Current Challenges to the United States’ AIDS Drug Assistance Program and Possible Implications of the Affordable Care Act

Abstract

AIDS Drug Assistance Programs, enacted through the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, are the “payer of last resort” for prescription medications for lower income, uninsured, or underinsured people living with HIV/AIDS. ADAPs face declining funding from the federal government. State funding of ADAP is discretionary, but some states increased their contributions to meet the gap in funding. The demand for ADAP support is increasing as people living with HIV are living longer; the antiretroviral therapy (ART) guidelines have been changed to recommend initiation of treatment for all; the United States is increasing HIV testing goals; and the recession continues. In the setting of increased demand and limited funding, ADAPs are employing cost containment measures. Since 2010, emergency federal funds have bailed out ADAP, but these are not sustainable. In the coming years, providers and policy makers associated with HIV care will need to navigate the implementation of the Affordable Care Act (ACA). Lessons learned from the challenges associated with providing sustainable access to ART for vulnerable populations through ADAP should inform upcoming decisions about how to ensure delivery of ART during and after the implementation of the ACA.

PPACA and Low-Income People Living with HIV: 2014 Qualified Health Plan Enrollment in a Medicaid Nonexpansion State

“…7 ADAP is funded through annual federal allocations and discretionary state support; federal funding has declined in the last few years. 8 Although many ADAP clients in Medicaid expansion states are being shifted to public insurance, in Medicaid nonexpansion states the need for continued strong ADAP funding persists because ADAPs fund direct provision of medications or support patients' enrollment in QHPs. In addition, consideration should be given to redirecting ADAP funds that have been spent on medications to provide support for services not currently covered by insurance programs such as case management, adherence support, and housing assistance that have improved HIV outcomes.…”

The Prospect Of A Generation Free Of HIV May Be Within Reach If The Right Policy Decisions Are Made

“…22,43 Disruptions in treatment, however, reduce the clinical and public health benefits of cART. 31,32 This not only makes today's spending on HIV drugs less cost-effective, but it also reduces future cost savings from reduced HIV incidence resulting from the preventive benefits of cART.…”

The Affordable Care Act and the Burden of High Cost Sharing and Utilization Management Restrictions on Access to HIV Medications for People Living with HIV/AIDS

“…2 Individuals who cannot suppress their viral loads are also at increased risk of acquiring AIDS and transmitting the virus to others. 2,3,4 Viral load suppression is one of the primary public health goals for People Living with HIV/AIDS (PLWHA), and a high priority for maintaining and ensuring a high quality of life and wellbeing for these individuals. 5,6 The US Centers for Disease Control and Prevention (CDC) estimates that 76% of individuals who are in care achieve viral load suppression, highlighting the importance of encouraging HIV-infected individuals to get into care as soon as possible, and stay in care.…”

“…14 Poor medication adherence can lead to reduced health outcomes for PLWHA and an increase in drug resistant HIV strains that can be transmitted to others. 3,15,16 Because of the strong connection between poverty and vulnerability to HIV infection, prodigious attention has been focused on the HIV/AIDS epidemic in the impoverished city of Detroit, Michigan, a region devastated by economic and financial struggle in recent years. According to 2013 estimates, Detroit has the highest HIV prevalence rate in Michigan, at 7040 per 100,000 individuals.…”

“…Access to life-saving ART medications is one of the most crucial components of appropriate health care services for PLWHA. 1,3 Adequate access to ART for PLWHA is a top priority for Michigan's Statewide Coordinated Statement of Need and CDC's strategic HIV prevention plan. 6,17 The prominent need for HIV Care services in Michigan generally, and Detroit in particular, underscores the importance of examining the impact of the ACA in making health care more affordable for this population of great need in Michigan.…”