices – Continue Current Price Negotiations – Access to DOD Prices Medicare Part D – Allow ADAP Expenditures to count toward True Out- of-Pocket Expenses – Encourage States to Wrap Around Drug Benefit with ADAP dollars – Encourage States to Create State Pharmacy Assistance Programs

16. POSSIBLE SOLUTIONS Medicaid Expansion – Early Treatment for HIV Act – Ensure states enact at state level Create an ADAP Entitlement, along with all Ryan White Services Increase Access to ADAP Drugs & Services – Greater Use of ADAP Dollars for Adherence & Outreach – Greater Use of Minority AIDS Initiative Dollars for Outreach – Increased Funding for all Ryan White Programs

17. POSSIBLE SOLUTIONS Addressing State Variability – Establish a floor for eligibility (350% of FPL) – Require all Antiretrovirals & OI Drugs on Formularies – Greater Portability – Adjust Hard Harmless, while Increase Appropriations – Develop a Severity of Need Index – HRSA Review ADAP Supplemental Criteria

18. POSSIBLE SOLUTIONS Unobligated Balances – HRSA Review Current Policy – Increase Amount Allowed to Carry-over from 2-5% and relax one or both penalties ADAP Rebate Dollars – Clarify it is not program income

19. POSSIBLE SOLUTIONS Congress Investigate Number of Patients on Pharmacy Assistance Programs & Address ways to meet their needs Public Policies that encourage companies to research and develop new drugs

20. CONCLUDING THOUGHTS FY10 Budget & Appropriations Ryan White Extension Health Reform Future Review of Ryan White Program, including ADAP

21. THE FULL REPORT CAN BE ACCESSED AT: www.theaidsinstitute.org/downloads/ ADAPReportMarch2009TheAIDSIns titute.pdf or www.aidsaction.org/images/pdf/aids_ drug_assistance_program.pdf

22. Thank you! CSchmid@theaidsinstitute.org wmccoll@aidsaction.org