Introduction: ADAP – AIDS Drug Assistance Program
ADAP is a program that provides access to medications used to treat HIV and prevent the onset of related opportunistic infections. The treatment and medications are to be provided to low-income individuals with HIV disease who have limited or no coverage from private insurance. The Department of Health Services in every state of the United States of American is responsible for the administration of ADAP for the particular state. The program is funded though several Funds and governmental funding (HIV Uninsured Care Programs – Summary). The program is present in all the states, as well as in the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, the Federated States of Micronesia, American Samoa, and the Republic of the Marshall Islands (Nonprofit National Association of State Health Department, 2009).
In order to be qualified for receiving treatment and medicine from ADAP one must be HIV-infected and a resident of the state he/she is applying for it in. Granting or denying of the membership to the patient depends also on the income for the family unit. In order to be eligible for the treatment one cannot have an income of more than $ 32, 490 for a family unit of one. Additionally, to participate in the program one cannot be subject to any benefits that could pay for the medications (HIV Uninsured Care Programs – Summary, 2009).
The medications are usually distributed though the headquarters of the Apothecary shops in the main cities of the state. Medication is shipped directly to the eligible clients’ homes, furthermore, there is also an option to pick up medications at the shop headquarters (HIV Uninsured Care Programs – Summary, 2009). As for the treatment, it can be obtained by HIV positive patients in the hospitals participation in the program. Though, one of the aims of the program is to decrease hospitalizing and increase on-the-spot help.
Controversy around the ADAP Program
The program has been successful for many-many years and has saved thousands of lives all over the United States. It was initially supported an actively promoted by both the democratic and republican parties. Moreover, the program was supported actively by both parties to the point that its appropriations exceeded presidential requests every year. However, since 2003 the situation began to change. Overwhelmed by the rough start of the financial crisis politicians became more interested in solving economic problems than those of AIDS. Thus, the budget of many states that was before used for ADAP began to be used differently. As a consequence, many states became unable to provide help to those suffering from AIDS. Such state of things caused, or more correctly, did not manage to prevent several deaths, and have put many people waiting lists.
In particular, three states have tightened income eligibility requirements, five states have restricted the list of drugs they cover and treatment they provide, what is more –all in all thirteen states have started to put the applicable candidates on lengthy waiting lists (Kaplan, Tomaszewski, Gorin 2004).
The negative effects of the above are clear. What also has to be remembered is that the target group of ADAP has always been the working class people. They are the people that do not have high incomes and lack insurance, they are the people whose prescription benefits could never come close to matching the high prices of HIV drugs. Finally, they are sometimes the working poor, this makes them to be earning too much to qualify for Medicaid, though at the same time, the jobs that they hold do not provide health plans (Kaplan, Tomaszewski, Gorin, 2004).
Without a shadow of doubt, the distribution of ADAP funds varies greatly from state to state. While, in some states treatment and providing of medications gets limited, other states continue to implement the program unchangeably. It would be fair, if HIV patients from states lacking HIV treatment support could apply for help in other states. Though, such is impossible, because one should be a resident of the state to be eligible. As of now, the solutions are not found, and people continue to die without even having a chance to be helped.
Several Examples: Virginia, Alabama, Oregon, Kentucky
Starting from 2003 the waiting list of ADAP in Alabama had been growing by nine or ten people a week. In order to save the state budget the coverage for the Fuzeon – an HIV drug used primary by those who have run out of other options – was taken off. In Oregon, to cover budget deficit the state had to eliminate some Medicaid prescription coverage, and restrict several drugs. This, of course, caused the waiting lists to expand greatly (Kaplan, 2003). Same had occurred in Kentucky, where many patients have been denied of treatment they used to be receiving. Such interruption had decreased positive effects of the treatment and through the penitents several steps back into their fatal illness (Kaplan, Tomaszewski, Gorin, 2004). The waiting list in West Virginia became smaller due to deaths of several HIV patients, as well as the situation is not better in North Carolina, Colorado, and Nebraska (Kaplan, Tomaszewski, Gorin, 2004). Furthermore, Texas and Florida consider joining the list of states that are cutting back their AIDS treatment spending.
The ADAP Problem
The biggest problem regarding the discussed program is that the federal funding for the program is not linked to how many people use it. While it is linked to how many AIDS cases are diagnosed in that state. Consequently, states with high populations of people living with AIDS, but low poverty levels receive more funds than they need, while states with lower populations of people living with AIDS but high poverty levels receive far too little. Additionally, the amount of AIDS cases does not include people with HIV who do not yet have developed serious form of AIDS or people who moved to the state after, for example, being diagnosed in another state (Heys, 2004). It should be noted that waiting lists are only one cost containment measure for an ADAP in fiscal distress, but equally important are removing drugs from the formulary and further limiting financial eligibility.
Recent ADAP Statistic and its Implications
As of March 1, 2009, there are sixty-two individuals on ADAP waiting lists in three states: sixteen individuals in Indiana, nineteen in Montana, and twenty-seven in Nebraska. Of course, this number seems to be very low in comparison with the amount of four-hundred people on waiting lists in 2004 – 2005. However, as seven additional ADAPs intend to implement cost containment measures by the end of March 2010, the amount of people on the lists will go up.
In 2009 several factors were reported to contribute to anticipated or current cost. These factors, according to Nonprofit National Association of State Health Department are: “level federal funding awards, decreases in state general funding for ADAPs, higher demand for ADAP services due to increased testing efforts, higher demand for ADAP services as a result of higher unemployment, increased drug costs and insurance/Medicare Part D wrap-around costs” (Nonprofit National Association of State Health Department, 2009).
Additionally, new cost-containment measures will be taken in California, Hawaii, Kentucky, Maine, North Dakota, Vermont, and Washington before March, 2010. Thus, we can see that both small states and big states suffer from the cost-cuts on ADAP. Though, it is obvious, that while bigger states, if choose to, could find sources to support the program on the needed level, while smaller states would never manage to do so.
Recent studies have also indicated that HIV/AIDS infection rates are on the rise most in rural and suburban areas. In addition to that, most impacted populations are now ethnic minorities. Thus, currently it is time for the ADAP funding to adapt to these demographic changes. To carry out the adaptation the targets should be move from urban population centers to more appropriately disburse funds to where they are most needed.
Without a question solutions should be found to improve the conditions of AIDS patients eligible for ADAP. It is so important to take actions on the matter because the effect on large numbers of low income HIV individuals the current situation has is horrifying, moreover, this situation worsens the health of HIV positive individuals and is also dangerous to public health in general.
In my opinion, the Congress should review the CARE Act, and should seriously think of revising the act to make it fit current needs. Some services suggested by the act, should be reevaluated and more funds should be made available for AIDS drugs and treatment. Additionally, ADAP program must be reformed in such a way that provides more help for distressed states without providing too much money for those states that already receive sufficient funding for their ADA Programs. The lives of many people are in the hands of this program, though it is rather complicated to reform it in such a way that would allow more balanced funding for individual states based on their unique challenges each of them has.
In several states the officials suggest ADAP funds to be cut further, advocating this solution by the fact that it would help to avoid future cost-cutting in 2010-2011. Though, such explanation does not make sense, many people require help right now, and they should not be denied of this help because of an excuse that several years later they would be able to get it (Levy, 2009).
The actions of Bush Administration in regards to ADAP program have been devastating. Because of inappropriate distribution of funds, many people die without receiving treatment, and many more are currently on waiting lists. It is obvious that, people infected with HIV do not have time to stand in line and wait around for treatment, because for these people every minute counts. What makes the problem even more serious is that people affected are those with very low incomes, and no connection that could be used to assist the situation. Thus, it should be only hoped that new president would reconsider funds’ distribution and would return the program to the way it used to function in late eighties and all through the nineties.
Though, I consider that problems with funding are not the only barrier on the way of successful ADAP implementation. I believe that, though being effective, several ADAP policies need to be changed. First of all, I think that it should be possible for a patient to turn to ADAP headquarters in every state, no matter if he/she is its resident or not. Additionally, I consider that funds should not be distributed only based on the data on the amount of infected in the state, but also based on wide set of factors. I even think that problems with the ADAP funding formula contribute to the need for caps and cutbacks that some ADAPs implement, thus the formula should be altered. However, without disregarding the above weaknesses of ADAP one must remember that ADAP saves people’s lives, especially lives of those who lost hope to be saved.
Department of Health and Human Services (January 2005). “A Pocket Guide to Adult HIV/AIDS Treatment January 2005 edition”. Retreieved on April 23, 2009 from <http://www.hab.hrsa.gov/tools/HIVpocketguide05/PktGARTtables.htm>.
Heys, J. (2003). “Funding Cuts Hurt AIDS program – Patients Dying Awaiting Drugs”. THE CHARLESTON GAZETTE – Charleston. Retrieved on April 24, 2009 from <http://www.aegis.com/news/newsday/2003/ND031101.html>
HIV Uninsured Care Programs – Summary. Retrieved on April 24, 2009 from <http://www.health.state.ny.us/diseases/aids/resources/adap/index.htm>
Kaplan, L.E., Tomaszewski, E., Gorin, S. (2004). “Current Trends and the Future of HIV/AIDS Services: A Social Work Perspective”. Health and Social Work, Vol. 29.
Levy J.A. (2009). “Not an HIV Cure, but Encouraging New Directions”. N Engl J Med 360 (7): 724–725.
Nonprofit National Association of State Health Department the Adap Watch. (2009). Retrieved on April 25, 2009 from <www.nastad.org/Docs/Public/InFocus/200948_NASTAD%20ADAP%20Watch%20-%204-09.pdf>.
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