Annual Report May 19, 2004 Jennifer Kates Henry J. Kaiser Family - - PowerPoint PPT Presentation

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National ADAP Monitoring Project

Annual Report

May 19, 2004

Jennifer Kates Henry J. Kaiser Family Foundation

and

Murray Penner National Alliance of State and Territorial AIDS Directors

Also Produced in Partnership with the AIDS Treatment Data Network

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National ADAP Monitoring Project

About the National ADAP Monitoring Project

• First commissioned in 1996 in response to rapid

changes in ADAPs.

• The Project provides timely information on the

current status of ADAPs, trends over time, and key issues affecting client access.

• The National ADAP Survey, conducted each year,

serves as the basis for the Project’s Annual Report. Other data from NASTAD used to supplement findings.

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National ADAP Monitoring Project

The National ADAP Monitoring Project Annual Report, May 2004

• The 8th annual report released by the Project.
• 54 of 57 state and territorial ADAPs responded to

the June 2003 survey.

• Data from June 2003 and FY 2003 except where

noted

• ADAPs are dynamic programs:

– ADAPs make changes during course of fiscal year – Data may have changed between the data collection period and the release of the Annual Report.

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National ADAP Monitoring Project

Continued…

• Data provide a “snapshot” of program activity

during June 2003, and FY 2003

• In addition, national and state level trends in

ADAP utilization, expenditures, funding and other measures over time, since 1996

• Update on ADAP drug formularies and cost

containment measures

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National ADAP Monitoring Project

Findings

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National ADAP Monitoring Project

ADAP Client Utilization, June 2003

• ADAPs served 85,825 clients in June 2003 (67%
• f total clients enrolled in that month—128,465 in

June 2003)

• Ten states accounted for 73% of June 2003 clients

served

• Clients served ranged from 1 to over 16,000
• Continues to increase, but at slower rate

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National ADAP Monitoring Project

ADAP Clients by Race/Ethnicity, June 2003

Hispanic 25% African American 33% White 38% American Indian/Alaskan Native <1% Native Hawaiian/PI <1% Asian 1% Unknown 1% Other 1%

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National ADAP Monitoring Project

Other Client Demographics, June 2003

• Mostly male (79% were male, 21% female)
• Primarily younger adults (60% between ages 25 and 44)
• Very low-income (81% of clients fell at or below 200%

FPL, with 49% at or below 100% FPL)

• Most have no other form of insurance coverage (13% with

private insurance; 8% with Medicare; 7% with Medicaid coverage)

• Indications of advanced HIV disease (42% of clients had

CD4 count < 350)

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National ADAP Monitoring Project

ADAP Drug Expenditures, June 2003

• ADAP drug expenditures totaled $77.4 million in

June 2003 (when annualized, represents $928.7 million, or 97% of the budget)

• Ten states accounted for 77% of June 2003

expenditures

• Expenditures ranged from $620 to $16.3 million
• Continues to increase, but at slower rate

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National ADAP Monitoring Project

ADAP Drug Expenditures by Class, June 2003

• 54 states provided expenditure data by class—

representing nearly all of total expenditures

• Antiretrovirals continue to account for the bulk of

expenditures (86%)

• OI and other drugs make up 10% of drug spending

– Including 4% spent on the 14 “A1” drugs recommended by the PHS/IDSA guidelines

• Similar to last year’s breakdown

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National ADAP Monitoring Project

Per Capita Drug Expenditures, June 2003

• $902 per client in June 2003 (increase from $838

in June 2002)

• If annualized, represents $10,824 per person per

year

• Per capita expenditures range from $319 to $1,402

in June 2003

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National ADAP Monitoring Project

ADAP Prescriptions Filled by Class, June 2003

• ADAPs filled 300,540 prescriptions in June 2003
• Antiretrovirals (ARVs) represented 61% of total

prescriptions filled

• Opportunistic Infection (OI) and other drugs

represented 37%

– Including 11% spent on the 14 “A1” drugs recommended by the PHS/IDSA guidelines

• Similar to last year’s breakdown

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National ADAP Monitoring Project

ARVs Most Expensive: Expenditures per Prescription, June 2003

$258 $357 $343 $306 $439 $94 Total All ARVs NRTIs NNRTIs PIs OIs/Other

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National ADAP Monitoring Project

ADAP Drug Formularies, FY 2003

• Range from 18 to 474 drugs covered; 4

jurisdictions with open formularies

• Sixteen states did not provide all approved

antiretroviral drugs at the time of the survey (not including Fuzeon).

• Seventeen states offer all 14 PHS/IDSA guideline

drugs for the prevention of OIs (up from 15 last year)

– 39 states cover 10 or more (same as in June 2002) – 2 states cover none (down from 3 in June 2002)

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National ADAP Monitoring Project

ADAP Drug Formularies, continued

• 33 states provide Fuzeon (first drug in a new class
• f drugs – fusion inhibitors)
• 20 states reported coverage of hepatitis C (HCV)

treatments

• 22 states offer hepatitis A and B vaccines

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National ADAP Monitoring Project

National ADAP Budget by Source, FY 2003

Total Budget - $961.5 M

ADAP Supplemental $21,430,000 2% Title I $17,513,824 2% Other Federal $35,575,680 4% State $171,858,836 18% Federal Earmark $692,896,000 72% Title II Base $22,205,368 2%

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National ADAP Monitoring Project

National ADAP Budget

• FY2003 budget grew to $961.5 million (increase
• f $83 million, or 9% over FY02)
• Federal earmark is largest component (72%), with

state general revenue at 18%

• Title II base funding decreased by 23% from

FY02, dropping to $22.2 million

• Title I contributions to ADAP decreased by 11%

from FY02, dropping to $17.5 million

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National ADAP Monitoring Project

Key Themes & Trends

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National ADAP Monitoring Project

Trends in Clients Served and Drug Expenditures

• Increasing, but biggest increase early on, after earmark

introduced and HAART

• National trends mask important differences at state level;

between June 2002 and June 2003: – 41 ADAPs had an increase in clients served, 11 had decreases – 35 ADAPs had increases in drug expenditures, 18 had decreases

• Clients served and Drug Expenditures largely function of

the budget

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National ADAP Monitoring Project

Increasing ADAP Client Utilization Over Time, but at Slower Rates

• 10,000

20,000 30,000 40,000 50,000 60,000 70,000 1996 1997 1998 1999 2000 2001 2002 2003

Trends in ADAP Client Utilization, 1996-2003

7% 15% 46% 20% 9% 10% 10%

182%

Note: Based on 40 state/territorial ADAPs that provided data for each fiscal year. American Samoa, District of Columbia, Florida, Georgia, Guam, Louisiana, the Marshall Islands, Missouri, New Mexico, North Dakota, Northern Mariana Islands, Puerto Rico, Tennessee, Vermont, Virgin Islands, Wyoming not included.

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National ADAP Monitoring Project

Increasing ADAP Drug Expenditures Over Time, but at Slower Rates

$0 $10,000,000 $20,000,000 $30,000,000 $40,000,000 $50,000,000 $60,000,000 $70,000,000 1996 1997 1998 1999 2000 2001 2002 2003

Trends in ADAP Drug Expenditures,1996-2003

93%

37%

23% 12% 16% 12% 9%

412%

Note: Based on 42 state/territorial ADAPs that provided data for each fiscal year. American Samoa, District of Columbia, Georgia, Guam, Louisiana, the Marshall Islands, Missouri, New Mexico, North Dakota, the Northern Mariana Islands, Puerto Rico, Tennessee, Vermont, Virgin Islands, Wyoming not included.

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National ADAP Monitoring Project

Increasing ADAP Budget Over Time, but at Slower Rates

National ADAP Budget, Rate of Growth in Dollars and Percent, FY 1996-2003

$182.3 $139.2 $155.5 $59.0 $85.7 $68.4 $82.8 9% 8% 12% 9% 30% 38% 97% $0 $50 $100 $150 $200 96-97 97-98 98-99 99-00 00-01 01-02 02-03 Millions of Dollars 0% 20% 40% 60% 80% 100% 120%

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National ADAP Monitoring Project

Other than Earmark, Additional Sources of Funding Highly Variable and Not Available to all ADAPs

Number of ADAPs Receiving Funding from Different Sources, FY 2003 57 39 24 12 17

Federal Earmark State Funding Title II Base Funding Title I Funding ADAP Supplemental

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National ADAP Monitoring Project

Several ADAPs Faced Budget Cuts Overall or For Particular Funding Sources

Number of ADAPs with Decreases in Overall Budget and by Funding Source, FY 2002-2003 5 12 17 4 11

Decrease in Overall Budget Decrease in State Funding Decrease in Title II Base Funding Decrease in Title I Funding Decrease in ADAP Supplemental

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National ADAP Monitoring Project

What People Get Depends on Where They Live

• Income eligibility ranges from 125% FPL to 500% FPL
• Formulary variation significant in terms of number and

types of drugs offered (4 to 474, not all recommended drugs offered)

• Variations in access are the result of both the availability
• f other resources – and therefore the size of the “gap”

ADAPs are asked to fill – and state discretion over ADAP program design

• Not just variation across the country, but program changes

may occur at multiple times during fiscal year for any given ADAP

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National ADAP Monitoring Project

Resource Constraints Lead to Cost Containment Measures that May Limit Client Access

Number of ADAPs by Cost Containment Measure, as of April 2004

11 2 3 1

Closed Enrollment Reduced Formulary Per Capita Spending Limits Cost Sharing

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National ADAP Monitoring Project

States with waiting lists – April 2004 (9 ADAPs) – 1,263 individuals

AL (304) AR GA ID (5) IL IN KY (123) MO MT (4) NV NH OH SC SD (43) TX VA WY OK ME MD NJ NY OR AK (9) CO (292) LA UT CA KS MS FL HI NM AZ ND MN IA WI MI NE WA PA NC (449) TN

WV (34)

VT MA RI DE CT Guam Virgin Islands Puerto Rico DC

State ADAPs with Waiting Lists, as of April 2004

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National ADAP Monitoring Project

States with current cost containment measures (other than waiting lists) – 7 states AL AR GA ID IL IN KY MO MT NV NH OH SC SD TX VA WY OK ME MD NJ NY OR AK CO LA UT CA KS MS FL HI NM AZ ND MN IA WI MI NE WA PA NC TN

WV

VT MA RI DE CT Guam Virgin Islands Puerto Rico DC

ADAPs with Current or Planned Cost-Containment Measures, as of April 2004

States with current cost-containment measures in place and anticipate the need to implement additional measures in FY2004 – 1 state States without current cost-containment measures in place but anticipate the need to implement measures in FY2004 – 9 states

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National ADAP Monitoring Project

Looking Forward…

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National ADAP Monitoring Project

• Importance of ADAPs, particularly for low-

income, uninsured people with HIV/AIDS

– Growing over time – Challenges of fiscal and treatment environment – Health and fiscal benefits due to ADAP, but do not directly accrue to the program

• Key issues on the horizon:

– State Fiscal Environment, Medicaid, and ADAPs – Medicare Prescription Drug Law – IOM Report – Reauthorization of the CARE Act in FY 2005 – ADAP Crisis Task Force