Status of ADAP Waiting Lists and Other Cost-Containment Measures - - PowerPoint PPT Presentation

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Status of ADAP Waiting Lists and Other Cost-Containment Measures - - PowerPoint PPT Presentation

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Status of ADAP Waiting Lists and Other Cost-Containment Measures Jennifer Kates Kaiser Family Foundation and Murray Penner National Alliance of State and Territorial AIDS Directors December 15, 2004 Figure 1 What are ADAP Waiting Lists?

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SLIDE 1

Status of ADAP Waiting Lists and Other Cost-Containment Measures

Jennifer Kates Kaiser Family Foundation

and

Murray Penner National Alliance of State and Territorial AIDS Directors December 15, 2004

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SLIDE 2

Figure 1

What are ADAP Waiting Lists?

  • Faced with increasing numbers of clients and

demand, rising drug costs, and limited funding, ADAPs need to contain costs

  • ADAPs establish waiting lists as one tool for

containing costs

  • Other cost containment measures include:
  • Lowering financial eligibility
  • Limiting or reducing ADAP formularies
  • Establishing monthly or annual expenditure caps
  • Using drug purchasing strategies
  • Using other Ryan White CARE Act funds (Title II

base), often at the expense of other services

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SLIDE 3

Figure 2

What are ADAP Waiting Lists - continued

  • ADAP eligible individuals join waiting lists and do

not receive medications from ADAP until they move into the program

  • Those on waiting lists may access state- or

manufacturer-operated Pharmacy Assistance Programs while on ADAP waiting lists

  • States face challenges in managing waiting lists –

some states choose other cost containment measures instead

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SLIDE 4

Figure 3

Current Status of ADAP Waiting Lists

The Administration’s $20 million ADAP Initiative is now underway and waiting list numbers have begun to decrease

As of November 22, 2004:

  • 9 ADAPs reported a waiting list - 4 of those were not

eligible for the Administration’s Initiative

  • 813 individuals were on waiting lists in those states,

with 758 of those clients due to be enrolled in the Initiative

  • 13 ADAPs have instituted cost containment measures

(other than waiting lists) since April ‘03

  • 6 ADAPs anticipate new or additional cost containment

measures before March 31, 2005

Source: National Alliance of State and Territorial AIDS Directors, ADAP Watch, December 2004.

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SLIDE 5

ADAPs Eligible for Administration’s Initiative, June 2004

Figure 4

AL AR GA ID IL IN KY MO MT NV NH OH SC SD TX VA WY OK ME MD NY OR AK CO LA UT CA KS MS FL NM AZ ND MN IA WI MI NE WA PA NC TN NJ

WV

VT MA RI DE CT DC Puerto Rico Virgin Islands Guam HI

Source: National Alliance of State and Territorial AIDS Directors, ADAP Watch, December 2004.

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SLIDE 6

ADAPs with Waiting Lists by Eligibility Status for President’s Initiative, November 2004

Figure 5

AL (244) AR (31) GA ID IL IN KY MO MT NV NH OH SC SD TX VA WY (2) OK ME MD NY OR AK (4) CO LA UT CA KS MS FL NM AZ ND MN IA (12) WI MI NE (15) WA PA NC (493) TN NJ

WV (5)

VT MA RI DE CT DC Puerto Rico Virgin Islands Guam HI (7)

Eligible ADAPs with Waiting Lists (5 states – 758 individuals) Not-Eligible ADAPs with Waiting Lists (4 states – 55 individuals)

Source: National Alliance of State and Territorial AIDS Directors, ADAP Watch, December 2004.

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SLIDE 7

ADAPs With Additional Cost Containment Measures, Current & Planned, November 2004

Figure 6

AL AR GA ID IL IN KY MO MT NV NH OH SC SD TX VA WY OK ME MD NY OR AK CO LA UT CA KS MS FL NM AZ ND MN IA WI MI NE WA PA NC TN NJ

WV

VT MA RI DE CT DC Puerto Rico Virgin Islands Guam HI

Current Current & Anticipated None in Place, but Anticipated

Source: National Alliance of State and Territorial AIDS Directors, ADAP Watch, December 2004.

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SLIDE 8

Implementation of the Administration's $20 Million ADAP Initiative: Enrollment Status as of 11/04

Figure 7

591 758 55

300 600 900 Eligible & Enrolled Eligible - Yet to be Enrolled Not Eligible - Currently on Waiting Lists

Sources: National Alliance of State and Territorial AIDS Directors, ADAP Watch, December 2004; Kaiser Family Foundation and National Alliance of State and Territorial AIDS Directors, National ADAP Monitoring Project Data Analysis, December 2004.

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SLIDE 9

Figure 8

Analysis of ADAP Waiting List Trends

  • First analysis of trends over time
  • ADAPs surveyed regularly between July 2002

November 2004 (18 survey periods total)

  • Data on waiting lists and other cost containment

measures collected and verified

– Whether waiting list in place – Number of people on waiting list – Whether other cost containment measures in place and/or anticipated

  • Implementation of Administration’s $20 Million

ADAP Initiative included in survey periods

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SLIDE 10

Figure 9

Key Findings

  • Fluctuation across states:

– Number of people on waiting lists ranged from low of 537 to high of 1629; average was 862. – Number of states with waiting lists ranged from low of 6 to high of 11

  • Fluctuation within states

– Number of people went up and down, sometimes eliminated, then reinstated

  • Eighteen states had a waiting list at some point

between 7/02 – 11/04

– Most of these states had them in place for more than one survey period – 1 had a waiting list throughout, in all 18 periods – 7 had waiting lists in at least 10 of the periods

Source: Kaiser Family Foundation and National Alliance of State and Territorial AIDS Directors, National ADAP Monitoring Project Data Analysis, December 2004.

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SLIDE 11

Number of States with ADAP Waiting Lists by Survey Period, 7/02 – 11/04

Figure 10 7 7 9 9 9 7 8 6 7 9 9 9 9 9 11 9 11 9

2 4 6 8 10 12

Jul- 02 Oct- 02 Dec- 02 Jan- 03 Feb- 03 Mar- 03 Apr- 03 May- 03 Jun- 03 Aug- 03 Sep- 03 Nov- 03 Jan- 04 Mar- 04 May- 04 Jul- 04 Sep- 04 Nov- 04

Source: Kaiser Family Foundation and National Alliance of State and Territorial AIDS Directors, National ADAP Monitoring Project Data Analysis, December 2004.

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SLIDE 12

Number of People with HIV/AIDS on ADAP Waiting Lists, by Survey Period, 7/02 – 11/04

Figure 11

626 537 541 628 726 630 791 1,263 1,518 1,307 1,108 552 552 568 622 1,629 813 1,110

300 600 900 1,200 1,500 1,800

Jul- 02 Oct- 02 Dec- 02 Jan- 03 Feb- 03 Mar- 03 Apr- 03 May- 03 Jun- 03 Aug- 03 Sep- 03 Nov- 03 Jan- 04 Mar- 04 May- 04 Jul- 04 Sep- 04 Nov- 04 Source: Kaiser Family Foundation and National Alliance of State and Territorial AIDS Directors, National ADAP Monitoring Project Data Analysis, December 2004.

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SLIDE 13

Number of People with HIV/AIDS on ADAP Waiting Lists, by State & Survey Period, 7/02 – 11/04

Figure 12

200 400 600 800 1,000

Jul- 02 Oct- 02 Dec- 02 Jan- 03 Feb- 03 Mar- 03 A pr- 03 May- 03 Jun- 03 A ug- 03 Sep- 03 Nov- 03 Jan- 04 Mar- 04 May- 04 Jul- 04 Sep- 04 Nov- 04

Alabama Alaska Arkansas Colorado Guam Hawaii Idaho Indiana Iowa Kentucky Montana Nebraska North Carolina Oregon South Dakota Utah West Virginia Wyoming

Source: Kaiser Family Foundation and National Alliance of State and Territorial AIDS Directors, National ADAP Monitoring Project Data Analysis, December 2004.

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SLIDE 14

Figure 13

Conclusions

  • Administration’s $20 Million ADAP Initiative has helped to

alleviate waiting lists in FY 2004

– Reaching almost half of those eligible in short time – Outstanding questions/issues

  • How to address those on waiting lists in non-eligible states?
  • Looking ahead to FY 2005 and beyond
  • Overall challenge: “capped funding” affects number of

clients who can be served and amount of services provided

  • ADAPs have limited set of tools for managing program

costs and demand

  • Waiting lists most visible example of this – but only one

measure of unmet need

  • Waiting lists fluctuate regularly

– Hard to predict and plan for – States face challenges in managing those on waiting lists