We Need A Better Solution!
More Rambling From Paul Kawata

I am concerned that we are trying to balance AIDS Drug Assistance Program (ADAP) budget shortfalls on the backs of People with AIDS (PWAs). Ohio recently changed the income eligibility levels for PWAs to qualify for its ADAP program. As a result, on July 1st 274 clients lost their HIV medications. New Jersey will change its income eligibility levels, so that on August 1st 947 PWAs will lose their benefits. Changing income eligibility levels to qualify for ADAP benefits may balance your books in the short term; but it is a false solution.

It won’t be long before this change forces PWAs to quit their jobs. Its not worth your job if you don’t have access to these life prolonging medications. PWAs who quit their jobs will need more financial support and more HIV/AIDS services. Turning any short term cost savings into a long term budget nightmare.

Given the resistance profile of some of these drugs, it is imperative that PWAs stay on top of their regimen, not miss any doses, and follow their doctor’s recommendations. At a minimum, we need to grandfather in the 1221 PWAs who may lose or have lost their ADAP benefits. It is unfair to ask these folks to scramble to figure out solutions to a problem they did not create.

We need the National HIV/AIDS Strategy (NHAS) to address the 2158* (as of July 22nd) individuals on ADAP waiting lists and 1221 PWAs who will lose or have lost their benefits due to changes in income eligibility levels. What America are we going to be? On one hand we have the NHAS goal of increasing access to care and optimize health outcomes, on the other hand we have ADAP waiting lists and individuals losing their benefits as a way to balance ADAP budgets. I hope we are the America defined by the President in the National HIV/AIDS Strategy. However, it’s going to take money. Without additional dollars to carry out the President’s ambitious agenda, the strategy is just a plan waiting for the shredder.

*From the National Alliance of State and Territorial AIDS Directors (NASTAD):
ADAPs with Waiting Lists (2,158 individuals, as of July 22, 2010)
Florida: 839 individuals Georgia: 192 individuals Hawaii: 13 individuals Idaho: 29 individuals Iowa: 98 individuals Kentucky: 214 individuals Louisiana: 189 individuals* Montana: 22 individuals North Carolina: 182 individuals Ohio: unknown individuals** South Carolina: 231 individuals South Dakota: 23 individuals Utah: 126 individuals

ADAPs with Other Cost-containment Strategies (instituted since April 1, 2009)
Arizona: reduced formulary Arkansas: reduced formulary, lowered financial eligibility to 200% FPL Colorado: reduced formulary Illinois: reduced formulary Iowa: reduced formulary Kentucky: reduced formulary Louisiana: discontinued reimbursement of laboratory assays Missouri: reduced formulary North Carolina: reduced formulary North Dakota: capped enrollment, cap on Fuzeon, lowered financial eligibility to 300% FPL Ohio: reduced formulary, lowered financial eligibility to 300% FPL Utah: reduced formulary, lowered financial eligibility to 250% FPL Washington: client cost sharing, reduced formulary (for uninsured clients only)

ADAPs Considering New/Additional Cost-containment Measures (before March 31, 2011***)
Arizona: waiting list California: proposed elimination of ADAP services in city and county jails Florida: reduced formulary, lowered financial eligibility Illinois: reduced formulary, lowered financial eligibility, monthly expenditure cap Oregon: reduced formulary, client cost sharing, annual expenditure cap Wyoming: reduced formulary