ADAPs Under the Gun with Federal Funding Cuts

The AIDS Drug Assistance Programs (ADAPs) have had a rocky start in 2013. Initially, sequestration -- which are the budgets cuts to particular categories of federal spending that began on March 1, 2013 as an austerity fiscal policy that were enacted by the Budget Control Act of 2011 [1] -- is reportedly going to result in up to 15,700 people living with HIV/AIDS losing their access to treatment. As if the sequestration wasn't bad enough, ADAPs took another blow later that month when President Obama signed into law the Consolidated and Further Continuing Appropriates Act of 2013 on March 26, 2013. [2]  The CR failed to include the $50 million that was announced on World AIDS Day last year by the president ($35 million for ADAPs; $15 million for Part C clinical care).

It remains unclear how sequestration will impact ADAPs, but reports indicate that the funding could be cut by as much as 5.2%. The combined impact of the federal funding cuts under sequestration and the CR will likely result in ADAP waiting lists.

As of April 11th, three states still had waiting lists left over from the "Perfect Storm" that ravaged ADAPs for several years, resulting in nearly 10,000 people living with HIV/AIDS being denied access to treatment. According to the National Alliance of State & Territorial AIDS Directors (NASTAD), Idaho has 14 people on its waiting list, South Dakota has 17 people on its waiting list and Florida currently has a waiting list, although no one is on it. [3]

NASTAD also reports the following cost containment measures: [4]

• Florida: Formulary reduction 
• Idaho: Enrollment cap 
• Illinois: Formulary reduction, expenditure cap (monthly) 
• Indiana: Enrollment cap 
• Kentucky: Expenditure cap (annual) 
• Montana: Elimination of all support services 
• New Mexico: Expenditure cap (monthly) 
• Puerto Rico: Formulary reduction 
• South Dakota: Expenditure cap (annual) 
• Tennessee: Formulary reduction 
• Utah: Formulary reduction, enrollment cap 
• Virgin Island (U.S.): Formulary reduction 
• Washington: Pay insurance premiums only if client is prescribed and taking ARVs
• Wyoming: Enrollment cap

Whereas there is an advocacy effort underway to convince The White House to re-program the funding that was lost under the CR back into ADAPs, there is no certainty that it will occur. And it most certainly will not occur unless the HIV/AIDS community is vocal about it.

To that end, 169 organizations endorsed a national sign-on letter that was spearheaded by the ADAP Coalition and sent to President Obama on April 8th. The letter, in part, reads: "We greatly appreciate your leadership on the domestic HIV epidemic. Your prioritization of addressing the ADAP crisis by providing $70 million in emergency funding over the course of 2010 – 2012 and an additional $15 million for Part C programs during FY2012 demonstrates your deep commitment to individuals living with HIV/AIDS. On behalf of these individuals, we hope that you continue your steadfast leadership by authorizing again this transfer of $45 million as soon as possible in FY2013."

Numerous organizations are also coordinating various advocacy efforts. The ADAP Advocacy Association will be dedicating a significant portion of its 2013 Annual Conference to this issue when it convenes in Washington, DC this summer.

In the meantime, ADAP stakeholders should be aware that The ADAP Coalition has published its ADAP Need Number for fiscal years 2013 and 2014:

"FY2013 and FY2014 – Based on the model, in order to maintain the program and allow for new enrollment, there is a need for an additional $54 million in revenues for ADAPs in FY2013, and $134 million in revenues in FY2014. These amounts have been divided into a federal and state share based upon historical data and the current fiscal situation in states. Historically, the federal share was 80 percent and the state share was 20 percent. Due to the current fiscal crisis among states the split has been adjusted to an 85 percent federal share and a 15 percent state share. The state share of the increase is based upon the current portion (13 percent) of total ADAP revenues that derive from state appropriations and a recognition of the severe fiscal constraints facing states at this time. The 85/15 percent split is applied to the overall ADAP revenue. The final projected additional remaining federal need for FY2013 is $46 million and the increased need for FY2014 is $114 million for a total of $160 million."[5]

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[1] Wikipedia, "Budget sequestration in 2013," 2013.
[2] Public Law, 113-6.
[3] National Alliance of State & Territorial AIDS Directors, "The ADAP Watch," April 11, 2013.
[4] National Alliance of State & Territorial AIDS Directors, "The ADAP Watch," April 11, 2013.
[5] The ADAP Coalition, "ADAP Budget Projection - Fiscal Years 2013 and 2014," January 2013.