The AIDS Drug Assistance Program (ADAP) provides medications for the treatment
of HIV disease. Program funds may also be used to purchase health insurance
for eligible clients. Amendments to the Ryan White CARE Act in October 2000
added additional language allowing ADAP funds to be used to pay for services
that enhance access, adherence, and monitoring of drug treatments. The program
is funded through Title II of the CARE Act, which provides grants to States
ADAP grants are awarded to all 50 States, the District of Columbia, Puerto
Rico, Guam and the U.S. Virgin Islands
Congress earmarks funds that must be used for the ADAP, an important
distinction since other Title II spending decisions are made locally. The
ADAP earmark is by far the fastest growing component of CARE
Act appropriations. State ADAPs also receive money from their respective
States, other CARE Act programs, and through cost-savings strategies.
A formula based on AIDS prevalence is used to award ADAP funds to States
and Territories. However, three percent of the total earmark
is reserved for supplemental grants to States and Territories with demonstrated
severe need that prevents them from providing medications consistent with
Public Health Service Guidelines to clients.
ADAP clients do not have adequate health insurance or the financial resources
necessary to cover the cost of medications.
Many clients are enrolled in ADAP only temporarily while they await acceptance
into other insurance programs, like Medicaid.
The ADAP in each State and Territory is unique in that it decides which
medications will be included in its formulary, and how those medications
will be distributed.
Many States and Territories provide medications through a pharmacy reimbursement
model. Patients show enrollment cards at participating pharmacies to receive
their medications, and the pharmacy invoices the ADAP for payment.
Some ADAPs use pharmacies located within public health clinics to distribute
A few ADAPs purchase drugs and mail them to clients directly.
Each State and Territory establishes its own eligibility criteria. All require
that individuals document their HIV status. Nine programs require a CD4 count
of 500 or less. Fifteen States have established income eligibility at 200
percent or less of the Federal Poverty Level (FPL). Nationally, more than
80 percent of ADAP clients have incomes at 200 percent or less of the FPL.
Pressure on ADAP resources has increased substantially.
Highly Active Antiretroviral Therapy (HAART) is the standard of care for
the majority of individuals living with HIV disease. Its cost may be $12,000
per year or more, in addition to the costs of addressing opportunistic
infections, side affects, and other treatment issues.
AIDS mortality has decreased dramatically in the United States since 1995,
and HIV incidence remains constant at approximately 40,000 new infections
annually. Therefore, the total number of individuals living with HIV disease
continues to climb.
The epidemic is growing rapidly among minorities, who have historically
experienced higher risk for poverty, lack of health insurance, co-morbidity,
and disenfranchisement from the health care system. The result is a growing
number of individuals living with HIV disease who require public support.
SOURCE: Health Resources & Services Administration