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Streamlining and Modernizing the AIDS Drug
Assistance Program (ADAP) of the Ryan White CARE
Act AIDS Action Policy Recommendations Spring,
2005 www.aidsaction.org
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The Problem
Ryan White CARE Act Reauthorization

• The structural and financial ability of the
  United States to provide life saving HIV
  medications to individuals living with HIV is in
  crisis.
• Waiting lists
• Limits on formularies
• Limits on eligibility
• Inability to access lowest pricing

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The Solution
Ryan White CARE Act Reauthorization

• A new AIDS Drug Assistance Program, Title V of
  the Ryan White CARE Act
• In America, no one in need of life saving
• HIV medications will have to be
• without them.

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The Goals of Our Proposal
Ryan White CARE Act Reauthorization

• Ensure Access to all HIV Medications
• Support pursuit of care and treatment near job or
  family
• Increase number of people served in every state
  and territory
• Reward state participation and flexibility
• Reinforce accountability and use of health
  outcome measures and
• Establish a responsible program funding level.

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1. Ensure Access to all HIV Medications
Ryan White CARE Act Reauthorization

• Our proposal seeks to
• Establish a baseline HIV/AIDS drug formulary
  which will allow individuals to move between
  states. Recommend an open formulary including
  all FDA-approved antiretroviral therapeutics, all
  FDA-approved prophylaxes and therapeutics for
  opportunistic infections, all medications to
  treat side effects and major psychiatric
  disorders associated with HIV.
• Ensure state ADAPs are able to purchase drugs at
  the lowest possible federal price. If necessary,
  purchase should be negotiated through a single
  federal agency (most likely the Public Health
  Service) at the Federal Ceiling Price (FCP).

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2. Support pursuit of care and treatment near
job or family
Ryan White CARE Act Reauthorization

• Our proposal seeks to
• Enhance portability among state programs.
• Create client eligibility for services through
  the new state ADAP program within 30 days in the
  new home state.
• Transfer reimbursement for the new enrollee after
  30 consecutive days to the new states program.
• Issue an ADAP participant card to every
  eligible Person Living with HIV.
• Improve accountability and enhance the reporting
  of health outcomes.

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3. Increase number of people served in every
state and territory
Ryan White CARE Act Reauthorization

• Our proposal seeks to
• Set minimum eligibility requirement of 350 of
  federal poverty level for all states and
  territories.
• Encourage states and territories to continue to
  exceed this standard.
• Establish a state by state national enrollment
  and certification process.

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4. Reward state participation and flexibility
Ryan White CARE Act Reauthorization

• Our proposal seeks to ensure the continuing
  strength of states and territories managed ADAPs
  by
• Creating incentives for state contributions.
• Encouraging states to purchase insurance policies
  that meet the newly created eligibility criteria.
• Requesting states with laws which prohibit
  purchase of insurance policies to create an
  exception for ADAP.

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4. Reward state participation and flexibility
Ryan White CARE Act Reauthorization

• Our proposal seeks to ensure the continuing
  strength of states and territories managed ADAPs
  by
• Allowing states to use a percentage of ADAP funds
  to create flexible ways to expand treatment and
  medical support services to ensure adherence and
  full program participation.
• Allowing small set aside for technical
  assistance.

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5. Reinforce accountability and use of health
outcome measures
Ryan White CARE Act Reauthorization

• Our Proposal Supports the Enhancement of
  Standards of Care by
• Establishing a Clinical Advisory Panel to allow
  professional clinical review of the guidelines by
  doctors, nurses and public health professionals.
• Establishing a PHS Guidelines Panel to Integrate
  Guidelines w/ADAP composed of doctors, nurses,
  and pharmacists.
• Requiring HRSA to report health status of ADAP
  clients to Congress annually (Data gathered
  bi-annually from states). Data to include CD4
  counts, Viral Load, results of resistance
  testing.

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5. Reinforce accountability and use of health
outcome measures
Ryan White CARE Act Reauthorization

• Our proposal supports the enhancement of
  standards of care by
• Ensuring Consistency Between Formulary Guidelines
  and Medicaid Guidelines.
• Creating an on-going structure for the Center for
  Medicaid Services (CMS), the Health Resources
  Services Administration, and relevant
  individuals, agencies and organizations (with HIV
  expertise) to ensure coordination and
  consistency.
• Requiring a report to Congress about the
  implementation integrating state and national
  standards of care and consistency of Medicaid and
  ADAP formulary guidelines by 2008.

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6. Establishes a responsible program funding
level.
Ryan White CARE Act Reauthorization

• Our proposal establishes a responsible program
  funding level and recommends strengthening ADAP
  by
• Ensuring ADAP continues to be fully funded by
  managing growth beginning with 1.5 billion in FY
  2006 and increasing the base by 100 million each
  year to 2.0 billion in 2011.
• Moving ADAP from Title II and placing it into a
  new Title V in order to support long-term growth
  and understanding of the ADAP program.

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Ryan White CARE Act Reauthorization

• In Summary,
• our proposal enhances portability, supports
  gathering and reporting of health outcomes and
  enhances client services through utilization of
  an ADAP Participant Access Card.

Participant Access Card
ADAP - Title V Americas new AIDS Drug Assistance
Program Streamlining and modernizing the CARE
Act Keeping it strong
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Ryan White CARE Act Reauthorization

• In America, no one in need of life saving HIV
  medications will have to be
• without them.

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Our Solution
Ryan White CARE Act Reauthorization

• A new AIDS Drug Assistance Program, Title V of
  the Ryan White CARE Act

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ADAP - Title V
Ryan White CARE Act Reauthorization

• Streamlining and Modernizing the CARE Act
• Keeping the CARE Act Strong