Medicine Abandonment is a Barrier to Health Equity

By: Ranier Simons, ADAP Blog Guest Contributor

One of the most important developments in medical science is the evolution of pharmaceuticals. Prescription drugs are used to treat and cure disease, prevent disease, slow aging, govern family planning, and even enhance biomechanical functioning. The United States spends more on over-the-counter and prescription drugs than any other country. In 2020, the U.S. spent $348.4 billion on prescription drugs.[1] America's drug prices are 250% higher than 32 countries that are a part of the Organization for Economic Co-operation and Development known as the OECD.[2]

Researchers are increasingly focused on exploring the relationship between drug finance and care access. Inquiry shows that drug prices and the pathways in which patients pay for medications result in unequal access to care. Unequal access to care results in health inequities. Care disparity is the subject of a report recently published by the Pharmaceutical Research and Manufacturers of America, known as PhRMA. PhRMA is a non-profit advocacy group that lobbies on behalf of its member biopharmaceutical companies. It believes in advancing innovation, making medicines more affordable, and improving access for all. The report, entitled "Understanding Medicine Abandonment as a Barrier to Health Equity", uses real-world data to highlight health disparities.

Abandonment, in this report, is defined as when a patient does not fill a newly prescribed brand-name medication within 30 days of approval from their insurance. The report's 2020 IQVIA sourced data showed that African-Americans were disproportionately likely to abandon new prescriptions than their white counterparts. Additionally, the results indicated that people with lower incomes have a higher likelihood of medication abandonment than those with higher incomes.[3] Research has shown that regular adherence to medication regimens is almost more important than the medication itself.[5]

African-Americans were overall seven percent more apt to abandon new prescriptions. However, that percentage was higher regarding specific diseases. The rate increased to 20 percent for insulin usage, 31 percent for atypical antipsychotic drugs, and 41 percent for HIV Pre-Exposure Prophylaxis (PreP) usage.[3] Rates of abandonment, in regards to insurance cost-sharing, also followed the same trend among racial lines. African-Americans were 10 to 34 percent more likely to abandon medication when the out-of-pocket price was $125 or more after insurance than white patients.[3] Similar results were observed regarding income in the absence of race. Patients with commercial insurance who had an annual income of less than $50,000 were more likely to have medication abandonment than those making over $100,000. In general, those earning less than $50,000 were 16 percent more likely not to fill prescriptions than those annually earning $100,000 or more.

The report is an acceptable baseline of inquiry. However, it cannot prove direct causal relationships of inequality. The analysis compares differing rates of abandonment by race and income. It does not include the influence of confounding variables such as racism, health status, education, and social determinants of health.[3]

"Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks."[4] It is vital to explore how these things influence health inequalities and contribute to medicine abandonment.

Photo Source: Healthy Mendocino

One important SDOH is culture. The study showed that African-Americans had a 31 percent higher likelihood of medicine abandonment regarding atypical antipsychotic drugs. In addition to the cost factor, there is documented stigma African-Americans associate with mental issues. One such study showed that 63 percent of African-Americans surveyed believed that mental health issues are a sign of personal weakness.[6] This sentiment would indicate that an African-American patient would likely not fill a needed mental health prescription even if they were fearless enough to seek help. 

Racism is another SDOH. Institutionalized racism in medicine contributes to a pervasive African-American distrust of doctors and medication.[7] Racial differences in medical care and inclusion or lack of inclusion in medical research are part of medical institutional racism. The Tuskegee Experiment, gynecology’s roots of torture in slavery, and the poor representation of African-Americans in clinical trials are just a few examples.

Outside of race, the issue of drug pricing is also not binary. The PhRMA report showed a correlation between the income of insured patients and the likelihood of medicine abandonment. However, price is complex. The way patients pay for medication is also a source of concern. Patients pay monthly premiums for their insurance that include differing drug coverages. However, in addition to their premiums, they must pay copays for their medications. Those copays are often part of a matrix, including high insurance deductibles. 

In an effort to help patients afford their medications, many drug manufacturers have copay assistance programs. These programs are supposed to pay for the patients’ copays to the insurance company to reduce the financial burden and increase adherence. However, copay accumulator programs presently are a challenge to those efforts.

The Hepatitis B Foundation defines copay accumulator as "a strategy used by insurance companies and Pharmacy Benefit Managers (PBMs) that stop manufacturer copay assistance coupons from counting towards two things: 1) the deductible and 2) the maximum out-of-pocket spending."[8] This results in patients paying even more for their medications, with the insurance companies paying less. This phenomenon is supported by the PhRMA report, which shows that medicine abandonment increases as the amount of out-of-pocket expenses to the patient increases.

The intersection of race, economics, healthcare finance, and SDOH is a complex web. PhRMA's report is a solid stepping stone on which to wade through the constantly moving stream of health equity reform discourse and change. The report is available online here.

[1] Centers for Medicare & Medicaid Services (2021, December 15). NHE Fact Sheet. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet#:~:text=Prescription%20drug%20spending%20increased%203.0,the%20households%20(26.1%20percent)
[2] Mulcahy, A. (2021, January 28). Prescription drug prices in the United States are 2.56 Times those in other countries. Retrieved from https://www.rand.org/news/press/2021/01/28.html
[3] Pharmaceutical Research and Manufacturers of America. (2022). Understanding Medicine Abandonment as a Barrier to Health Equity. Retrieved from  https://phrma.org/-/media/Project/PhRMA/PhRMA-Org/PhRMA-Org/PDF/S-U/Understanding-Medicine-Abandonment-as-a-Barrier-to-Health-Equity_2022.pdf
[4] Cherry, A. (2021, October 14). The social determinants of health: why they matter to improving health outcomes. Retrieved from https://maximus.com/article/social-determinants-health-why-they-matter-improving-health-outcomes
[5] DiMatteo MR, Giordani PJ, Lepper HS, et al. Patient adherence and medical treatment outcomes: a meta-analysis. Med Care. 2002;40(9):794-811
[6] Ward, E. C., Wiltshire, J. C., Detry, M. A., & Brown, R. L. (2013). African American men and women's attitude toward mental illness, perceptions of stigma, and preferred coping behaviors. Nursing Research, 62(3), 185–194. https://doi.org/10.1097/NNR.0b013e31827bf533
[7] Institute of Medicine (U.S.) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care; Smedley BD, Stith AY, Nelson AR, editors. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington (D.C.): National Academies Press (U.S.); 2003. The Culture of Medicine and Racial, Ethnic and Class Disparities in Health Care. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK220349/
[8] Hepatitis B Foundation. (2020, March 4). Copay accumulators – What they are and what they mean for your prescriptions. Retrieved from https://www.hepb.org/blog/copay-accumulators-mean-prescriptions/

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

Rx Drug Coupon Concerns Pit Prices Against Patients

Guest Blog By: Marcus J. Hopkins, Blogger

Drug manufacturer coupons have increasingly become a popular method of reducing the price consumers pay for their medications. Insurers, Pharmacy Benefits Managers (PBMs), and other payors, however, argue that these cost saving tools actually drive prices upward and result in patients choosing expensive brand name drugs over less expensive generic alternatives, essentially costing the payors more money, in the long run. As a result, some payors are taking the extraordinary step of no longer counting drug coupons toward patients’ out-of-pocket costs and deductibles, meaning that once patients use a coupon, they’ll be left to pay the remaining cost of the drug out-of-pocket.

When looking at how and when these coupons are used, however, Health Affairs = a leading journal in health policy thought and research – found that just 21% of coupons used in the 200 highest expenditure drugs of 2014 had a direct generic substitute, while another 28% had an “imperfect substitute.” The remaining 51% of drug had either no generic substitute or only branded alternatives (Van Nuys et al., 2018).

For patients living with HIV (and, more recently, Hepatitis C), the past decade has been revolutionary in terms of the medications that have been made available to treat the disease. In 2007, most patients began treatment using a two- or three-pill regimen with various storage requirements. A year earlier, the first single-pill regimen, Atripla (Gilead), was approved by the FDA for the treatment of HIV.  In 2017, virtually patients begin HIV treatment with a single-pill regimen. The sad reality, however, is that there are no generic substitutes available in the United States for HIV drugs, and manufacturer coupons that reduce co-pays for them play a vital role in determining whether or not patients can afford the lifesaving medications they need.

“Consumers with life-threatening conditions are caught in the crossfire of an ongoing battle between insurers and drug companies over drug pricing. No matter who wins the battle, the casualties will be the patients, taxpayers, and the general public,” says Eddie Hamilton of the Columbus, Ohio-based ADAP Educational Initiative.

Photo Source: Consumer Reports

He is correct. In the rush to lower expenditures in the post-Affordable Care Act (ACA) market, insurers have increasingly begun weaponizing their drug formularies – the list of drugs payors will cover and for how much – against manufacturers to force lower pricing agreements, all of which are confidential under existing Trade Secrets laws. Placing brand name drugs in higher-cost tiers has been a relatively ineffective weapon when it comes to lowering overall prices, but has been an effective barrier to treatment for many patients living with HIV and other chronic illnesses for which there are few, if any, generic and/or effective alternatives.

This latest salvo against drug manufacturers will ultimately end up hurting consumers more than it will lower expenditures for insurers.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

Access to HIV/AIDS Medicines in Exchange Plans

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

The ADAP Advocacy Association earlier this week announced the framework for its 9th Annual Conference, which includes seven (7) town-hall style panel discussions about various issues impacting access to care and treatment for people living with HIV/AIDS. Among them, a discussion on the access to HIV/AIDS medicines (and other services) in exchange plans.

The panel on the "Affordable Care Act: Marketplace Cost Sharing & Barriers to Healthcare" will be moderated by Scott Evertz, former Director for the Office of National AIDS Policy, and current board member for the Community Access National Network (CANN). It is an opportunity to dig deeper into the ongoing discriminatory practice by insurance companies, requiring inordinately high co-payments and co-insurance for medications used in the treatment of HIV and AIDS.

This ongoing issue has routinely been covered by the ADAP Blog, because it is one of the most commonly expressed concerns by the patient community. View previous blogs on the topic here, here, and here, as well as here.

The Pharmaceutical Research and Manufacturers of America® (PhRMA) recently released several new fact sheets, which provide an in-depth, state-by-state look at coverage and access in the 2016 exchange plans. In a statement released by PhRMA, they are summarized as follows: "From deductibles and cost sharing to prescription drug coverage and formulary data, each fact sheet lays out the specifics for a given state compared to the national average, according to research analyzing 2016 silver health insurance exchange plans. Based on the data and information gathered, the fact sheets also include suggestions for improving exchange coverage in each state."

The fact sheets are available online at AccessBetterCoverage.org.

Photo Source: AccessBetterCoverage.org

Of particular interest to our readers is the fact sheet on HIV/AIDS medications, outlined in the Formulary Access for Patients with HIV/AIDS. A troublesome finding is approximately 10% of the plans use high tier placement or coinsurance for all single source HIV medicines.[1]

An excellent patient-centric resource available at AccessBetterCoverage.org is the "In Your State" tool. It allows patients to learn more about the marketplace plans in each state, including important fact sheets.

For example, in Alabama the following actions are recommended:[2]

• Enforcing non-discrimination requirements, which apply to benefit design and provider networks; 
• Establishing stronger rules regarding exceptions and appeals processes, which help enrollees get the medicines and care their doctors recommend; and  
• Enhancing the state's marketplace website or advocating for a Healthcare.gov page that allows for easier plan comparisons, including searchable formularies and estimates of total out-of-pocket costs.

To utilize this tool, CLICK HERE.

The rising share of patient cost-sharing is widely viewed as the next frontier in the healthcare reform battle. It is one that disproportionately impacts people living with chronic conditions, such as HIV/AIDS.

__________
[1] Avalere, "Formulary Access for Patients with HIV/AIDS," page 9, 2016.
[2] AccessBetterCoverage.org, "In Your State: Alabama," 2016; available online at http://accessbettercoverage.org/states/alabama.

Are ACA Exchange Plans Fair to People Living with HIV/AIDS?

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

On April 25th, Avalere Health published a comprehensive study on marketplace exchange plan formularies offered under the Affordable Care Act ("ACA"); it includes a cross-condition analysis addressing formulary coverage, cost sharing and access. The study, which was prepared for the Pharmaceutical Research and Manufacturers of America® (PhRMA), suggests that certain disease classes -- including HIV/AIDS -- experience bias under many of the plans.

Most of the law’s major provisions were phased in by January 2014, with other provisions phased in by 2020. The ACA has numerous implications generally on the United State’s health care delivery system, but more specifically on the access to healthcare afforded to people living with HIV/AIDS, as well Viral Hepatitis. What’s more, ongoing Medicaid expansion and the implementation of insurance exchanges will also impact nearly all health care providers, as well as their patients.

According to the Avalere study, formulary access for patients with HIV/AIDS has expanded though other barriers remain. The study included the following summary:[1]

Classes Included:

• Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTIs), Protease Inhibitors (PIs), and HIV-Other

Coverage for Key HIV Classes:

• In high-enrollment states, the average exchange plan covers at least 43 of 51 HIV/AIDS medications
• Single-source products in the therapeutic area appear on formulary at least 65% of the time in all states other than Utah, which has coverage 25% of the time

Utilization Management for HIV Classes:

• Exchange plans have continued to reduce their use of UM for HIV/AIDS medications. Now, exchange plans use UM less frequently than employer plans for these medicines

Tiering and Cost Sharing for Key HIV Classes:

• Preferred placement has increased for HIV/AIDS medications in 2016 exchange plans, though employer plans still use the specialty tier far less often than exchange plans do. And, a portion of plans continue to place all HIV drugs on the specialty tier
• Copays are common across HIV classes, with an average copayment of $66. When used, coinsurance is 35% on average

Photo Source: PhRMA

One of the more alarming findings demonstrates that many of the marketplace exchange plans require high cost sharing, which could be discriminatory. In 2016, about 1 in 10 health plans are placing all HIV medicines in certain classes on the specialty tier.[2]

This discriminatory practice took center stage in 2014, when four insurance carriers were sued by the National Health Law Program (NHeLP) and the AIDS Institute. The complaint charged “inordinately high co-payments and co-insurance for medications used in the treatment of HIV and AIDS" against Coventry Health Care Inc., Cigna Corp., Humana Inc. and Preferred Medical.[3]

Additional findings include:[4]

• In states with high exchange enrollment, average plans cover at least 43 of 51 drugs.
• Across classes, plans cover HIV/AIDS innovators at least 76% of the time, except Utah.
• In 2016, exchange plans use Prior Authorization for HIV meds less often than before, but still more than employer plans.
• Exchange plans’ placement of HIV/AIDS drugs on the preferred tier rises to more than half of the time in 2016.
• Copays are more common than coinsurance, though when used, coinsurance averages 35%.
• Exchanges have lower coverage for STRs than for other single-source NTRIs.
• Ten percent or fewer plans in 44 states and D.C. require coinsurance above 30% for all covered NNRTIs.
• New Jersey has the highest proportion of plans requiring coinsurance of 30% or more for all covered NRTIs.
• Alaska, Minnesota, and New Jersey have the highest percentage of plans requiring coinsurance above 30% for all protease inhibitors.
• Coinsurance above 30% for all covered therapies in HIV-other class is most common among plans in Alaska, New Jersey, Utah.

The ACA has largely benefited patients living with HIV/AIDS by expanding access to care, and lowering the ranks of the uninsured and under-insured. That said, despite some marked improvements in many exchange plans there remain ongoing barriers facing too many patients. Among them, higher deductibles, co-payments and co-insurance.

__________

[1] Avalere Health, "PlanScape® Review of Patient Access to Medicines in Exchange Plans, By Condition," p. 62, April 2016.

[2] Pharmaceutical Research and Manufacturers of America®, "New Avalere Study: Health plan formularies continue to suggest bias against individuals with certain health conditions," April 2016.

[3] Insurance Business Magazine, "Insurers accused of HIV discrimination in ACA marketplace," June 3, 2014.
[4] Avalere Health, "PlanScape® Review of Patient Access to Medicines in Exchange Plans, By Condition," p. 63-73, April 2016.

Losing Access to ADAP: What It Means to be HIV-Positive

Checklists. Every individual and organization has one in some sort of fashion, including the U.S. government. Whether they are logged into memory or jotted on paper it lists tasks to be completed usually in a specific priority. At some point or another everyone has endured that feeling of accomplishment when one of these “To Do’s” has been fulfilled and crossed off the list. This week in America the government proved to its people that they could cross off a task in their own agenda by killing Osama bin Laden. The next task that the government should surge their efforts towards in the interest of its citizens here at home: addressing the ongoing AIDS Drug Assistance Program (“ADAP”) crisis and how the number of patients losing access to this much needed program is not only rising, but getting fiscally worse. It must be illustrated to those [with the power to solve this problem] on what it means to be HIV positive today and the consequences of ignoring this issue will result in a financial burden on all Americans.

Doctors, therapists and social workers endlessly explain to the HIV patient that exercise, a well-balanced diet, and a stress-free environment are not only beneficial, but also vital for keeping the virus from developing internally and taking over. Of course, none of these variables are possible unless the patient adheres to the life-saving medications that allow them to be productive in their lives and keeps them from a hospital bed. And up until the recent years even with new infections the fatality rate from AIDS-related complications has significantly decreased. Applause for this breakthrough goes not only towards the medications that have been discovered to keep HIV-positive individuals healthy, but most importantly to the Federal and State government-funded program, ADAP through Part B of the Ryan White Care Act. Without this program, some speculate that HIV/AIDS would triumph as the leading cause of death in the country. For thousands upon thousands of HIV-positive individuals nationwide this “payer of last resort” is the only access they have to receiving the medications and medical care needed for ongoing sustainment as well as preventing the spread of the virus to non-infected people.

With that said, there is a shared anxiety in the HIV/AIDS community at the fact that this program is in jeopardy beyond extreme measures. Although the community is grateful that the President has ordered an additional emergency $25M in funds to Ryan White in FY2010 and its been further ordered for the continuation of some funds in the FY2011 budget (when so many programs have been cut in other committees) it must be pleaded that it isn’t enough to keep ADAPs afloat for another year. The continuation of insufficient funding for this program will not only definitively throw more HIV-positive individuals on waiting lists in the most obvious manner (7,674 in 11 states as of 4/22/11) but more individuals will be rejected altogether. Sadly, it doesn’t stop there: Eleven states with waiting lists will soon turn to 20, or 30, and soon all states and U.S. Territories will fall into this trap. Will this problem be addressed then?

With an unstable economy still at large many Americans, especially HIV-positive individuals, find themselves working two jobs in an attempt to pay the bills and get ahead. One job has no insurance and the other job has an insurance plan that doesn’t cover the HIV medical necessities. An individual that fits this example will most likely not qualify for ADAP even if they make only $500 over the eligibility limits in their state. Consequently, two-thirds of their salaries go towards monthly prescriptions and medical costs. The remaining few extra dollars at the end of the week doesn’t always cover the rent, food and bills. Sooner or later a definite choice will have to be made as to what’s more of a priority to pay for- the roof over their head or for groceries or for another month’s supply of medications and overdue blood work. In other words, ending up on the streets, starving or allowing the virus to strengthen, spread within and onto others and ultimately take over both physically and financially for all? Let’s not forget the rising stress levels from working two jobs under the influence of a compromised immune system. In this lose-lose scenario the individual’s health deteriorates because of no exercise, poor diet and high stress. The only hope for this individual is to be accepted to the ADAP program - with a price to pay by giving up one job and slashing their income by more than half. At least in this case this person’s HIV medicine, blood work, and doctor visits (all covered by Ryan White programs) will be covered. But, what happens when they are thrown off the program because the State had run out of funds? Out comes the virus from its hideout ready to take on more victims and dollars from the taxpayers.

Finally, if all the recent talk about lowering the Federal Poverty Level (“FPL”) for the ADAP program in some states gets approved then the result sets HIV-positive individuals in danger of still making too much money- even on one salary. There is no question these people, who so desperately need the help, will get kicked off the ADAP program for sure. To utter it once more- poor diet, lack of exercise, increase in stress level, and hardly clinging on to what pills are left in the pill box- will the virus take over? The answer is YES, without question or argument. Thousands of Americans are victims to this and thousands more are already in danger of falling into this category under the same foreshadowing issue. Scarily, these “thousands” will turn to millions in the coming years if this topic is not addressed. Is that what it will take for the government to understand that HIV/ AIDS and the ADAP Program under Ryan White are once again situations that cannot continue to be overlooked?

This is a true story of what it’s like to be HIV-positive in this day in age. One can only pray that all the wonderful testimonies about how healthy individuals have become thanks to the progress in medications and treatment will not become a story of the past. When diagnosed with HIV its assured by so many that a full life expectancy is imminent. That may no longer be the case.

Access to ADAP is the treatment livelihood for countless Americans living with HIV/AIDS, and it needs to be a top public health priority in the government. “Fighting to survive” should never be on any HIV-positive person’s checklist in this day in age.

Blog by Christopher Myron, ADAP Advocacy Association member from New York City

Has Darkness Fallen on the Sunshine State?

What was once revered by many in the HIV/AIDS community as a model state for the AIDS Drug Assistance Program (“ADAP”) – even to the point where many people living with HIV/AIDS fled their home state and moved to Florida where access to care and treatment was all but assured – has turned into a nightmare. High unemployment and inadequate federal/state funding, coupled with poor budgeting by the State Department of Health ("DOH") has led 3,967 Floridians living with HIV/AIDS to be placed on ADAP waiting lists, and that doesn’t even take into account the 6,500+ patients who were saved by a last-minute deal inked at the 11th hour with Welvista Pharmacy. And now, darkness seems to have befallen the Sunshine State as the state seeks to change its ADAP eligibility from 400% of the Federal Poverty Level (“FPL”) down to 200% FPL under the state's proposed Rule 64D-4.

What does that mean?

It means hundreds - if not thousands - of Floridians living with HIV/AIDS will be deemed ineligible for access to their live-saving medications under Part B of the Ryan White CARE Act. What the Florida Department of Health's Bureau of HIV/AIDS has proposed would be equivalent to playing in a basketball game, only to have the referee change the rules mid-way through the game in a manner that almost assure your team’s defeat. Except, what is happening in Florida is more than a game…it is a matter of life and death!

According to the AIDS Healthcare Foundation ("AHF"), Florida's Legislature is compelling DOH to hold workshops on Rule 64D-4. This rule concerns HIV/AIDS patient care services eligibility criteria, among which the income requirement is included - reducing the FPL income requirement from 400% FPL to 200% FPL. There is no alternative for these patients other than pharmaceutical Patient Assistance Programs ("PAPs"), which are not sustainable substitutes. The Legislature is trying to make a political statement that the ADAP waiting list can be effectively eliminated by lowering FPL eligibility. The change will not only throw off a massive amount of current ADAP clients, but also significantly reduce the wait list number. Florida would then no longer have the greatest wait list in the country and this action would set a precedent for other states to enact the same measure.

Making "cents" out of the mess

The math is simple. The Florida Legislature is trying to close the state's ADAP funding gap by balancing the budget on the backs of the very people the program is designed to help. With the high cost of the anti-HIV medications, access to care and treatment would be outside the reach for most of the Floridians living with HIV on currently on the state's ADAP waiting list.

"If you make $30,000 a year, you wouldn't qualify to ADAP," Carl Schmid of The AIDS Institute told the Florida Independent. "The drugs cost between $10,000 and $20,000 a year. You'd spend half your income on drugs" (04/11).

With the economic downturn, more Floridians are turning to ADAP for their anti-retroviral medications.

According to the National Alliance of State & Territorial AIDS Directors ("NASTAD"), in June 2009 there were 13,258 clients served on Florida’s ADAP. The Florida ADAP budget in fiscal year 2009 was $93,404,741 – of which $8,000,000 was the state contribution, or 9% of the total budget. In June 2009, drug expenditures totaled $5,747,226 with 27,992 prescriptions filled in Florida.1

In comparison to the previous year, there were 10,738 clients served by Florida’s ADAP in June 2008 – which represented a 23% increase. That same month, drug expenditures were $3,868,505 for 17,792 prescriptions filled, or increase of 49% and 57%, respectively.2

Considering that Florida only contributes about 9% toward its State ADAP (all other funding comes from the federal earmark and pharmaceutical company rebates), it is hard to imagine the Florida Legislature implementing more cost containment strategies. Then again, they did cut $2 million from the program two years ago - which many HIV/AIDS advocates contend helped to fuel the ongoing crisis in the Sunshine State.

So much for a safety net in Florida. But the Fat Lady isn't singing just yet...

The impending firestorm...

The proposed eligibility change has the state’s HIV/AIDS community up in arms. Don’t expect them to sit around quietly, either. The Department of Health has scheduled three public meetings in Tallahassee, Tampa and Miami, each of which will include a discussion of the proposed "changes to the Federal Poverty Level" as well as other issues about Drug Assistance Program eligibility. Expect nothing less than a firestorm in these three cities over the coming weeks. A massive mobilization effort is underway. Let's just hope that Florida's Legislature - as well as their newly-elected Governor - is listening.

Late last year, Florida had initiated the process of lowering its ADAP eligibility to 300% FPL (Rule Amendment No: 64D-4.002, F.A.C.), but it was halted when the Governor Rick Scott was sworn into office. His very first order of business as the state's new chief executive was to halt all pending regulatory actions, including the proposed rule impacting ADAP.

[Photo: Florida Governor Rick Scott]

Some HIV/AIDS advocates were totally blindsided when the new rule was proposed that called for even steeper eligibility restrictions. Yet others have been bracing for the worst. Florida, like many other states, finds itself in the midst of a fiscal mess; but rather than adopting policies based on what is often termed "shared sacrifice," Floridians living with HIV/AIDS appear to be the ones sacrificed under the proposed changes.

"And unfortunately, it may be for all Ryan White B funded programs....this really shouldn't be a surprise to anyone, as it was being proposed to lower it it to 300% of FPL before Governor Scott suspended rule making in the State," summarized David Brakebill, aaa+ member from Key West.

----

1 National Alliance of State & Territorial AIDS Directors, “National ADAP Monitoring Project Annual Report,” Summary Table I, p. 13, May 2010.

2 National Alliance of State & Territorial AIDS Directors, “National ADAP Monitoring Project Annual Report,” Summary Table II - Total Clients Enrolled/Served, Drug Expenditures, and Prescriptions Filled, June 2008 and June 2009, p. 14, May 2010.