1. Anne Giuranna Rhodes, Services Analyst HIV Care Services, Division of Disease Prevention Virginia Department of Health

2. Began 11/2010, ended 8/2012 Highest number was 1,112 in 12/2011 Waitlist Significant drop in cost per person in early 2011 due to NASTAD agreements Direct ADAP Began collecting rebates in 2011 Served 387 persons in 2012 Medicare D

3.  Virginia ADAP expanded ADAP enrollment criteria and reduced the wait list throughout 2011 and 2012  November 2011: CD4 count at or below 200  December 2011: CD4 count at or below 350  April 2012: CD4 count at or below 500  July 2012: removal of clinical criteria  August 2012: began immediate processing of new applications (no longer placed any new persons on waitlist)  Eliminated the wait list as of August 30, 2012.

4. Data Source: AIDS Drug Assistance Program Waitlist Data Division of Disease Prevention, Office of Epidemiology, Virginia Department of Health, December 2012

6.  Active Clients December 31, 2012: 3,613 (2,276)  Clients Served Jan-Dec 2012: 4,001 (3,008)  Avg. Persons Served Per Month 2012: 2,118 (1,816)  Avg. Total Cost per Month 2012: $1.86M ($1.65M)  Avg. Cost Per Person Per Month 2012: $881 ($913)  Avg. New Clients Per Month 2012: 101 (14) *Numbers in parentheses are from 1 year ago (January to December 2011)

7. Began waitlist Data Source: AIDS Drug Assistance Program Data Division of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013

8. Data Source: AIDS Drug Assistance Program Data Division of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013

9. Data Source: AIDS Drug Assistance Program Data Division of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013

10. Lab results are from 2010 and later, from Ryan White and the Electronic HIV/AIDS Reporting System (eHARS), Division of Disease Prevention, Virginia Department of Health Total Clients =4,001

11. Data Source: Medicare Part D Assistance Program Data (MPAP) Division of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013 Total Clients = 387

12. Paid by Rx Companies to rebate to 340B price for any co- pay paid on retail Rx VDH able to capture rebates for Medicare Part D starting in 1/2011 Projections of amount of revenue generated are often not feasible VDH sends list of co-pays by drug to companies and receives one check from each company

13. Rebates allow Virginia to recoup the cost differential between the price paid for the medication at point- of-sale and the 340B price, when ADAP pays for any part of the drug cost.

14. Data Source: AIDS Drug Assistance Program, Financial Tracking Data Division of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013

15.  Value of dispensed drug is the sum of all filled prescriptions for direct ADAP  Does not include any returned medication, increases in drug inventory levels, or revenue generated from ADAP (Medicaid backbilling, Rebates) Data Source: AIDS Drug Assistance Program Data Division of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013

16. Covers medications and medical care (through Dec 2013) Enrollment of 350- 450 in 2013 Average Annual Premiums are $2,748 per client Can Collect Rebates on Medications Cap on annual costs of $6,250 (in- network), $10K (out of network)

17. Assumptions: Enrollment of Eligible Clients in Health Care Exchanges in January 2014 Rebate Total Estimates for Year = $6.8M Net Expenditures Estimate = $34.7 M Division of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013 $41.6M $13.2M $27.2M $1.2M Exchanges