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NATIONAL ADAP MONITORING PROJECT 2015 ANNUAL REPORT
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ACKNOWLEDGEMENTS The National Alliance of State & Territorial AIDS Directors (NASTAD) thanks state ADAP and AIDS program managers and staff for their time and effort in completing the National ADAP Monitoring Survey, which serves as the foundation for this report, and for providing ongoing updates to inform the National ADAP Monitoring Project. NASTAD also thanks Lanny Cross, NASTAD consultant, for his valuable contributions to NASTAD’s ADAP Monitoring and Technical Assistance Program. Finally, without the guidance and support from Murray Penner, NASTAD Executive Director, this report would not be possible. The National ADAP Monitoring Project is one component of NASTAD’s National ADAP Monitoring and Technical Assistance Program which provides ongoing technical assistance to all state and territorial ADAPs. The program also serves as a resource center, providing timely information on the status of ADAPs, particularly those experiencing resource constraints or other challenges, to national coalitions and organizations, policy makers, industry members, and state and federal government agencies. NASTAD received support for the National ADAP Monitoring and Technical Assistance Program in 2014 from the following companies: AbbVie, Bristol-Myers Squibb, Gilead Sciences, Janssen Therapeutics and ViiV Healthcare. NASTAD also receives funding to provide technical assistance to ADAPs through a Training and Technical Assistance Cooperative Agreement with the Health Resources and Services Administration (HRSA). Amanda Bowes, Ann Lefert, and Britten Pund are the contributing authors and editors of this document.
Murray C. Penner, Executive Director Maria Courogen, Washington, Chair May 2015
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NATIONAL ADAP MONITORING PROJECT
THE REFORMATION OF ADAP: INTEGRATION INTO A CHANGING HEALTH SYSTEM The AIDS Drug Assistance Program (ADAP) was introduced as a line item in the then Title II (now Part B) of the federal Ryan White Program appropriation in 1996. This represented the first time that low-income, under and uninsured individuals had relatively unrestricted access to HIV antiretroviral (ARV) medications. In 2000, the program was expanded to allow for the purchase of insurance for individuals who could otherwise not afford coverage. While several states chose to purchase insurance for clients, it was not until the implementation of the Affordable Care Act (ACA) in 2013 that ADAPs significantly shifted services to include purchasing or continuing insurance for its clients. Today, ADAPs provide life-saving HIV treatments to low income, uninsured, and underinsured individuals living with HIV/AIDS in all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, American Samoa, the Federated States of Micronesia, Guam, the Northern Mariana Islands, Republic of Palau and the Republic of the Marshall Islands. Most ADAPs also provide private insurance continuation and Medicare Part D and Medicaid wrap-around services to eligible individuals. The structure of ADAP has changed in the past two decades, taking the form of a two-pronged program to provide: 1) the full purchase of medications and/or 2) the purchase of insurance coverage or payment of co-payments/coinsurance or deductibles — on behalf of eligible individuals. And ADAP continues to evolve in order to interact with the changing health system and to meet the needs of people living with HIV (PLWH). Through this transition, it is important to understand the basics of ADAP.
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The Funding to Provide Services The total ADAP budget remained constant between FY2013 and FY2014 at $2.01 billion. • In FY2014, the ADAP earmark was $782 million. The earmark was onequarter of the total ADAP budget in FY1996, the year it was created, rose to more than two-thirds (68%) of the budget in FY2000 and has most recently declined as a share of the overall budget to 35% in FY2014. The ADAP earmark itself decreased by 1% from FY2013, when ADAPs experienced a 5% decrease to all federal funding sources.
• Drug rebates accounted for $960.3 million, or 43%, of the overall ADAP budget in FY2014. This funding represents money that is paid to the state by manufacturers as a result of active filing of rebate claims based on drug purchases.
• State contributions accounted for $233.2 million, or 11%, of the overall ADAP budget in FY2014.
The Individuals Seeking Service from ADAP • Race/Ethnicity: Thirty-five percent of clients served by ADAP in June 2014 were NonHispanic Black/African American while 31% and 28% were Non-Hispanic White and Hispanic, respectively. • Gender: The majority (71%) of clients served by ADAP in June 2014 were male. Twenty-seven percent were female, 0.4% were transgender and 2% were reported as gender unknown. • Age: The overwhelming majority (90%) of clients served by ADAP in June 2014 were between the ages of 25 and 64 years; 40% were aged 25 – 44 years while 50% were aged 45 – 64 years. • Income Level: The majority (56%) of clients served by ADAP in June 2014 had incomes below 138% of the Federal Poverty Line (FPL).1 In 2014, the ACA expanded Medicaid eligibility to most people with income up to 133% of the federal poverty level (FPL). However, in addition to new income accounting rules for most Medicaid populations (called “Modified Adjusted Gross Income”), there is an additional 5% disregard of income in calculating eligibility, effectively bumping the Medicaid income eligibility threshold to 138% FPL.
1 The 2014 Federal Poverty Level (FPL) was $11,670 (slightly higher in Alaska and Hawaii) for a household of one.
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The Service Being Provided The distribution of drug expenditures and prescriptions provided within ADAPs varies across the country, reflecting differing formularies and prescribing patterns. ARVs, the standard of care for HIV, account for the majority of ADAP drug expenditures and prescriptions filled. ADAP drug expenditures were $159,108,884 in June 2014, ranging from a low of $51,881 in North Dakota, to a high of $28.5 million in California (see Table 20).
In June 2014, the average expenditures per prescription were significantly higher for ARVs ($401) than non-ARVs ($69 for “A1” OIs and $42 for all other drugs).
ADAPs purchase or continue insurance and pay for premiums, co-payments and deductibles on behalf of ADAP clients, closely interacting with existing other payer sources. ADAP payment of client co-payments was 20% of overall drug purchases (see Table 22).
Twenty-four states reported 40% or more of total ADAP drug expenditures spent on co-payments in June 2014.
The information contained in this Report outlines how ADAP has evolved as a result of its growth and health care system changes.
FACT 1:
Since the advent of ADAP being able to purchase insurance, the overall structure of the program has not changed. The structure of the program, a twopronged approach to purchasing medications at full cost or purchasing insurance, has not shifted dramatically since 2003. The proportion of clients served by each Composition of ADAP Clients Served, June 2002 and June 2014
61,456 (42%)
5,272 (7%) 85,416 (58%) 74,763 (93%)
Uninsured Individuals Insured Individuals
June 2002
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June 2014
approach has changed dramatically. As ADAPs have honed their program structures and worked to meet the infrastructure needs of supporting a two-pronged program, they have gained the ability to serve more clients. The number of uninsured clients served by ADAP increased by 84% between 2002 and 2014. By comparison, the number of insured clients served by ADAP increased by 1066% between 2002 and 2014.
FACT 2:
Health reform has been implemented differently in states, creating new disparities and illuminating further stressors on the public health system in the US. This has acutely impacted ADAP – causing a divide among states and regions and their ability to provide comprehensive services to clients. Medicaid expansion under the ACA extends Medicaid eligibility to 138% FPL regardless of disability, family status, financial resources and other individual factors that impact eligibility decisions in non-expansion states. The ACA requires newly eligible Medicaid beneficiaries (those ineligible under past Medicaid law, but who Current Status of State Medicaid Expansion Decisions NH
VT WA
ME ND
MT
MA
MN
OR SD
ID
NY
WI
MI
CT
WY
PA
IA
NE
NV
IL
DE WV
CO
MO
KS
VA NC
OK
NM
DC
SC
AR MS
GA
AL
AK TX
Adopted (29 States including DC) Adoption under discussion (6 States)
MD
KY TN
AZ
NJ
OH
IN
UT CA
RI
Not Adopting at this time (16 States)
LA FL
HI
State Health Insurance Marketplace Types, 2015 NH
VT WA
ME ND
MT
MA
MN
OR
WI
SD
ID
NY CT PA
IA
NE
NV
IL
OH
IN
CA
MO
KS
VA
OK
NM
NC
MS
AL
State-based Marketplace
GA
LA FL
HI
DC
StatePartnership Marketplace
SC
AR
AK TX
MD
KY TN
AZ
NJ DE
WV
UT CO
RI
MI
WY
Federallyfacilitated Marketplace
Federallysupported State-based Marketplace
Source: Kaiser Family Foundation
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are eligible post-expansion) to have access to a benchmark benefits package that includes ten categories of essential health benefits; this benchmark is not available in non-expansion states. The ACA also established Marketplaces to create a convenient electronic platform for eligible individuals to shop for health insurance coverage. In addition to enrolling eligible individuals into health insurance coverage, Marketplaces screen for Medicaid eligibility and administer premium tax credits and cost-sharing reductions for Qualified Health Plans, as applicable. Based on ADAPs assessments of which plans to purchase for their clients, the majority of HIV ARVs were reported as being covered by at least one private insurance plan within each state. However, nine HIV ARVs were reported as not being covered by at least one private insurance plan available in a state, in or out of the ACA marketplace, including: amprenavir, APV (Agenerase) (n = 7, 15%); tenofovir, disproxil fumarate, TDF (Viread) (n = 2, 4%); and tenofovir disoproxil fumarate and emtricitabine (Truvada) (n = 2, 4%). The HIV ARVs reported by an ADAP as not being covered by at least one private insurance plan were: abacavir, zidovudine, lamivudine (Trizivir); cobicistat, elvitegravir, emtricitabine, tenofovir disoproxil fumarate (Stribild); efavirenz, emtricitabine, tenofovir disproxil fumarate (Atripla); emtricitabine, rilpivirine, tenofovir disoproxil fumarate (Complera); stavudine, d4T (Zerit); and zidovudine, azidothymidine, AZT, ZDV.
FACT 3:
ADAPs provide a safety-net that bends and stretches to ensure that PLWH receive access to medications. ADAPs are a leader within the Ryan White Program on linkage to and retention in care, demonstrating improved health outcomes. ADAPs play a critical role in efforts to end the HIV epidemic nationally by having a measurable impact on multiple “bars” within the HIV prevention to care continuum, most notably linkage to and retention in care and treatment. ADAPs’ support of insurance and direct provision of ARV therapy and other medications to PLWH is necessary in order for clients to achieve optimal health outcomes including viral load suppression. Viral load suppression in turn greatly reduces HIV transmission and rates for new infections. In addition to viral load suppression, improved access to care and treatment is associated with elevations in CD4 count and reductions in PLWH’s progression to CDC-defined AIDS.2 • The majority (63%) of all clients served by ADAPs in June 2014 were reported as virally suppressed, defined as having a viral load that is less than or equal to 200 copies/mL. Eleven percent of clients served in June 2014 were reported as having had a viral load recorded as greater than 200 cells/mL while 26% were reported as having an unknown viral load (see Table 14). Rates for viral load suppression were calculated based on the most recent viral load recorded for each client as of 2 The AIDS case definition used as part of this Survey may be found here and is consistent with the most recent ADAP Data Report (ADR) submission. The ADR is the reporting system through which ADAP grantees must submit quarterly reports to HRSA as part of the funding requirements. More information on the ADR may be found here. CDC released an updated case definition in April 2014 (located here).
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June 30, 2014 among those served by the ADAP program in June 2014 (including those clients not on ARV medications). If a client did not receive a viral load during June 2014, ADAPs reported based on the last viral load recorded for that individual prior to June 30, 2014. • Forty-two percent of all clients served by ADAPs in June 2014 had a CD4 count recorded as greater than 500 cells/mm3. Thirty-six percent of clients served had a CD4 count less than or equal 500 cells/mm3 while 22% were reported as having an unknown CD4 count (see Table 13). CD4 count data were calculated based on the most recent CD4 count recorded for each client as of June 30, 2014 among those served by the ADAP program in June 2014 (including those clients not on antiretroviral medications). If a client did not receive a CD4 count during June 2014, ADAPs reported based on the last CD4 count recorded for that individual prior to June 30, 2014. • Clients served by ADAPs during June 2014 were reported as having the following HIV statuses: Thirty-four percent were “HIV-positive, not AIDS” Twenty-eight percent were “HIV-positive, AIDS status unknown” Twenty-six percent were “CDC-defined AIDS” Twelve percent were “Unknown” Engagement in ADAP 258,469 (100%)
238,253 (92%)
ADAP client enrollment – the number of clients enrolled in ADAP in FY2013 211,945 (82%)
175,759 (68%)
ADAP client utilization – the number of clients served by ADAP (receiving medications) in FY2013 ADAP client retention – the number of clients who were successfully recertified by ADAP twice in a 12-month period of time
ADAP client enrollment
ADAP client utilization
ADAP client ADAP client retention health outcome
ADAP client health outcome – the number of ADAP clients who reported an increased CD4 count over a 12-month period of time
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FACT 4:
ADAP clients are obtaining new forms of coverage. People are moving to Medicaid and are thriving; ADAP is no longer necessary for the majority of those individuals. People are moving to private insurance options; ADAP is remaining the primary payer. People are, in some instances for the first time, able to access insurance and comprehensive health services beyond those covered through the Ryan White Program. ADAPs have spent considerable time over the past year assisting its clients in transitioning to new forms of coverage; as a direct result, ADAP enrollment is shifting. • ADAPs served over 146,000 clients in June 2014, representing a 4% decrease overall from June 2013. Sixteen (16) ADAPs reported increases of 5% or more clients served while twenty-one (21) reported decreases of 5% or more in the number of clients served. For the purposes of this Report, ADAP clients are considered to be enrolled in either the full-pay medication program or the insurance program. Full-pay medication program clients are defined as those individuals who receive medications paid in full by ADAP with no coordination of insurance or benefits. Insurance program clients are defined as those who have some type of coverage other than ADAP (i.e., private insurance, Medicaid, Medicare) and ADAP pays the premiums, deductibles and/or co-payments/coinsurance on behalf of clients. Over 85,000 clients (58%) were served by an ADAP’s full-pay medications program only. Over 58,000 clients (40%) were served by an ADAP-funded insurance program only.3 Over 3,000 clients (2%) were served by ADAP’s full-pay medications and insurance programs.4 • During ADAP FY2013 (April 1, 2013 – March 31, 2014), 258,469 clients were enrolled nationwide in ADAPs. Client enrollment ranged from 129 individuals in Alaska to 41,192 in California in FY2013. Fewer clients are typically served in ADAPs than are enrolled at any given time—ADAPs served 238,253 clients in FY2013 (see Table 5). Over 144,000 clients (60%) were served by an ADAP’s full-pay medications program only. Over 78,000 clients (33%) were served by an ADAP-funded insurance program only.5 Over 15,000 clients (7%) were served by ADAP’s full-pay medications and insurance programs.6 3 Individuals who had an insurance (i.e., Medicare Part D, Medicaid, private insurance) payment (premium, copayment/co-insurance, and/or deductible) paid on their behalf using ADAP funds, either fully or in part. 4 This includes clients who enrolled in an insurance plan mid-year and those who were enrolled in an insurance plan that did not cover one or more medically necessary medications such that the ADAP’s full-pay prescription program did instead. 5 Individuals who had an insurance (i.e., Medicare Part D, Medicaid, private insurance) payment (premium, copayment/co-insurance, and/or deductible) paid on their behalf using ADAP funds, either fully or in part. 6 This includes clients who enrolled in an insurance plan mid-year and those who were enrolled in an insurance plan that did not cover one or more medically necessary medications such that the ADAP’s full-pay prescription program did instead.
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• Seventeen ADAPs (36%) reported that they provide services to individuals incarcerated in county or city jails.7 Of these, six reported having used federal funds to support this provision and one reported having used state funds. Ten ADAPs used a combination of federal and state funds. ADAP Clients by Type of Coverage, June 2014
61,456 (42%)
85,416 (58%)
105,807 (20%)
431,694 (80%)
$182 (10%)
$1,672 (90%) Uninsured/ full-pay Insured/ partial pay
ADAP clients served
ADAP prescriptions filled
Average cost per client
FACT 5:
People living with HIV enrolled in ADAP cannot afford insurance. ADAP remains the primary payer for those individuals. The Ryan White Program allows states to use ADAP dollars to purchase health insurance and pay insurance premiums, co-payments and/or deductibles for individuals eligible for ADAP, provided the insurance has comparable formulary benefits to that of the ADAP. States are increasingly using ADAP funds for this purpose. • Twenty-eight (58%) ADAPs reported that they pay premiums on behalf of clients. Twenty-eight (58%) ADAPs reported that they pay deductibles while 32 (67%) pay co-payments/co-insurance costs (prescriptions only) and 9 (19%) pay copayments/co-insurance costs (medical only).8 • Forty-five ADAPs reported using funds for insurance purchasing/continuation in 2014 representing $421 million in estimated expenditures in FY2014. ADAPs reported spending over $110.7 million on insurance purchasing/continuation in June 2014 (see Table 26). By comparison, forty-four ADAPs used funds for insurance purchasing/continuation in 2013, totaling $397 million in FY2013 and $27.6 million in June 2013. 7 In September 2007, the HIV/AIDS Bureau (HAB) updated their policy describing the use of Ryan White HIV/AIDS Program funds for transitional social support and primary care services for incarcerated persons. The policy supports the use of Ryan White HIV/AIDS Program funds for incarcerated persons as they prepare to exit the correctional system as part of effective discharge planning or when they are in the correctional system for a brief period, which would not include any discharge planning. More information on the policy may be found here. 8 Federal ADAP funds cannot be used to pay for medical co-payments/co-insurance.
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• In June 2014, 61,456 ADAP clients were covered by such arrangements (see Chart 21 and Table 25). Clients served through insurance coordination increased 17% from June 2013 (52,568 clients served). Among clients who received insurance purchasing/continuation services: 8,264 (13%) had premiums payments only made on their behalf; 26,886 (44%) had deductible/co-payment/co-insurance payments only made on their behalf; and 25,515 (42%) had premiums and deductible/co-payment/co-insurance payments made on their behalf. • In June 2014, the average cost per client was $1,672 for drug purchases/copayments and $182 for insurance purchasing and continuation. ADAP Clients Served, by Other Payers, June 2014
4%
8%
2% 2% 1%
Medicaid Medicaid and Medicare Medicare Part D Full Subsidy 19
8% 50%
Medicare Part D Partial Subsidy Medicare Part D Standard Benefit Private Insurance Coverage
24%
No Form of Insurance Unknown
The landscape of public health and the overall health system has changed over time, presenting new opportunities for access to care for vulnerable populations but also illuminating existing and continued gaps to access care. ADAPs have navigated the processes of change and growth to remain relevant by expanding and updating its structure, assisting clients in accessing new forms of medications and medical coverage, and maintaining and providing vital and enabling services that bolster those available through the Ryan White Program.
9 Asset limits for full- vs. partial-subsidy under Medicare Part D may be found here.
12
13
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METHODOLOGY Since 1996, NASTAD’s National ADAP Monitoring Project has surveyed all jurisdictions receiving federal ADAP earmark funding through the Ryan White Program. In FY2014, 59 jurisdictions received earmark funding and were surveyed; 48 responded. American Samoa, Delaware, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont, and Virgin Islands (U.S.) did not respond. This 20th release of the Annual Report updates prior findings with data from ADAP’s fiscal year 2014 as well as a detailed snapshot of data from the month of June 2014. The Annual Report reflects the latest available data and discusses recent policy and programmatic changes affecting ADAPs. The annual survey requests data and other program information for a one-month period (June), the current fiscal year, and other periods as specified. After the survey is distributed, NASTAD conducts extensive follow-up to ensure completion by as many ADAPs as possible. Data used in this report are from June 2014 and FY2014, unless otherwise noted. All data reflect the status of ADAPs as reported by survey respondents. It is important to note that some program information may have changed between data collection and the Annual Report’s release. Due to differences in data collection and availability across ADAPs, some are not able to respond to all survey questions. Where trend data are presented, only states that provided data in relevant periods are included. In some cases, ADAPs have provided revised program data from prior years and these revised data are incorporated where possible. Therefore, data from prior year reports may not be comparable for assessing trends. It is also important to note that data from a one-month snapshot may be subject to one-time only events or changes that could in turn appear to impact trends; these are noted where information is available. Data exceptions specific to a particular jurisdiction are provided in the notes section on relevant charts and tables.
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CHARTS AND TABLES Charts for each major finding, tables, with data provided by state, and a complete ADAP glossary are included in the full report. State-level data from this report are available on the NASTAD website.
Charts Chart 1:
Total ADAP Budget, FY1996-FY2014
21
Chart 2:
Total ADAP Budget, by Source, FY1996-FY2014
21
Chart 3:
Total ADAP Budget, by Source, FY2014
22
Chart 4:
Part B ADAP Earmark, FY1996-FY2014
22
Chart 5:
Part B ADAP Supplemental Funding, FY2001-FY2014
22
Chart 6:
Part B Base Contribution Directed to ADAP, FY1996-FY2014
23
Chart 7:
Part A Contribution Directed to ADAP, FY1996-FY2014
23
Chart 8:
State Contribution, FY1996-FY2014
23
Chart 9:
Estimated Drug Rebates, FY1996-FY2014
24
Chart 10:
ADAP Client Enrollment, June 2003-2014
24
Chart 11:
ADAP Client Utilization, June 1996-2014
24
Chart 12:
ADAP Clients Served and Top Ten States, by Clients Served, June 2014
25
Chart 13:
ADAP Clients Served, by Other Payers, June 2014
25
Chart 14:
ADAP Clients Served, by Race/Ethnicity, June 2014
26
Chart 15:
ADAP Clients Served, by Gender, June 2014
26
Chart 16:
ADAP Clients Served, by Age, June 2014
27
Chart 17:
ADAP Clients Served, by Income Level, June 2014
27
Chart 18:
ADAP Drug Expenditures and Top 10 States, by Drug Expenditures, June 2014
28
Chart 19:
ADAP Drug Expenditures and Prescriptions Filled (Including Drug Purchases and Co-Payments), June 2014
Chart 20:
ADAP Drug Expenditures and Prescriptions Filled (Including Drug Purchases and Co-Payments), by Drug Category, June 2014
Chart 21:
28
28
Clients Served and Estimated Expenditures in Insurance Purchasing and Continuation, 2014
29
Chart 22:
ADAP Premium Assistance, by Income Level, FY2014
29
Chart 23:
ADAP Deductible Assistance, by Income Level, FY2014
30
Chart 24:
ADAP Co-Payments/Co-Insurance (prescription only) Assistance, by Income Level, FY2014
Chart 25:
ADAP Co-Payments/Co-Insurance (medical only) Assistance, by Income Level, FY2014
Chart 26:
32
ADAP Medicare Part D Premium Assistance, by Income Medicare Benefit Level, FY2014
Chart 29:
31
ADAP Requires Client Tax Return Submission, by Income Level, FY2014
Chart 28:
31
ADAP Requires Client Takes Advance Tax Credit, by Income Level, FY2014
Chart 27:
30
32
ADAP Medicare Part D Deductible Assistance, by Income Medicare Benefit Level, FY2014
33
Chart 30:
ADAP Co-Payments Assistance, by Medicare Benefit Level, FY2014
33
Chart 31:
ADAP Medicare Part D Donut Hole Assistance, FY2014
34
Chart 32:
ADAP Eligibility, by Medicare Benefit Level, FY2014
34
Chart 33:
ADAP Provision of Services for Incarcerated Individuals, FY2014
35
Table 1:
Total Budget, FY2013 and FY2014
37
Table 2:
Total ADAP Budget, by State and by Source, FY2014
38
Table 3:
Major FY2014 Budget Categories Compared with FY2013
40
Table 4:
Cost Recovery and Other Cost-Saving Mechanisms (Excluding
Tables
Drug Rebates), FY2013
42
Table 5:
Total Clients Enrolled/Served and Program Expenditures, FY2013
44
Table 6:
Total Clients Enrolled and Served, June 2013 and June 2014
46
Table 7:
ADAP Clients Served by Other Payers, June 2014
47
Table 8:
ADAP Clients Served, by Race/Ethnicity, June 2014
48
Table 9:
ADAP Clients Served, by Gender, June 2014
49
Table 10:
ADAP Clients Served, by Age, June 2014
50
Table 11:
ADAP Clients Served, by Income Level, June 2014
51
Table 12:
ADAP Clients Served, by HIV/AIDS Status, June 2014
52
Table 13:
ADAP Clients by CD4 Count, Enrolled During 12-Month Period, June 2014
54
Table 14:
ADAP Clients by Viral Load, Enrolled During 12-Month Period, June 2014
56
Table 15:
ADAP Client Enrollment Processes, as of June 30, 2014
57
Table 16:
ADAP Client Financial Eligibility Requirements, as of June 30, 2014
58
Table 17:
ADAP Client Medical Eligibility Requirements, as of June 30, 2014
59
Table 18:
ADAP Client Eligibility Requirements, as of June 30, 2014
60
Table 19:
ADAP Drug Purchasing, June 2014
61
Table 20:
ADAP Drug Expenditures (Including Purchases and Co-payments), June 2014
Table 21:
ADAP Drug Expenditures (Including Purchases and Co-payments), by Drug Category, June 2014
Table 22:
63
ADAP Prescriptions Filled (Including Purchases and Co-payments), June 2014
Table 23:
62
64
ADAP Prescriptions Filled (Including Purchases and Co-payments), by Drug Category, June 2014
65
Table 24:
ADAP Prescription Distribution, June 2014
66
Table 25:
Clients Served Through Insurance Purchasing and Continuation, 2014
68
Table 26:
ADAP Funds Used and Clients Served Through Insurance Purchasing and Continuation, 2014
69
Table 27:
ADAP Policies Related to Insurance Purchasing as of June 30, 2014
70
Table 28:
ADAP Policies Related to Medicare Part D, as of June 30, 2014
72
Table 29:
ADAP Management Practices in Place, as of June 30, 2014
74
Table 30:
Key Dates in the History of ADAP
76
Table 31:
HIV/AIDS Antiretroviral and Opportunistic Infection Medications
77
Glossary A glossary of key ADAP terms can be found on the NASTAD website.
22
CHARTS
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
40
TABLES
37
Table 2: Total ADAP Budget, by State and by Source, FY2014
State/Territory Alabama Alaska American Samoa Arizona
Total FY2014 Budget Part B ADAP Earmark
% of Total Budget
Part B ADAP Supplemental
1
% of Total Budget
Part B Base Contribution Directed to ADAP
% of Total Budget
Part B Supplemental Directed to ADAP
% of Total Budget
$19,776,510
$10,035,042
51%
$796,339
4%
$0
0%
$0
0%
$2,390,836
$544,108
23%
$51,071
2%
$0
0%
$8,871
0.4%
$1,651
$1,651
100%
$0
0%
--
--
--
--
$28,162,067
$10,822,719
38%
$0
0%
$0
0%
$0
0%
Arkansas
$5,433,335
$4,024,255
74%
$331,264
6%
$0
0%
$0
0%
California
$453,575,244
$97,901,516
22%
$9,189,227
2%
$1,500,000
0.3%
$0
0%
Colorado
$18,440,295
$9,727,071
53%
$0
0%
$0
0%
$0
0%
Connecticut
$27,260,304
$9,109,479
33%
$0
0%
$0
0%
$33,713
0.1%
Delaware
$4,180,084
$2,680,084
64%
$0
0%
$0
0%
$0
0%
District of Columbia
$9,449,635
$9,449,635
100%
$0
0%
$0
0%
$0
0%
$0
$0
0%
$0
0%
--
--
--
--
Florida
$131,374,926
$85,493,534
65%
$6,681,392
5%
$2,700,000
2%
$0
0%
Georgia
0%
Federated States of Micronesia
$51,358,755
$31,015,825
60%
$2,911,205
6%
$0
0%
$0
Guam
$69,355
$69,355
100%
$0
0%
--
--
--
--
Hawaii
$4,114,682
$1,974,147
48%
$0
0%
$0
0%
$0
0%
Idaho
$5,371,592
$721,625
13%
$67,733
1%
$0
0%
$0
0%
Illinois
$53,939,883
$28,972,323
54%
$2,719,398
5%
$0
0%
$0
0%
Indiana
$45,773,323
$7,777,694
17%
$730,029
2%
$2,070,600
5%
$0
0%
$4,830,439
$1,697,552
35%
$132,044
3%
$0
0%
$28,913
0.6%
$22,835,557
$2,522,384
11%
$0
0%
$0
0%
$0
0%
$4,830,922
$4,830,922
100%
$0
0%
--
--
--
--
$37,362,491
$16,057,388
43%
$1,282,605
3%
$1,832,193
5%
4%
$2,424,065
$1,017,210
42%
$0
0%
$156,855
6%
$1,459,800 $0
$826
$826
100%
$0
0%
--
--
--
--
$68,017,127
$25,072,742
37%
$0
0%
$0
0%
$0
0%
Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland
0%
Massachusetts
$24,070,089
$14,426,714
60%
$0
0%
$0
0%
$0
0%
Michigan
$41,409,633
$12,409,633
30%
$0
0%
$0
0%
$0
0% 1%
Minnesota
$10,064,066
$5,979,412
59%
$0
0%
$20,383
0.2%
$64,271
Mississippi
$7,603,480
$7,603,480
100%
$0
0%
--
--
--
--
Missouri
$39,083,769
$9,872,387
25%
$0
0%
$0
0%
$0
0% 0%
Montana
$1,375,518
$362,464
26%
$27,917
2%
$114,500
8%
$0
Nebraska
$3,470,631
$1,545,631
45%
$125,000
4%
$0
0%
$0
0%
$11,564,891
$6,118,122
53%
$0
0%
$1,713,241
15%
$0
0%
Nevada New Hampshire New Jersey
$4,165,194
$965,194
23%
$0
0%
$0
0%
$0
0%
$93,647,360
$30,442,819
33%
$2,449,129
3%
$0
0%
$997,282
1%
$2,303,598
$2,299,456
100%
$0
0%
$0
0%
$0
0%
$375,444,243
$111,252,394
30%
$0
0%
$1,055,757
0.3%
$12,179,085
3%
North Carolina
$57,459,630
$22,137,530
39%
$2,077,872
4%
$0
0%
North Dakota
$1,437,458
$174,214
12%
$13,856
1%
$49,388
3%
$1,747,084 $0
0%
New Mexico New York
Northern Mariana Islands Ohio
3%
$9,082
$9,082
100%
$0
0%
--
--
--
--
$28,529,871
$15,879,871
56%
$0
0%
$0
0%
$0
0% 0%
Oklahoma
$16,013,111
$4,401,580
27%
$0
0%
$825,531
5%
$0
Oregon
$36,315,598
$4,645,149
13%
$0
0%
$0
0%
$0
0%
Pennsylvania
$95,045,318
$28,128,501
30%
$0
0%
$416,817
0.4%
$0
0%
$23,754,044
$15,924,457
67%
$1,304,273
5%
$71,074
0.3%
$1,923,247
8%
$653
$653
100%
$0
0%
--
--
--
--
$1,918,436
$1,776,815
93%
$141,621
7%
--
--
--
--
$33,567,631
$12,876,129
38%
$1,032,646
3%
$0
0%
$0
0% 0%
Puerto Rico Republic of Palau Rhode Island South Carolina
$1,598,316
$396,316
25%
$0
0%
$22,000
1%
$0
$48,837,811
$14,034,527
29%
$1,317,307
3%
$5,283,858
11%
$1,268,395
3%
Texas
$120,889,316
$59,979,065
50%
$5,629,751
5%
$0
0%
$0
0%
Utah
0.6%
South Dakota Tennessee
$6,360,342
$2,104,601
33%
$167,772
3%
$779,556
12%
$37,904
Vermont
$370,720
$370,720
100%
$0
0%
--
--
--
--
Virgin Islands (U.S.)
$537,207
$497,046
93%
$40,161
7%
--
--
--
--
Virginia
$49,697,868
$17,906,035
36%
$1,680,695
3%
$2,969,329
6%
$323,524
1%
Washington
$38,935,074
$9,721,292
25%
$0
0%
$0
0%
$0
0%
$6,600,315
$1,400,315
21%
$0
0%
$0
0%
$0
0%
Wisconsin
$27,812,566
$4,579,097
16%
$429,803
2%
$425,000
2%
$0
0%
Wyoming Total
$1,464,830 $2,212,331,573
$236,138
16% 35%
$22,165 $41,352,275
2% 2%
$275,484 $22,281,566
19% 1%
$0
0% 1%
West Virginia
1
$781,975,926
$20,072,089
Part B ADAP supplemental awards were provided to 27 states that met federal eligibility criteria, applied for funding, and were able to meet the mandated matching requirement or receive a waiver.
Note: 48 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island and Vermont did not respond. The total FY2014 budget includes federal, state, and drug rebates. A dash (--) indicates the ADAP did not report data.
38
Table 2: Total ADAP Budget, by State and by Source, FY2014 (continued) ADAP Emergency Funding
% of Total Budget
Part A Contribution Directed to ADAP
% of Total Budget
State Contribution
% of Total Budget
Estimated Drug Rebates
$3,638,484
18%
$0
0%
$4,306,645
22%
$1,000,000
5%
$686,786
29%
$0
0%
$0
0%
$0
0%
$0
0%
--
--
--
--
--
--
--
--
$1,651
$792,146
3%
$0
0%
$1,000,000
4%
$15,547,202
55%
$0
0%
$28,162,067
% of Other State or Total Federal Budget
% of Total Budget
Total FY2014 Budget
$0
0%
$19,776,510
$1,100,000
46%
$2,390,836
$0
0%
$0
0%
$82,816
2%
$995,000
18%
$0
0%
$5,433,335
$11,000,000
2%
$0
0%
$53,644,944
12%
$278,601,026
61%
$1,738,531
0.4%
$453,575,244
$0
0%
$0
0%
$4,513,224
24%
$4,200,000
23%
$0
0%
$18,440,295
$0
0%
$0
0%
$0
0%
$18,117,112
66%
$0
0%
$27,260,304
$0
0%
$0
0%
$0
0%
$1,500,000
36%
$0
0%
$4,180,084
$0
0%
$0
0%
$0
0%
$0
0%
$0
0%
$9,449,635
$0
0%
--
--
--
--
--
--
--
--
$0
$11,000,000
8%
$0
0%
$10,500,000
8%
$15,000,000
11%
$0
0%
$131,374,926
$2,541,600
5%
$2,027,000
4%
$11,587,504
23%
$1,257,439
2%
$18,182
0.04%
$51,358,755
$0
0%
--
--
--
--
--
--
--
--
$69,355
$0
0%
$0
0%
$440,535
11%
$1,700,000
41%
$0
0%
$4,114,682
$770,295
14%
$0
0%
$701,800
13%
$3,110,139
58%
$0
0%
$5,371,592
$5,411,162
10%
$0
0%
$14,850,000
28%
$1,987,000
4%
$0
0%
$53,939,883 $45,773,323
$0
0%
$195,000
0%
$0
0%
$35,000,000
76%
$0
0%
$923,948
19%
$0
0%
$547,982
11%
$1,500,000
31%
$0
0%
$4,830,439
$0
0%
$0
0%
$10,829,714
47%
$9,483,459
42%
$0
0%
$22,835,557
$0
0%
--
--
--
--
--
--
--
--
$4,830,922
$3,034,961
8%
$5,500
0.01%
$0
0%
$13,690,044
37%
$0
0%
$37,362,491
$0
0%
$0
0%
$50,000
2%
$1,200,000
50%
$0
0%
$2,424,065
$0
0%
--
--
--
--
--
--
--
--
$826
$0
0%
$0
0%
$0
0%
$42,930,000
63%
$14,385
0.02%
$68,017,127
$0
0%
$250,000
1%
$1,893,375
8%
$7,500,000
31%
$0
0%
$24,070,089
$0
0%
$0
0%
$0
0%
$29,000,000
70%
$0
0%
$41,409,633
$0
0%
$0
0%
$0
0%
$4,000,000
40%
$0
0%
$10,064,066
$0
0%
--
--
--
--
--
--
--
--
$7,603,480
$0
0%
$0
0%
$3,290,796
8%
$25,692,980
66%
$227,606
1%
$39,083,769
$232,287
17%
$0
0%
$200,000
15%
$400,000
29%
$38,350
3%
$1,375,518
$0
0%
$0
0%
$900,000
26%
$900,000
26%
$0
0%
$3,470,631
$0
0%
$0
0%
$625,278
5%
$3,108,250
27%
$0
0%
$11,564,891
$0
0%
$0
0%
$0
0%
$3,200,000
77%
$0
0%
$4,165,194
$5,758,130
6%
$0
0%
$0
0%
$54,000,000
58%
$0
0%
$93,647,360
$0
0%
$0
0%
$0
0%
$0
0%
$4,142
0.2%
$2,303,598
$0
0%
$8,796,739
2%
$28,750,000
8%
$195,910,268
52%
$17,500,000
5%
$375,444,243
$3,000,000
5%
$0
0%
$14,797,144
26%
$10,000,000
17%
$3,700,000
6%
$57,459,630
$0
0%
$0
0%
$0
0%
$1,200,000
83%
$0
0%
$1,437,458
$0
0%
--
--
--
--
--
--
--
--
$9,082
$0
0%
$0
0%
$650,000
2%
$8,000,000
28%
$4,000,000
14%
$28,529,871
$0
0%
$0
0%
$786,000
5%
$6,000,000
37%
$4,000,000
25%
$16,013,111
$0
0%
$0
0%
$123,724
0.3%
$4,667,629
13%
$26,879,096
74%
$36,315,598
$0
0%
$0
0%
$6,000,000
6%
$60,500,000
64%
$0
0%
$95,045,318
$3,596,177
15%
$0
0%
$0
0%
$919,280
4%
$15,536
0.1%
$23,754,044
$0
0%
--
--
--
--
--
--
--
--
$653
$0
0%
--
--
--
--
--
--
--
--
$1,918,436
$0
0%
$0
0%
$5,658,856
17%
$14,000,000
42%
$0
0%
$33,567,631
$0
0%
$0
0%
$0
0%
$1,180,000
74%
$0
0%
$1,598,316
$7,485,930
15%
$747,794
2%
$7,200,000
15%
$11,500,000
24%
$0
0%
$48,837,811
$0
0%
$152,221
0.1%
$32,010,159
26%
$22,800,000
19%
$318,120
0.3%
$120,889,316
$1,327,143
21%
$0
0%
$0
0%
$1,500,000
24%
$443,366
7%
$6,360,342
$0
0%
--
--
--
--
--
--
--
--
$370,720
$0
0%
--
--
--
--
--
--
--
--
$537,207
$11,000,000
22%
$116,644
0.2%
$5,681,266
11%
$10,020,375
20%
$0
0%
$49,697,868
$0
0%
$0
0%
$4,905,231
13%
$16,148,254
41%
$8,160,297
21%
$38,935,074
$0
0%
$0
0%
$0
0%
$5,200,000
79%
$0
0%
$6,600,315
$412,461
1%
$0
0%
$6,345,520
23%
$15,620,685
56%
$0
0%
$27,812,566
$0 $72,611,510
0% 3%
$0 $12,290,898
0% 1%
$367,500 $233,240,013
25% 11%
$549,427 $960,335,569
38% 43%
$14,116 $68,171,727
1% 3%
$1,464,830 $2,212,331,573
39
Table 3: Major FY2014 Budget Categories Compared with FY2013
State/Territory Alabama Alaska
2013 Part B Base Contribution Directed to ADAP
2014 Part B Base Contribution Directed to ADAP
% Change
2013 Part B Supplemental Directed to ADAP
$796,339
0%
$321,420
$0
-100%
$155,153
$0
-100%
$3,434,816
$51,071
11%
$0
$0
0%
$0
$8,871
100%
$247,239
2013 Part B ADAP Supplemental
2014 Part B ADAP
$10,035,042
3%
$796,339
$544,108
-3%
$45,984
2014 Part B ADAP Earmark
$9,747,521 $562,869
2014 Part B Supplemental Directed % Change to ADAP
% Change
% Change
2013 Part B ADAP Earmark
Supplemental
1
2013 ADAP Emergency Funding
$1,651
$1,651
0%
$0
$0
0%
--
--
--
--
--
--
--
$10,543,186
$10,822,719
3%
$861,342
$0
-100%
$0
$0
0%
$194,284
$0
-100%
$792,146
Arkansas
$4,173,720
$4,024,255
-4%
$331,264
$331,264
0%
$0
$0
0%
$64,621
$0
-100%
$0
California
$98,380,203
American Samoa Arizona
Colorado Connecticut Delaware District of Columbia
$97,901,516
0%
$7,713,428
$9,189,227
19%
$1,494,000
$1,500,000
0.4%
$1,738,531
$0
-100%
$10,761,268
$9,509,736
$9,727,071
2%
$776,913
$0
-100%
$0
$0
0%
$0
$0
0%
$1,058,652
$10,149,812
$9,109,479
-10%
$0
$0
0%
$0
$0
0%
$0
$33,713
100%
$2,910,559
$2,680,084
-8%
$0
$0
0%
--
$0
--
--
$0
--
--
$14,092,127
$9,449,635
-33%
$0
$0
0%
$561,264
$0
-100%
$0
$0
0%
$0
$0
$0
$0
0%
$0
0%
--
--
--
--
--
--
--
Florida
$83,986,318
$85,493,534
2%
$6,861,392
$6,681,392
0%
$4,000,000
$2,700,000
-33%
$2,920,207
$0
-100%
$13,093,050
Georgia
$31,611,268
$31,015,825
-2%
$0
$2,911,205
100%
$0
$0
0%
$566,494
$0
-100%
$11,129,428 $0
Federated States of Micronesia
$0
Guam
$80,040
$69,355
-13%
$0
$0
0%
$2,960
--
--
$0
--
--
Hawaii
$1,962,973
$1,974,147
1%
$0
$0
0%
$0
$0
0%
$0
$0
0%
$0
5%
$56,377
$67,733
20%
$0
$0
0%
$0
$0
0%
$770,295
$0
0%
$0
$0
0%
$5,411,162
Idaho
$690,075
$721,625
Illinois
$27,692,804
$28,972,323
5%
$2,262,406
$2,719,398
20%
$0
Indiana
$7,545,100
$7,777,694
3%
$616,409
$730,029
18%
$1,967,001
$2,070,600
5%
$0
$0
0%
$0
Iowa
$1,616,273
$1,697,552
5%
$132,044
$132,044
0%
$0
$0
0%
$0
$28,913
100%
$923,948
$2,522,384
4%
$0
0%
Kentucky
$4,701,657
$4,830,922
3%
$384,109
$0
-100%
--
--
--
$0
--
--
$0
Louisiana
$15,699,628
$16,057,388
2%
$1,282,605
$1,282,605
0%
$1,500,000
$1,832,193
22%
$541,649
$1,459,800
170%
$4,181,655
$989,385
$1,017,210
3%
$0
$0
0%
$119,673
$156,855
31%
$0
$0
0%
$0
0%
$0
$0
0%
--
--
--
--
--
--
--
$0
0%
$0
$0
0%
$0
$0
0%
$0
$0
0%
$0 $0
Kansas
Maine
$2,415,263
$0
$0
$0
0%
$0
$0
0%
$0
$826
$826
Maryland
$27,565,018
$25,072,742
-9%
$0
$0
0%
$0
Massachusetts
$13,917,303
$14,426,714
4%
$0
$0
0%
$0
Michigan
$12,420,524
$12,409,633
-0.1%
$0
$0
0%
$0
$0
0%
$0
$0
0%
$5,800,789
$5,979,412
3%
$0
$0
0%
$12,343
$20,383
65%
$80,795
$64,271
-20%
$0
2%
$0
$0
0%
$0
--
--
$0
--
--
$0
$0
$0
Marshall Islands
Minnesota Mississippi
$7,481,081
$7,603,480
Missouri
$9,673,525
$9,872,387
2%
$0
0%
--
--
$0
0%
$0
Montana
$341,712
$362,464
6%
$27,917
$27,917
0%
$187,582
$114,500
-39%
$0
$0
0%
$436,954
Nebraska
$1,498,212
$1,545,631
3%
$122,399
$125,000
2%
--
$0
--
--
$0
--
--
Nevada
$5,990,352
$6,118,122
2%
$0
$0
0%
--
$1,713,241
--
$0
$0
0%
$0
$966,937
$965,194
-0.2%
$0
$0
0%
$0
$0
0%
$0
$0
0%
$0
New Jersey
$29,978,367
$30,442,819
2%
$2,449,129
$2,449,129
0%
$250,000
$0
-100%
$1,033,447
$997,282
-3%
$5,758,130
New Mexico
$2,215,724
$2,299,456
4%
$0
$0
0%
$0
$0
0%
$0
$0
0%
$0
$110,870,226
$111,252,394
0.3%
$0
$0
0%
$1,910,583
$1,055,757
-45%
$3,789,690
$12,179,085
221%
$0
North Carolina
$21,617,647
$22,137,530
2%
$1,766,087
$2,077,872
18%
$0
$0
0%
$378,372
$1,747,084
362%
$3,000,000
North Dakota
$169,609
$174,214
3%
$13,856
$13,856
0%
$104,173
$49,388
-53%
$0
$0
0%
$0
$9,082
$9,082
0%
$0
$0
0%
--
--
--
--
--
--
--
$15,303,043
$15,879,871
4%
$0
$0
0%
$0
$0
0%
$0
$0
0%
$0
$811,668
$825,531
0%
$0
New Hampshire
New York
Northern Mariana Islands Ohio
$4,401,580
4%
$346,751
$0
-100%
2%
$0
$0
$4,524,566
$4,645,149
3%
$0
$0
0%
$0
$0
--
$0
$0
--
Pennsylvania
$27,855,846
$28,128,501
1%
$0
$0
0%
$1,191,646
$416,817
-65%
$0
$0
0%
$0
Puerto Rico
$18,326,048
$15,924,457
-13%
$1,304,273
$1,304,273
0%
$2,506,143
$71,074
-97%
$535,819
$1,923,247
72%
$3,596,177
Oklahoma Oregon
Republic of Palau Rhode Island South Carolina
$4,244,379
$0
$653
$653
0%
$0
0%
--
--
--
--
--
$2,194,058
$1,776,815
-19%
$141,621
$141,621
0%
$339,235
--
--
$0
--
--
$0
$12,640,017
$12,876,129
2%
$1,032,646
$1,032,646
0%
$0
$0
0%
$0
$0
0%
$0
$0
--
--
$0
$377,463
$396,316
5%
$30,837
$0
-100%
$44,561
$22,000
-51%
$0
$0
0%
$313,699
Tennessee
$14,054,256
$14,034,527
-0.1%
$1,148,184
$1,317,307
15%
$5,096,140
$5,283,858
4%
$269,140
$1,268,395
371%
$3,367,526
Texas
$57,395,140
Utah
South Dakota
$59,979,065
5%
$4,688,984
$5,629,751
20%
$0
$0
0%
$0
$0
0%
$0
$2,053,598
$2,104,601
2%
$167,772
$167,772
0%
$690,363
$779,556
13%
$37,894
$37,904
0.03%
$1,327,143
Vermont
$362,929
$370,720
2%
$0
$0
0%
$0
--
--
$0
--
--
$0
Virgin Islands (U.S.)
$567,037
$497,046
-12%
$41,026
$40,161
-2%
$206,752
--
--
$0
--
--
$0
$17,377,426
$17,906,035
3%
$1,419,676
$1,680,695
18%
$745,202
$2,969,329
298%
$2,024
$323,524
15884%
$4,984,251
Washington
$9,527,196
$9,721,292
2%
-100%
$0
$0
0%
$0
$0
0%
West Virginia
$6,600,315
$1,400,315
-79%
$0
$0
0%
--
$0
--
--
$0
--
--
Wisconsin
$4,459,715
$4,579,097
3%
$364,343
$429,803
18%
$319,590
$425,000
33%
$0
$0
0%
$412,461
Wyoming Total
$228,639
$236,138
$18,679 $37,983,131
$22,165 $41,352,275
19% 9%
$275,484
$0
$24,382,299
$22,281,566
100% -9%
$0
$781,975,926
3% -1%
$0
$787,671,426
$12,308,120
$20,072,089
0% 63%
$0 $75,000,000
Virginia
1
$778,339
$0
Part B ADAP Supplemental awards were provided to states that met federal eligibility criteria, applied for funding, and were able to meet the mandated matching requirement or receive a waiver.
Note: 48 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island and Vermont did not respond. This table does not include the "Other State or Federal" category ($68,171,727), which is reported in the total budget in Tables 1 and 2. A dash (--) indicates the ADAP did not report data.
40
$0
Table 3: Major FY2014 Budget Categories Compared with FY2013
(continued)
% Change
2013 Part A Contribution Directed to ADAP
2014 Part A Contribution Directed to ADAP
% Change
2013 State Contribution
2014 State Contribution
% Change
2013 Estimated Drug Rebates
$3,638,484
6%
$0
$0
0%
$4,400,000
$4,306,645
-2%
$1,000,000
$1,000,000
$686,786
178%
$0
$0
0%
$0
$0
0%
$0
$0
2014 ADAP Emergency Funding
2014 Estimated Drug % Change Rebates 0% 0%
$0
--
--
--
--
--
--
--
--
--
--
$792,146
0%
$0
$0
0%
$1,000,000
$1,000,000
0%
$23,651,916
$15,547,202
-34%
$0
0%
$0
$0
0%
$82,816
$82,816
0%
$800,000
$995,000
24%
$11,000,000
2%
$0
$0
0%
$34,025,412
$53,644,944
58%
$272,266,735
$278,601,026
2%
$0
-100%
$0
$0
0%
$4,477,589
$4,513,224
1%
$4,710,000
$4,200,000
-11%
0%
$0
$0
0%
$0
$0
0%
$16,361,893
$18,117,112
11%
$0 $0
--
--
$0
--
--
$0
--
--
$1,500,000
--
$0
0%
$0
$0
0%
$0
$0
0%
$0
$0
0%
$0
--
--
--
--
--
--
--
--
$11,000,000
-16%
$0
$0
0%
$13,500,000
$10,500,000
-22%
$11,000,000
$15,000,000
36%
$2,541,600
-77%
$0
$2,027,000
100%
$8,502,400
$11,587,504
36%
$100,000
$1,257,439
1157%
$0
0%
$0
--
--
$0
--
--
$0
--
--
$0
0%
$0
$0
0%
$440,000
$440,535
0.1%
$1,325,000
$1,700,000
28%
$0
--
$0
$3,300,000
--
$770,295
0%
0%
$801,800
$701,800
-12%
$3,110,139
-6%
$5,411,162
0%
$0
$0
0%
$14,000,000
$14,850,000
6%
$1,978,888
$1,987,000
0.4%
$0
0%
$171,828
$195,000
13%
$0
$0
0%
$20,225,000
$35,000,000
73%
$923,948
0%
$0
$0
0%
$547,982
$547,982
0%
$932,000
$1,500,000
61%
$0
0%
$0
$0
0%
$3,000,000
$10,829,714
261%
$8,000,000
$9,483,459
--
--
--
--
19%
$0
0%
$0
--
$0
--
$6,000,000
$3,034,961
-27%
$0
$5,500
100%
$0
$0
0%
$2,100,000
$13,690,044
552%
$0
0%
$0
$0
0%
$50,000
$50,000
0%
$1,200,000
$1,200,000
0%
$0
--
--
--
--
--
--
$0
0%
$0
$0
0%
$0
$0
0%
$38,777,443
$42,930,000
11%
$0
0%
$1,265,954
--
$250,000
--
-80%
$1,893,375
$1,893,375
0%
$7,500,000
$7,500,000
0%
$0
0%
$0
$0
0%
$0
$0
0%
$28,500,000
$29,000,000
2%
$0
0%
$0
$0
0%
$1,064,718
$0
-100%
$4,044,272
$4,000,000
-1%
--
--
0%
$0
--
--
$750,000
--
--
$180,000
--
--
$0
0%
$0
$0
0%
$3,809,187
$3,290,796
-14%
$25,767,602
$25,692,980
-0.3%
$232,287
-47%
$0
$0
0%
$129,000
$200,000
55%
$200,000
$400,000
100%
$0
$0
--
--
$0
--
--
$900,000
--
--
$900,000
--
$0
0%
$0
$0
0%
$1,817,901
$625,278
-66%
$5,102,386
$3,108,250
-39%
$0
-100%
$180,000
$0
$3,200,000
$0
0%
$500,874
-100%
$3,000,000
$5,758,130
0%
$0
$0
0%
$0
$0
0%
$52,000,000
$54,000,000
4%
$0
0%
$0
$0
0%
$900,000
$0
-100%
$0
$0
0%
7%
$0
0%
$8,796,739
$8,796,739
0%
$33,570,000
$28,750,000
-14%
$162,843,917
$195,910,268
20%
$3,000,000
0%
$0
$0
0%
$20,583,490
$14,797,144
-28%
$5,000,000
$10,000,000
100%
$0
0%
$0
$0
0%
$0
$0
0%
$1,200,000
$1,200,000
0%
$0
--
--
--
--
--
--
--
--
--
--
$0
0%
$0
$0
0%
$650,000
$650,000
0%
$6,500,000
$8,000,000
23%
$0
0%
$0
$0
0%
$786,000
-50%
$0
0%
$0
--
--
$20,000
$123,724
519%
$4,935,000
$4,667,629
-5%
$0
0%
$0
$0
0%
$10,267,000
$6,000,000
-42%
$42,664,063
$60,500,000
42%
$3,596,177
0%
$0
$0
0%
$882,325
$0
-100%
$128,900
$919,280
613%
$0
--
--
--
--
--
--
--
--
--
$0
0%
$0
--
--
$70,000
--
--
$1,225,000
--
--
$0
0%
$0
$0
0%
$5,658,856
$5,658,856
0%
$11,000,000
$14,000,000
27%
$0
-100%
$0
$0
0%
$0
$0
0%
$1,000,541
$1,180,000
18%
$7,485,930
$1,560,725
$5,500,000
$6,000,000
9%
--
122%
$70,637
$747,794
959%
$7,200,000
$7,200,000
0%
$8,400,000
$11,500,000
$0
0%
$810,025
$152,221
-81%
$31,801,174
$32,010,159
1%
$22,800,000
$22,800,000
0%
$1,327,143
0%
$0
$0
0%
$0
$0
0%
$2,000,000
$1,500,000
-25%
$0
0%
$0
--
--
$0
--
--
$500,000
--
--
$0
0%
$0
--
--
$200,000
--
--
$0
--
--
$11,000,000
121%
$1,452,525
$116,644
-92%
$7,964,049
$5,681,266
-29%
$6,680,962
$10,020,375
50%
0%
$0
$0
0%
$6,732,204
$4,905,231
-27%
$16,765,527
$16,148,254
-4%
$0
37%
$0
--
--
$0
--
--
$0
--
--
$5,200,000
--
$412,461
0%
$0
$0
0%
$1,306,220
$6,345,520
386%
$16,055,000
$15,620,685
-3%
$0 $72,611,510
0% -3%
$0
$0
$367,500
$549,427
$224,205,723
$233,240,013
0% 4.03%
$549,427
$12,290,898
0% -6%
$367,500
$13,068,582
$855,771,471
$960,335,569
0% 12%
41
Table 4: Cost Recovery and Other Cost-Saving Mechanisms (Excluding Drug Rebates), FY2013 State/Territory Alabama Alaska
Private Insurance
Medicaid
Other
$151,860
$0
$0
$151,860
$1,151,641
$0
$0
$1,151,641
Total
American Samoa
--
--
--
--
Arizona
$0
$0
$0
$0
Arkansas
$0
$1,200
$0
$1,200
California
$0
$6,614,862
$92,487
$6,707,349
$10,000
$125,000
$0
$135,000
$750,000
$3,000,000
$0
$3,750,000
Colorado Connecticut Delaware
$0
$0
$0
$0
District of Columbia
$0
$0
$0
$0
Federated States of Micronesia
--
--
--
--
Florida
$0
$0
$0
$0
Georgia
$0
$0
$0
$0
Guam
--
--
--
--
Hawaii
$0
$0
$0
$0
Idaho
$0
$0
$0
$0
Illinois
$2,825,984
$18,408
$0
$2,844,392
Indiana Iowa
$0
$0
$0
$0
$120,000
$160,000
$120,000
$400,000 --
Kansas
--
--
--
Kentucky
--
--
--
--
Louisiana
$0
$0
$0
$0
Maine
$0
$0
$0
$0
Marshall Islands
--
--
--
--
$14,385
$0
$0
$14,385
Maryland Massachusetts
$0
$0
$0
$0
Michigan
$0
$1,597,843
$0
$1,597,843
Minnesota
$0
$0
$0
$0
Mississippi
--
--
--
--
$93,735
$5,407,511
$25,769,151
$31,270,397
Missouri Montana
$0
$0
$0
$0
Nebraska
$10,000
$10,000
$0
$20,000
Nevada
$0
$0
$0
$0
New Hampshire
$0
$0
$0
$0
New Jersey
$6,000,000
$3,000,000
$0
$9,000,000
New Mexico
$0
$143,816
$63,305
$207,121
$16,000,000
$1,500,000
$0
$17,500,000
North Carolina
$0
$0
$0
$0
North Dakota
$0
$0
$0
$0
New York
Northern Mariana Islands
--
--
--
--
Ohio
$0
$0
$0
$0
$70,000
$15,000
$0
$85,000
$26,537,749
$0
$0
$26,537,749
Oklahoma Oregon Pennsylvania
$0
$0
$4,157,402
$4,157,402
Puerto Rico
$0
$20,000,000
$919,280
$20,919,280
Republic of Palau
--
--
--
--
Rhode Island
--
--
--
--
South Carolina
$104,823
$185,123
$0
$289,946 $0
South Dakota
$0
$0
$0
Tennessee
$0
$0
$0
$0
Texas
$0
$0
$0
$0
Utah
$0
$0
$0
$0
Vermont
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
Virginia
$0
$500000
$0
$500,000
Washington
$0
$0
$0
$0
West Virginia
$0
$20,187
$0
$20,187
Wisconsin
$214,930
$1,515,419
$0
$1,730,349
Wyoming
$0 $52,903,466 14
$0 $43,314,369 18
$0 $31,121,625 6
$0 $128,991,101 19
Totals Total # of ADAPs
Note: 47 ADAPs reported data. American Samoa, Federated States of Micronesia, Kansas, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island and Vermont did not report data. A zero ($0) indicates the ADAP responded zero ($0) to the question.
42
43
Table 5: Total Clients Enrolled/Served and Program Expenditures, FY2013
State/Territory
Alabama Alaska American Samoa Arizona
FY2013 Clients Served
FY2013 Clients Enrolled 2
FY2013 New Clients Enrolled
Full-Pay Medications Only
ADAP-Funded Insurance Program Only 4
2,949
823
2,867
129
20
46
--
--
3,003
692
3
Full-Pay Medications and ADAP-Funded Insurance Program 5
Prescription Drugs
Prescription Dispensing Costs
82
0
$16,912,845
$283,669
44
33
$865,089
$80,597
--
--
--
--
--
1,274
1,154
393
$0
$426,964
Arkansas
886
100
758
128
0
$4,373,331
$146,059
California
41,192
4,550
19,682
17,344
0
$399,055,502
$2,013,080
Colorado
3,995
507
1,071
1,523
933
$11,506,069
$321,058
Connecticut
2,736
372
1,603
917
0
$24,994,396
$97,720
Delaware
1,795
180
151
1,145
0
$3,160,987
$0
District of Columbia
2,050
483
1,454
464
132
$11,887,965
$205,393
Federated States of Micronesia
--
--
--
--
--
--
--
Florida
22,404
4,715
18,123
2,135
561
$129,319,159
$0
Georgia
$2,424,980
7,317
1,915
6,070
373
71
$53,692,061
Guam
--
--
--
--
--
--
--
Hawaii
481
94
190
163
89
$1,156,278
$71,644
Idaho
289
67
265
0
0
$347,139
$0
Illinois
9,091
1,636
7,074
569
609
$43,848,652
$1,593,137
Indiana
2,950
917
430
732
1,788
$10,735,454
$35,113
815
142
387
206
171
$3,423,180
$190,251 $50,878
Iowa
1,546
147
440
586
226
$13,937,982
Kentucky
Kansas
--
--
--
--
--
--
--
Louisiana
6,553
1,881
3,619
1,971
178
$19,304,927
$0
903
99
32
581
83
$1,025,012
$3,840
--
--
--
--
--
--
--
7,165
627
3,312
2,261
907
$47,859,235
$380,458
Maine Marshall Islands Maryland Massachusetts
8,178
771
281
6,747
10
$3,340,011
$4,519
Michigan
5,312
922
2,674
2,638
0
$50,734,739
$220,863
Minnesota
1,823
180
559
1,264
0
$5,794,075
$0
Mississippi
--
--
--
--
--
--
--
Missouri
4,222
421
1,237
572
1,570
$32,059,083
$109,048
Montana
283
65
164
83
36
$851,919
$19,370
Nebraska
735
130
332
213
190
$3,580,645
$15,000
1,282
80
874
408
0
$7,752,423
$530,120
Nevada New Hampshire New Jersey New Mexico
524
53
148
218
96
$2,169,608
$7,119
8,226
988
5,913
1,781
0
$106,058,619
$871,142
1,008
249
53
955
0
$198,893
$0
26,439
3,102
11,957
12,314
0
$316,285,434
$1,767,346
North Carolina
8,514
1,734
6,651
1,106
293
$43,549,408
$2,238,131
North Dakota
156
44
55
0
0
$1,372,489
$10,187
--
--
--
--
--
--
--
Ohio
6,563
621
2,652
2,098
903
$19,285,252
$4,150,345
Oklahoma
1,794
285
582
684
438
$4,570,915
$337,440
Oregon
3,569
416
0
3,411
158
$16,865,410
$2,505,898
Pennsylvania
8,402
2,977
4,246
1,406
2,050
$84,248,770
$1,051,488
Puerto Rico
7,964
1,147
7,446
518
0
$44,668,866
$37,740
Republic of Palau
--
--
--
--
--
--
--
Rhode Island
--
--
--
--
--
--
--
South Carolina
5,737
929
3,754
1,340
281
$20,280,226
$1,045,160
South Dakota
276
40
208
0
0
$1,811,115
$19,950
Tennessee
6,091
808
2,961
2,324
806
$21,932,781
$625,198
Texas
18,587
2,828
16,500
1,621
466
$100,244,624
$0
Utah
747
199
457
130
126
$4,721,547
$200,075
Vermont
--
--
--
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
--
--
--
Virginia
6,322
1,183
3,679
614
1,111
$18,524,013
$2,961,383
Washington
4,855
479
372
2,946
744
$0
$0
503
68
246
108
133
$5,355,799
$51,112
Wisconsin
1,942
206
1,278
664
0
$21,383,800
$0
Wyoming Total
166 258,469
29 40,921
-144,127
-78,541
-15,585
$1,463,684 $1,736,509,411
$11,990 $27,115,465
New York
Northern Mariana Islands
West Virginia
1
This table represents ADAP program expenditures in FY2013 (April 1, 2013-March 31, 2014). Only expenditure categories requested in the National ADAP Monitoring Survey are represented in this table.
2
For some states, enrolled clients reported may be a snapshot in time rather than a cumulative unduplicated client count. In this instance, some ADAPs may report a higher number of clients served throughout the fiscal year compared to the number of clients enrolled in the program at the end of the fiscal year. 3
For the purposes of this report, ADAP clients are considered to be enrolled in either the full-pay medication program or the insurance program. Full-pay medication program clients are defined as those individuals who receive medications paid in full by ADAP with no coordination of insurance or benefits. Insurance program clients are defined as those who have additional coverage (i.e., insurance, Medicare) that ADAP is assisting through paying premiums, deductibles, or co-payments/co-insurance. 4 Individuals who had an insurance (i.e., Medicare Part D, Medicaid, private insurance) payment (premium, co-payment/co-insurance, and/or deductible) paid on their behalf using ADAP funds, either fully or in part. 5 This includes clients who enrolled in an insurance plan mid-year and those who were enrolled in an insurance plan that did not cover one or more medically necessary medications such that the ADAP’s full-pay prescription program did instead. 6
This category may include HIV disease monitoring laboratory assays paid with ADAP funds as authorized under the HRSA flexibility policy.
7
“Other” includes, but is not limited to, contract services to dispense medications, determine eligibility, and manage enrollment; pharmacy charges, dispensing and shipping fees, central pharmacy fees; as well as medical, dental, lab, and nutritional services. Federal ADAP funds may not be used to pay for medical, dental, lab, and nutritional services.
Note: 48 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont and Virgin Islands (U.S.) did not respond, but their federal ADAP earmark and ADAP supplemental awards were known and incorporated. A dash (--) indicates the ADAP did not report data.
44
Table 5: Total Clients Enrolled/Served and Program Expenditures, FY2013
(continued)
FY2013 ADAP Expenditures Insurance Premiums
Insurance Copayments and Deductibles
Client Outreach
Adherence and Monitoring 6
Quality Management
Program Administration
Other
7
Total Expenditures
$0
$420,328
$68,661
$68,661
$311,816
$962,783
$0
$18,960,102
$455,800
$0
$0
$60,885
$5,000
$55,209
$0
$1,522,580
--
--
--
--
--
--
--
--
1,580,321
$4,688,937
$0
$0
$70,245
$1,517,307
$0
$8,283,774
$0
$330,974
$0
$0
$0
$127,104
$0
$4,977,468
$12,333,351
$34,818,444
$0
$0
$0
$4,171,757
$6,990,312
$459,382,446
$2,476,992
$2,450,177
$0
$211,980
$0
$899,898
$0
$17,866,174
$1,085,512
$3,178,006
$0
$493,812
$242,344
$418,584
$170,965
$30,681,339
$128,983
$0
$0
$0
$113,170
$282,457
$0
$3,685,597
$853,206
$186,326
$0
$0
$0
$0
$0
$13,132,890
--
--
--
--
--
--
--
--
$11,091,804
$7,981,358
$0
$0
$0
$5,791,586
$40,603
$154,224,510
$3,253,225
$848,485
$0
$0
$0
$760,470
$0
$60,979,221
--
--
--
--
--
--
--
--
$380,000
$440,596
$0
$0
$0
$46,055
$0
$2,094,573
$0
$0
$0
$0
$0
$0
$0
$347,139
$1,949,451
$4,601,176
$0
$0
$0
$0
$0
$51,992,416 $32,199,694
$19,376,585
$727,558
$0
$0
$171,931
$1,153,053
$0
$144,493
$577,974
$0
$0
$31,501
$201,439
$0
$4,568,838
$374,577
$3,564,895
$0
$149,225
$0
$0
$0
$18,077,557
--
--
--
--
--
--
--
--
$9,860,098
$0
$0
$0
$0
$0
$0
$29,165,025
356,504
$399,524
$0
$0
$32,080
$93,565
$9,752
$1,920,277
--
--
--
--
--
--
--
--
$17,323,145
$13,407,018
$0
$1,490,001
$881,339
$2,246,364
$0
$83,587,560
$7,847,449
$2,890,909
$0
$199,250
$0
$790,766
$0
$15,072,904
$2,459,140
$551,140
$0
$350,754
$7,034
$0
$0
$54,323,670
$3,586,978
$0
$112,744
$55,620
$157,197
$525,709
$0
$10,232,323
--
--
--
--
--
--
--
--
$4,924,025
$4,322,371
$0
$0
$0
$0
$0
$41,414,527
$111,169
$368,976
$0
$0
$0
$0
$0
$1,351,434
$735,212
$735,212
$0
$0
$0
$282,000
$0
$5,348,069
$952,163
$0
$31,461
$372,116
$0
$0
$0
$9,638,283
$0
$974,390
$0
$0
$0
$0
$0
$3,151,117
$7,516,611
$6,463,557
$0
$0
$0
$1,100,000
$0
$122,009,929
$3,867,106
$0
$0
$0
$0
$0
$0
$4,065,999
$46,522,836
$0
$528,588
$608,629
$691,230
$2,846,246
$0
$369,250,309
$0
$2,812,694
$0
$0
$0
$414,008
$0
$49,014,241
$0
$100,540
$0
$0
$0
$0
$0
$1,483,216
--
--
--
--
--
--
--
--
$2,028,990
$451,861
$0
$0
$0
$817,526
$0
$26,733,974
$1,695,379
$1,496,192
$0
$85,307
$14,086
$345,478
$0
$8,544,797
$8,222,679
$2,459,387
$257,142
$9,838
$69,884
$2,151,257
$1,122,000
$33,663,495
$377,220
$7,838,558
$0
$0
$0
$1,662,260
$0
$95,178,296
$0
$2,969,051
$0
$350,815
$100,346
$699,517
$0
$48,826,335
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
$831,143
$2,685,352
$0
$0
$0
$724,283
$0
$25,566,164
$0
$2,249,057
$0
$0
$0
$0
$0
$4,080,122
$3,691,986
$2,839,198
$0
$0
$0
$890,106
$0
$29,979,269
$0
$0
$0
$0
$0
$0
$0
$100,244,624
$465,449
$664,754
$0
$0
$34,643
$262,057
$0
$6,348,525
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
$1,726,094
$4,654,771
$0
$213,994
$323,645
$2,037,442
$0
$30,441,342
$9,648,133
$0
$94,521
$2,945,405
$463,295
$1,493,947
$0
$14,645,301
$30,259
$0
$0
$0
$6,000
$0
$0
$5,443,170
$3,154,996
$0
$48,490
$0
$2,585
$7,755
$0
$24,597,626
$0 $193,419,064
$0 $126,149,746
$0 $1,072,946
$0 $7,666,292
$0 $3,729,371
$0 $35,777,988
$0 $8,333,632
$1,475,674 $2,139,773,915
45
Table 6: Total Clients Enrolled and Served, June 2013 and June 2014 June 2014 Clients Served State/Territory
Alabama Alaska American Samoa Arizona
June 2013 June 2014 Clients Enrolled Clients Enrolled
% Change
June 2013 Clients Served
1
% Change
1,756
1,893
8%
1,496
1,803
90
Full-Pay Medications and ADAP-Funded Insurance 3 0
1,893
27%
103
100
-3%
94
23
41
31
95
1%
--
--
--
--
--
--
--
--
--
2,267
1,592
-30%
1,831
374
870
0
1,244
-32%
Full-Pay Medications Only
ADAP-Funded Insurance Only 2
Total Clients Served
Arkansas
751
783
4%
560
675
108
0
783
40%
California
31,726
31,164
-2%
22,702
10,774
9,618
0
20,392
-10%
Colorado
3,541
2,155
-39%
2,265
299
1,462
2
1,763
-22%
Connecticut
2,155
1,939
-10%
1,715
709
724
0
1,433
-16%
--
1,466
--
--
82
621
0
703
--
1,499
1,622
8%
872
633
235
76
944
8%
Delaware District of Columbia Federated States of Micronesia
--
--
--
--
--
--
--
--
--
Florida
16,229
17,308
7%
14,058
11,291
1,895
1
13,187
-6%
Georgia
15%
8,135
7,879
-3%
5,111
5,784
110
8
5,902
Guam
1
--
--
1
--
--
--
--
--
Hawaii
356
302
-15%
286
68
157
1
226
-21%
Idaho
237
212
-11%
193
137
0
0
137
-29%
Illinois
8,610
6,959
-19%
5,549
4,125
409
469
5,003
-10%
Indiana
2,373
2,566
8%
2,326
363
2,203
0
2,566
10%
650
293
-55%
487
50
202
1
253
-48%
Kansas
1,262
1,279
1%
678
137
552
0
689
2%
Kentucky
2,165
--
--
1,525
--
--
--
--
--
Louisiana
4,376
5,555
27%
2,418
1,538
1,215
58
2,811
16%
816
807
-1%
353
15
365
6
386
9%
--
--
--
--
--
--
--
--
--
6,349
6,045
-5%
3,691
1,247
2,127
0
3,374
-9% -11%
Iowa
Maine Marshall Islands Maryland Massachusetts
5,641
6,232
10%
4,153
109
3,592
2
3,703
Michigan
4,368
4,626
6%
2,557
905
1,514
0
2,419
-5%
Minnesota
2,385
533
-78%
640
125
120
288
533
-17%
Mississippi
1,393
--
--
1,095
--
--
--
--
--
Missouri
2,898
3,255
12%
2,209
492
1,229
776
2,497
13%
221
240
9%
133
24
89
6
119
-11%
--
621
--
--
189
198
0
387
--
1,561
1,150
-26%
999
351
320
0
671
-33%
Montana
1
Nebraska Nevada New Hampshire New Jersey New Mexico
398
467
17%
159
91
135
59
285
79%
6,492
5,858
-10%
5,083
3,349
140
0
3,489
-31%
818
406
-50%
726
9
397
0
406
-44%
21,190
21,151
-0.2%
17,193
7,599
9,515
0
17,114
-0.5%
North Carolina
6,734
6,910
3%
5,250
4,394
633
6
5,033
-4%
North Dakota
144
153
6%
136
19
63
0
82
-40%
New York
Northern Mariana Islands
--
--
--
--
--
--
--
--
--
Ohio
5,048
5,159
2%
2,719
877
943
108
1,928
-29%
Oklahoma
1,369
1,373
0.3%
1,031
80
1,025
38
1,143
11%
Oregon
2,920
3,034
4%
2,849
3
2,780
2
2,785
-2%
Pennsylvania
6,014
6,464
7%
4,653
2,978
1,596
511
5,085
9%
Puerto Rico
6,183
6,947
12%
6,183
6,457
490
0
6,947
12% --
Republic of Palau Rhode Island South Carolina South Dakota
--
--
--
--
--
--
--
--
774
--
--
551
--
--
--
--
--
4,640
4,854
5%
3,565
2,227
1,257
4
3,488
-2%
196
231
18%
120
165
0
0
165
38%
4,466
4,917
10%
2,945
2,541
2,204
172
4,917
67%
Texas
17,110
18,069
6%
11,360
10,424
1,789
0
12,213
8%
Utah
664
550
-17%
468
225
226
7
458
-2%
Vermont
335
--
--
165
--
--
--
--
--
Virgin Islands (U.S.)
101
--
--
101
--
--
--
--
--
Virginia
4,985
5,192
4%
3,293
1,244
2,564
307
4,115
25%
Washington
4,007
3,111
-22%
2,922
115
1,982
66
2,163
-26%
--
408
--
--
82
165
27
274
--
1,843
1,001
-46%
954
215
454
0
669
-30%
156
157
1%
64
--
--
--
--
--
210,411 205,907
204,988 199,779
85,416
58,424
3,032
-3%
152,487 149,359
146,872 143,257
-4%
Tennessee
West Virginia Wisconsin Wyoming Total Comparison Total 1 1
For the purposes of this report, ADAP clients are considered to be enrolled in either the full-pay medication program or the insurance program. Full-pay medication program clients are defined as those individuals who receive medications paid in full by ADAP with no coordination of insurance or benefits. Insurance program clients are defined as those who have additional coverage (i.e., insurance, Medicare) that ADAP is assisting through paying premiums, deductibles, or co-payments/co-insurance. 2 Individuals who had an insurance (i.e., Medicare Part D, Medicaid, private insurance) payment (premium, co-payment/co-insurance, and/or deductible) paid on their behalf using ADAP funds, either fully or in part. 3 This includes clients who enrolled in an insurance plan mid-year and those who were enrolled in an insurance plan that did not cover one or more medically necessary medications such that the ADAP’s full-pay prescription program did instead.
Note: 47 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont, Virgin Islands (U.S.) and Wyoming did not respond. A dash (--) indicates the ADAP did not report data.
46
Table 7: ADAP Clients Served by Other Payers, June 2014 State/Territory
June 2014 Clients Served
Medicaid
Medicare Part D Standard Benefit
0
Private Insurance Coverage
No Form of Insurance
Unknown
90
0
1,803
95
0
0
0
1
9
62
23
0
--
--
--
--
--
--
--
--
--
318
9
8
30
513
365
0
0
108
0
0
675
0
2,425
5,182
10,774
1,244
1
Arkansas
783
0
0
California
Arizona
0
Medicare Part D Partial Subsidy
American Samoa
1,893
0
Medicare Part D Full Subsidy 1
Alaska
Alabama
0
Medicaid and Medicare
0
20,392
216
1,526
121
148
Colorado
1,763
551
0
149
52
207
505
299
0
Connecticut
1,433
0
0
0
0
329
445
659
0
Delaware
703
374
0
24
8
50
165
82
0
District of Columbia
944
0
4
0
0
0
294
633
13
--
--
--
--
--
--
--
--
--
Federated States of Micronesia
0
Florida
13,187
0
19
41
123
840
873
11,291
0
Georgia
5,902
19
0
74
124
387
131
5,098
69
--
-0
-0
-2
-3
-48
-105
-68
-0 0
Guam Hawaii
226
Idaho
137
0
0
0
0
0
1
136
Illinois
5,003
580
10
0
0
0
878
3,535
0
Indiana
2,566
0
0
0
190
0
0
282
2,094
253
0
24
0
0
16
163
50
0
Iowa
689
96
12
21
10
Kentucky
--
--
--
--
--
--
--
--
--
Louisiana
2,811
0
0
0
0
314
804
1,538
155
386
Kansas
22
99
112
0
242
12
11
0
--
--
--
--
--
--
--
--
--
3,374
0
0
150
31
136
1,810
1,247
0
Massachusetts
3,703
1,520
563
2
0
202
993
24
399
2,419
218
0
0
192
268
1,054
687
0
130
228
Michigan
0
375
Maryland
Maine Marshall Islands
0
63
Minnesota
533
0
0
0
50
125
0
Mississippi
--
--
--
--
--
--
--
--
--
Missouri
2,497
91
6
7
2
29
1,943
419
0
Montana
119
0
2
0
14
3
75
25
0
10
Nebraska
387
0
0
5
29
157
186
0
Nevada
671
0
0
0
0
160
160
351
0
New Hampshire
285
40
7
15
17
48
119
39
0
New Jersey
3,489
0
0
0
0
0
140
3,349
0
New Mexico
406
0
6
27
20
78
266
9
0
17,114
390
226
1,000
379
1,839
5,681
7,599
North Carolina
5,033
0
0
142
128
369
0
4,394
0
North Dakota
82
13
4
6
1
5
35
18
0 --
New York
--
--
--
--
--
--
Ohio
1,928
99
0
103
55
262
532
877
0
Oklahoma
1,143
0
6
17
37
165
1,042
58
0
Oregon
2,785
882
82
509
86
281
942
3
0 1,097
Northern Mariana Islands
--
--
0
Pennsylvania
5,085
147
42
0
0
0
1,621
2,178
Puerto Rico
6,947
6,313
0
0
0
0
490
144
0
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
0
Republic of Palau Rhode Island South Carolina
3,488
0
17
37
165
1,042
2,227
South Dakota
165
28
4
0
0
18
105
10
0
4,917
0
0
0
0
0
2,204
0
2,713
0
Tennessee Texas
12,213
1,634
155
10,424
Utah
458
0
0
2
3
7
221
225
0
--
--
--
--
--
--
--
--
---
Vermont
0
0
--
--
--
--
--
Virginia
4,115
0
0
0
196
221
2,506
1,192
2,163
70
131
225
88
203
1,331
115
0
274
0
0
20
27
65
80
82
0
West Virginia
--
--
0
Washington
Virgin Islands (U.S.)
--
0
0
Wisconsin
669
11
Wyoming Total
-146,872
--
--
--
--
--
--
--
--
11,901
3,011
2,726
2,151
11,221
35,848
73,656
6,540
1
7
33
8
74
321
215
0
0
Asset limits for full- vs. partial-subsidy under Medicare Part D may be found here.
Note: 47 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont, Virgin Islands (U.S.) and Wyoming did not respond. A dash (--) indicates the ADAP did not report data.
47
Table 8: ADAP Clients Served, by Race/Ethnicity, June 2014
State/Territory
Alabama Alaska American Samoa Arizona
June 2014 Clients Served
Non-Hispanic Black/African American
NonHispanic White
Hispanic
Asian
Native Hawaiian/Pacific Islander
American Indian/Alaskan Native
Multi-Racial
Other
Unknown
1,893
66%
27%
3%
1%
4%
0.1%
0.1%
0.1%
0%
95
19%
56%
16%
6%
0%
3%
0%
0%
0%
--
--
--
--
--
--
--
--
--
--
1,244
8%
42%
42%
2%
0.2%
2%
4%
0%
0%
40%
Arkansas
783
1%
1%
0.4%
0%
2%
California
20,392
9%
36%
47%
4%
0.3%
0.2%
2%
0%
0.3%
Colorado
1,763
7%
16%
48%
28%
2%
1%
0%
1%
1%
7%
47%
0%
Connecticut
1,433
36%
56%
6%
1%
0%
0.1%
0%
0%
0%
Delaware
703
64%
34%
1%
0%
0%
0%
2%
0%
0%
District of Columbia
944
53%
8%
12%
1%
0%
0%
0%
1%
26%
--
--
--
--
--
--
--
--
--
--
Florida
13,187
42%
27%
30%
1%
0.1%
0.2%
0.2%
1%
0%
Georgia
5,902
65%
22%
10%
0%
0.1%
Federated States of Micronesia
1%
1%
1%
0%
Guam
--
--
--
--
--
--
--
--
--
--
Hawaii
226
3%
54%
7%
19%
8%
1%
7%
0%
0%
Idaho
137
4%
67%
23%
1%
1%
1%
3%
0%
1%
Illinois
5,003
42%
27%
27%
2%
0.2%
0.1%
1%
2%
0.02%
Indiana
2,566
33%
55%
7%
2%
0.04%
0.1%
1%
2%
0%
253
19%
57%
15%
5%
0%
1%
2%
0%
0%
689
27%
49%
20%
1%
0%
0%
0%
Iowa Kansas
1%
1%
Kentucky
--
--
--
--
--
--
--
--
--
--
Louisiana
2,811
63%
26%
5%
0.4%
0.1%
0.1%
2%
0%
3%
386
18%
72%
5%
1%
0%
0.3%
3%
0%
0.3%
--
--
--
--
--
--
--
--
--
--
3,374
68%
17%
7%
1%
0.1%
0.2%
0.1%
6%
1%
Maine Marshall Islands Maryland Massachusetts
3,703
2%
0.1%
Michigan
2,419
47%
43%
4%
1%
0.1%
1%
0%
1%
3%
533
29%
44%
19%
3%
0%
0.4%
1%
0%
5%
Minnesota Mississippi Missouri
26%
42%
26%
0.2%
1%
0%
3%
--
--
--
--
--
--
--
--
--
--
2,497
49%
43%
7%
1%
0.2%
0%
0%
0%
0%
Montana
119
3%
85%
3%
0%
1%
8%
0%
0%
0%
Nebraska
387
21%
44%
23%
3%
1%
1%
0%
7%
0%
Nevada
671
0%
0%
0%
0%
0%
0%
0%
0%
100%
New Hampshire
285
16%
64%
12%
2%
0%
0.4%
4%
1%
0.4%
New Jersey
3,489
48%
19%
27%
2%
1%
0%
3%
0%
0%
New Mexico
406
4%
38%
52%
0.2%
1%
2%
1%
0.5%
1%
17,114
35%
26%
32%
2%
0.2%
0.4%
0%
0%
5%
North Carolina
5,033
61%
27%
9%
0.2%
0.1%
1%
0.5%
1%
0%
North Dakota
82
40%
55%
0%
0%
0%
5%
0%
0%
0%
New York
Northern Mariana Islands Ohio Oklahoma
--
--
--
--
--
--
--
--
--
--
1,928
37%
52%
6%
1%
0%
0.1%
1%
0%
3%
59%
10%
1%
0.3%
6%
5%
0%
0%
Oregon
2,785
5%
65%
24%
1%
0.4%
1%
1%
1%
0.1%
Pennsylvania
5,085
1,143
45%
19%
40%
13%
1%
0.1%
0.2%
0%
1%
0%
Puerto Rico
6,947
0%
0%
100%
0%
0%
0%
0%
0%
0%
Republic of Palau
--
--
--
--
--
--
--
--
--
--
Rhode Island
--
--
--
--
--
--
--
--
--
--
3,488
67%
26%
5%
0.4%
0.1%
0.1%
1%
0%
0.2%
South Carolina
5%
1%
0%
0%
4,917
53%
38%
5%
0.5%
0.02%
0.2%
0%
3%
0.04%
Texas
South Dakota
12,213
28%
17%
37%
1%
0.01%
0.2%
0%
1%
16%
Utah
Tennessee
165
28%
55%
0%
6%
4%
458
8%
60%
29%
2%
0%
1%
0%
0.2%
0%
Vermont
--
--
--
--
--
--
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
--
--
--
--
--
--
Virginia
4,115
58%
27%
11%
2%
0.2%
1%
0%
0%
1%
Washington
2,163
12%
64%
13%
2%
1%
2%
4%
1%
0.5%
West Virginia
274
31%
64%
5%
0%
0%
0%
0%
0%
0%
Wisconsin
669
28%
45%
24%
2%
0.4%
1%
0%
0%
0.3%
Wyoming Total
-146,872
-35%
-31%
-28%
-2%
-0.2%
-0.4%
-1%
-1%
-3%
Note: 47 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont, Virgin Islands (U.S.) and Wyoming did not respond. A dash (--) indicates the ADAP did not report data. A zero (0%) indicates the ADAP responded zero (0%) to the question.
48
Table 9: ADAP Clients Served, by Gender, June 2014
State/Territory
Alabama Alaska American Samoa
June 2014 Clients Served
Male
Female
Transgender
Unknown
1,893
72%
28%
0%
0%
95
77%
23%
0%
0%
--
--
--
--
--
1,244
85%
14%
0.4%
0%
Arkansas
783
81%
19%
0.1%
0%
California
20,392
90%
9%
1%
0%
Colorado
1,763
86%
13%
1%
0.1%
Connecticut
1,433
72%
28%
0.1%
0%
Delaware
703
61%
38%
0.1%
0%
District of Columbia
944
75%
24%
1%
0%
Arizona
Federated States of Micronesia
--
--
--
--
--
Florida
13,187
75%
24%
0.5%
0%
Georgia
0%
5,902
75%
25%
0.1%
Guam
--
--
--
--
--
Hawaii
226
92%
8%
0%
0%
Idaho
137
80%
20%
0%
0%
Illinois
5,003
82%
17%
1%
0%
Indiana
2,566
82%
18%
0%
0%
Iowa
253
74%
26%
0.4%
0%
Kansas
0%
689
77%
23%
1%
Kentucky
--
--
--
--
--
Louisiana
2,811
70%
29%
1%
0%
386
78%
22%
1%
0%
--
--
--
--
--
Maryland
3,374
66%
34%
0.03%
0%
Massachusetts
3,703
69%
30%
0.5%
0.1%
Michigan
2,419
82%
18%
0.1%
0%
533
75%
25%
0.2%
0%
Maine Marshall Islands
Minnesota Mississippi Missouri
--
--
--
--
--
2,497
81%
18%
1%
0%
Montana
119
90%
10%
0%
0%
Nebraska
387
78%
21%
1%
0%
Nevada
671
0%
0%
0%
100%
New Hampshire
285
76%
24%
0.4%
0%
New Jersey
3,489
68%
32%
0.1%
0%
New Mexico
406
90%
10%
0.2%
0%
New York
17,114
77%
23%
0.3%
0%
North Carolina
5,033
72%
27%
0.4%
0%
North Dakota
82
68%
32%
0%
0%
Northern Mariana Islands
--
--
--
--
--
Ohio
1,928
84%
15%
0.4%
0%
Oklahoma
1,143
85%
15%
0%
0%
Oregon
2,785
88%
12%
1%
0%
Pennsylvania
5,085
77%
23%
0.5%
0%
Puerto Rico
6,947
64%
36%
0%
0%
Republic of Palau
--
--
--
--
--
Rhode Island
--
--
--
--
--
3,488
71%
28%
0.4%
0%
South Carolina South Dakota Tennessee
165
63%
37%
0%
0%
4,917
25%
75%
0.4%
0.04%
Texas
12,213
19%
66%
1%
15%
Utah
458
86%
14%
0.2%
0%
Vermont
--
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
--
Virginia
4,115
72%
27%
1%
0.05%
Washington
2,163
88%
11%
1%
0.4%
West Virginia
274
75%
25%
0%
0%
Wisconsin
669
82%
16%
2%
0%
Wyoming Total
-146,872
-71%
-27%
-0.4%
-2%
Note: 47 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont, Virgin Islands (U.S.) and Wyoming did not respond. A dash (--) indicates the ADAP did not report data. A zero (0%) indicates the ADAP responded zero (0%) to the question.
49
Table 10: ADAP Clients Served, by Age, June 2014
State/Territory Alabama Alaska American Samoa Arizona
June 2014 Clients Served
≤12 Years
13-24 Years
25-44 Years
45-64 Years
>64 Years
Unknown
1,893
0%
5%
57%
36%
1%
0%
95
0%
2%
41%
55%
2%
0%
--
--
--
--
--
--
--
1,244
0.1%
3%
37%
53%
6%
0%
Arkansas
783
0%
7%
52%
39%
2%
0%
California
20,392
0%
2%
38%
53%
8%
0%
Colorado
1,763
0.3%
2%
39%
53%
6%
0%
Connecticut
1,433
0%
2%
33%
58%
7%
0%
Delaware
703
0%
2%
29%
64%
5%
0%
District of Columbia
944
0%
2%
36%
54%
8%
0%
--
--
--
--
--
--
--
Florida
13,187
0.02%
4%
38%
54%
4%
0%
Georgia
0%
Federated States of Micronesia
5,902
0.1%
5%
46%
47%
2%
Guam
--
--
--
--
--
--
--
Hawaii
226
0%
0%
25%
59%
16%
0%
Idaho
137
0%
6%
53%
39%
1%
0%
Illinois
5,003
0.1%
4%
49%
45%
2%
0%
Indiana
2,566
0.1%
6%
46%
45%
3%
0%
Iowa
253
0%
3%
47%
46%
4%
0%
Kansas
0%
689
1%
5%
44%
46%
4%
Kentucky
--
--
--
--
--
--
--
Louisiana
2,811
0%
6%
47%
45%
3%
0%
386
0%
1%
33%
61%
5%
0%
--
--
--
--
--
--
--
3,374
0.1%
2%
34%
55%
9%
0%
Massachusetts
3,703
0.03%
1%
24%
67%
8%
0.1%
Michigan
2,419
0.4%
4%
38%
52%
5%
0%
Minnesota
533
1%
4%
39%
50%
6%
0%
Mississippi
--
--
--
--
--
--
--
2,497
0.2%
8%
53%
38%
1%
0%
Maine Marshall Islands Maryland
Missouri Montana
119
0%
2%
40%
54%
4%
0%
Nebraska
387
1%
4%
47%
46%
3%
0%
Nevada
671
0%
0%
0%
0%
0%
100%
New Hampshire
285
0.4%
2%
28%
64%
6%
0%
New Jersey
3,489
0%
6%
40%
52%
2%
0%
New Mexico
406
0.2%
2%
29%
67%
2%
0%
17,114
0.02%
2%
36%
54%
7%
0%
North Carolina
5,033
0%
5%
45%
47%
4%
0%
North Dakota
82
1%
7%
65%
26%
1%
0%
Northern Mariana Islands
--
--
--
--
--
--
--
Ohio
1,928
0%
4%
39%
52%
6%
0%
Oklahoma
1,143
0%
4%
40%
53%
3%
0%
Oregon
2,785
0.1%
2%
37%
56%
5%
0%
Pennsylvania
5,085
0.02%
4%
36%
54%
6%
0%
Puerto Rico
6,947
0.1%
4%
32%
61%
3%
0%
Republic of Palau
--
--
--
--
--
--
--
Rhode Island
--
--
--
--
--
--
--
3,488
0.2%
6%
43%
48%
3%
0%
New York
South Carolina South Dakota
165
1%
1%
39%
56%
3%
0%
4,917
0.1%
8%
49%
42%
1%
0%
Texas
12,213
0.1%
4%
46%
35%
1%
15%
Utah
458
0%
1%
53%
44%
2%
0%
Vermont
--
--
--
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
--
--
--
Virginia
4,115
0.02%
7%
42%
48%
3%
0.05%
Washington
2,163
0%
0.3%
29%
63%
8%
0%
West Virginia
274
0%
3%
26%
64%
7%
0%
Wisconsin
669
1%
6%
43%
45%
5%
0%
Wyoming
--
--
--
--
--
--
--
146,872
0.1%
4%
40%
50%
5%
2%
Tennessee
Total
Note: 47 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont, Virgin Islands (U.S.) and Wyoming did not respond. A dash (--) indicates the ADAP did not report data. A zero (0%) indicates the ADAP responded zero (0%) to the question.
50
Table 11: ADAP Clients Served, by Income Level, June 2014 Financial Eligibility State/Territory
Full-Pay Medications (Uninsured)
ADAP-Funded Insurance Program
June 2014 Clients Served
≤100% FPL
101-138% FPL
1
139-200% FPL
201-300% FPL
301-400% FPL
>401% FPL
Unknown
Alabama
250% FPL
250% FPL
1,893
90%
4%
4%
2%
0.0%
0%
0%
Alaska
300% FPL
300% FPL
95
39%
16%
18%
27%
0%
0%
0%
--
--
--
--
--
--
--
--
--
--
Arizona
300% FPL
300% FPL
1,244
23%
11%
34%
32%
0%
0%
0%
Arkansas
400% FPL
400% FPL
783
53%
15%
22%
8%
1%
0%
0%
American Samoa
California
500% FPL
500% FPL
20,392
29%
11%
24%
23%
12%
1%
Colorado
500% FPL
400% FPL
1,763
41%
13%
20%
19%
7%
0.1%
0%
Connecticut
400% FPL
400% FPL
1,433
0%
0%
0%
0%
0%
0%
100%
Delaware
500% FPL
500% FPL
703
52%
10%
16%
14%
7%
2%
0%
District of Columbia
500% FPL
500% FPL
944
28%
9%
14%
18%
11%
4%
15%
--
--
--
--
--
--
--
--
--
Florida
400% FPL
400% FPL
13,187
51%
13%
19%
14%
4%
0%
0%
Georgia
300% FPL
300% FPL
5,902
53%
15%
18%
12%
0.02%
0%
2%
Federated States of Micronesia
0.1%
--
Guam
--
--
--
--
--
--
--
--
--
--
Hawaii
400% FPL
400% FPL
226
23%
17%
36%
21%
3%
0%
0%
Idaho
200% FPL
NA
137
62%
22%
16%
0%
0%
0%
0%
Illinois
300% FPL
16%
2%
0%
450% FPL
5,003
52%
11%
14%
5%
Indiana
300% FPL
300% FPL
2,566
50%
15%
20%
15%
0.3%
0.1%
0%
Iowa
200% FPL
400% FPL
253
14%
9%
36%
33%
8%
0.4%
0%
Kansas
300% FPL
300% FPL
689
39%
13%
23%
25%
0%
0%
0%
Kentucky
--
--
--
--
--
--
--
--
--
--
Louisiana
300% FPL
300% FPL
2,811
53%
14%
20%
13%
0%
0%
0%
Maine
500% FPL
500% FPL
386
47%
9%
15%
18%
8%
3%
0%
Marshall Islands Maryland Massachusetts
--
--
500% FPL 500% FPL
--
500% FPL 2
500% FPL
2
--
--
3,374
8%
8%
22%
29%
21%
12%
0%
3,703
44%
--
9%
--
15%
--
16%
--
10%
7%
0%
--
Michigan
450% FPL
400% FPL
2,419
13%
8%
26%
33%
13%
7%
0.2%
Minnesota
300% FPL
300% FPL
533
24%
5%
26%
45%
0%
0%
0%
Mississippi
--
--
--
--
--
--
--
--
--
--
Missouri
300% FPL
300% FPL
2,497
52%
11%
18%
19%
0.2%
0.04%
0%
Montana
430% FPL
430% FPL
119
40%
27%
13%
12%
4%
1%
3%
0%
0%
0%
0%
Nevada
400% FPL
400% FPL
671
0%
0%
0%
0%
0%
0%
100%
New Hampshire
Nebraska
400% FPL
400% FPL
285
34%
14%
24%
21%
7%
0%
0%
New Jersey
200% FPL
200% FPL
13%
7%
0%
400% FPL
400% FPL
406
28%
11%
31%
27%
4%
0%
0%
435% FPL
17,114
32%
14%
21%
20%
11%
2%
0%
North Carolina
300% FPL
300% FPL
5,033
55%
15%
20%
10%
0%
0%
0%
North Dakota
300% FPL
300% FPL
82
23%
18%
22%
28%
7%
1%
0%
--
--
--
--
--
--
--
--
--
Ohio
300% FPL
300% FPL
1,928
30%
14%
32%
23%
0%
0%
1%
Oklahoma
200% FPL
400% FPL
1,143
43%
12%
20%
11%
2%
0%
12%
Puerto Rico Republic of Palau Rhode Island
400% FPL
9%
18%
23%
--
2,785
47%
17%
19%
13%
4%
0%
0%
5,085
27%
11%
19%
23%
13%
8%
0%
200% FPL
200% FPL
6,947
93%
7%
0%
0%
0%
0%
0%
--
--
--
--
--
--
--
--
--
500% FPL
400% FPL
31%
22%
435% FPL
Oregon
3,489
20%
New Mexico
Pennsylvania
500% FPL
58%
New York
Northern Mariana Islands
500% FPL
387
3
500% FPL
3
--
--
--
--
--
--
--
--
--
--
--
South Carolina
300% FPL
550% FPL
3,488
48%
11%
17%
15%
5%
3%
0%
South Dakota
300% FPL
NA
165
44%
15%
21%
20%
0%
0%
0%
Tennessee
300% FPL
300% FPL
4,917
57%
13%
14%
16%
1%
0%
0%
Texas
200% FPL
200% FPL
12,213
79%
2%
4%
0%
0%
0%
15%
Utah
250% FPL
250% FPL
458
54%
12%
19%
13%
0%
0%
1%
Vermont
--
--
--
--
--
--
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
--
--
--
--
--
--
Virginia
400% FPL
400% FPL
4,115
59%
12%
15%
10%
3%
0%
0.4%
Washington
400% FPL
400% FPL
2,163
13%
10%
37%
34%
6%
0%
0%
West Virginia
400% FPL
400% FPL
274
0%
15%
47%
32%
5%
0%
0%
Wisconsin
300% FPL
300% FPL
669
31%
14%
25%
30%
0%
0%
1%
Wyoming
350% FPL Total
350% FPL
-146,872
-45%
-11%
-18%
-16%
-6%
-2%
-3%
1 In 2014, the ACA expands Medicaid eligibility to most people with income up to 133% of the federal poverty level (FPL). However, in addition to new income counting rules for most Medicaid populations (called “Modified Adjusted Gross Income”), there is an additional 5% disregard of income, effectively bumping the Medicaid income eligibility threshold to 138% FPL. 2
In Massachusetts, the 500% FPL income eligibilty requirement also includes a $5,060 allowance for each dependent.
3
In Pennsylvania, clients at >500% FPL who have dependents have an allowance for those dependents that account for income over the determined limit.
Note: 47 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont, Virgin Islands (U.S.) and Wyoming did not respond. A dash (--) indicates the ADAP did not report data. A zero (0%) indicates the ADAP responded zero (0%) to the question. The 2014 Federal Poverty Level (FPL) was $11,670 (slightly higher in Alaska and Hawaii) for a household of one.
51
Table 12: ADAP Clients Served, by HIV/AIDS Status, June 2014 HIV positive, AIDS status unknown
HIV positive, not-AIDS State/Territory
Alabama
June 2014 Clients Served
Full-Pay Medications Only
Full-Pay ADAP-Funded Medications and Insurance Only ADAP-Funded 1 Insurance 2 ---
All Clients Served
Full-Pay Medications Only
ADAP-Funded Insurance Only --
1,893
--
0%
--
Alaska
95
--
--
--
0%
--
--
American Samoa
--
--
--
--
--
--
--
1,244
15%
34%
0%
--
7%
10%
Arkansas
Arizona
783
66%
7%
0%
--
8%
1%
California
20,392
24%
19%
0%
--
11%
8%
Colorado
1,763
9%
46%
0.1%
--
0.1%
0.2%
Connecticut
--
1,433
--
--
--
59%
--
Delaware
703
--
--
--
31%
--
--
District of Columbia
944
--
--
--
0%
--
--
--
--
--
--
--
--
--
Florida
Federated States of Micronesia
13,187
30%
5%
0%
--
48%
9%
Georgia
0.3%
5,902
54%
1%
0.1%
--
13%
Guam
--
--
--
--
--
--
--
Hawaii
226
22%
35%
0.4%
--
0%
0%
Idaho
137
--
--
--
64%
--
--
Illinois
5,003
65%
6%
7%
--
4%
0.1%
Indiana
--
2,566
--
--
--
55%
--
Iowa
253
--
--
--
51%
--
--
Kansas
689
9%
38%
0%
--
2%
6%
Kentucky
--
--
--
--
--
--
--
Louisiana
2,811
--
--
--
42%
--
--
386
3%
50%
1%
--
1%
9%
Maine
--
--
--
--
--
--
--
Maryland
Marshall Islands
3,374
0.1%
0.03%
0%
--
25%
42%
Massachusetts
3,703
2%
48%
0.03%
--
1%
4%
Michigan
2,419
--
--
--
41%
--
--
Minnesota
533
--
--
--
0%
--
--
Mississippi
--
--
--
--
--
--
--
Missouri
2,497
9%
24%
15%
--
5%
12%
Montana
119
--
--
--
46%
--
--
Nebraska
387
--
--
--
0%
--
--
Nevada
671
--
--
--
0%
--
--
New Hampshire
285
--
--
--
52%
--
--
New Jersey
3,489
--
--
--
0%
--
--
New Mexico
406
1%
39%
0%
--
0%
1%
New York
17,114
--
--
--
28%
--
--
North Carolina
5,033
54%
6%
0.1%
--
6%
0.4%
North Dakota
82
13%
44%
0%
--
0%
0%
Northern Mariana Islands
--
--
--
--
--
--
--
Ohio
1,928
30%
34%
4%
--
0%
0%
Oklahoma
1,143
--
--
--
52%
--
--
Oregon
2,785
0.04%
7%
0%
--
0.04%
36%
Pennsylvania
5,085
0%
0%
0%
--
17%
14%
Puerto Rico
6,947
--
--
--
0%
--
--
--
--
--
--
--
--
--
Republic of Palau Rhode Island South Carolina South Dakota
--
--
--
--
--
--
--
3,488
33%
19%
0%
--
3%
1% --
165
--
--
--
85%
--
4,917
--
--
--
60%
--
--
Texas
12,213
--
--
--
0%
--
--
Utah
Tennessee
458
32%
36%
1%
--
0%
0.2%
Vermont
--
--
--
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
--
--
--
Virginia
4,115
16%
37%
4%
--
2%
2%
Washington
--
2,163
--
--
--
6%
--
West Virginia
274
--
--
--
57%
--
--
Wisconsin
669
--
--
--
42%
--
--
Wyoming Total
--
--
--
--
--
--
--
146,872
26%
22%
34%
10%
14%
12%
1
Individuals who had an insurance (i.e., Medicare Part D, Medicaid, private insurance) payment (premium, co-payment/co-insurance, and/or deductible) paid on their behalf using ADAP funds, either fully or in part.
2
This includes clients who enrolled in an insurance plan mid-year and those who were enrolled in an insurance plan that did not cover one or more medically necessary medications such that the ADAP’s full-pay prescription program did instead.
3
The AIDS case definition used as part of this Survey may be found here and is consistent with the most recent ADR submission. Please note, however, that an updated case definition was released by CDC in April 2014 (located here). Note: 47 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont, Virgin Islands (U.S.) and Wyoming did not respond. A dash (--) indicates the ADAP did not report data. A zero (0%) indicates the ADAP responded zero (0%) to the question. In some cases, an ADAP was able to report data though was unable to distinguish between clients served by the fullpay medications program only, the ADAP-funded insurance program only, and the full-pay medications and ADAP-funded insurance programs.
Note: Many ADAPs were unable to report HIV/AIDS Status separately for: clients served by a full-pay prescription program only; clients served by an ADAP-funded insurance program only; and clients served by a fully-pay prescription program and ADAP-funded insurance program. As such, the percentage of clients that fall into each HIV/AIDS Status category are reported under "All Clients Served" for each state for which this is the case.
52
Table 12: ADAP Clients Served, by HIV/AIDS Status, June 2014 HIV positive, AIDS status unknown (continued)
CDC-defined AIDS
(continued)
3
Unknown
Full-Pay Medications and ADAPFunded
All Clients Served
--
100%
--
--
--
0%
--
--
--
0%
--
0%
--
--
--
0%
--
--
--
100% --
Full-Pay Medications Only
ADAPFunded Insurance Only
Full-Pay Medications and ADAPFunded
All Clients Served
Full-Pay Medications Only
ADAPFunded Insurance Only
Full-Pay Medications and ADAPFunded
All Clients Served
--
--
--
--
--
--
--
--
--
0%
--
8%
26%
0%
--
1%
0.2%
0%
--
0%
--
12%
5%
0%
--
0.1%
0%
0%
--
0%
--
17%
19%
0%
--
1%
0.4%
0%
--
0%
--
7%
34%
0%
--
0.5%
2%
0%
--
--
5%
--
--
--
36%
--
--
--
0%
--
0%
--
--
--
69%
--
--
--
0%
--
100%
--
--
--
0%
--
--
--
0%
--
--
--
--
--
--
--
--
--
--
0.01%
--
8%
1%
0%
--
0%
0%
0%
--
0%
--
28%
0.5%
0.02%
--
3%
0.4%
0%
--
--
--
--
--
--
--
--
--
--
--
0%
--
8%
35%
0%
--
0%
0%
0%
--
--
0%
--
--
--
36%
--
--
--
0%
0.3%
--
14%
2%
2%
--
0%
0%
0%
--
--
0%
--
--
--
45%
--
--
--
0% 0%
--
4%
--
--
--
45%
--
--
--
0%
--
9%
36%
0%
--
0%
0.1%
0%
--
--
--
--
--
--
--
--
--
--
-0%
--
7%
--
--
--
51%
--
--
--
0%
--
0.3%
35%
0.3%
--
0%
0%
0%
--
--
--
--
--
--
--
--
--
--
---
0%
--
11%
21%
0%
--
0%
0%
0%
0%
--
0.4%
45%
0.03%
--
0.03%
1%
0%
--
--
35%
--
--
--
22%
--
--
--
1%
--
100%
--
--
--
0%
--
--
--
0%
--
--
--
--
--
--
--
--
--
--
8%
--
6%
12%
8%
--
0.2%
0.1%
0.04%
--
--
1%
--
--
--
52%
--
--
--
1%
--
100%
--
--
--
0%
--
--
--
0%
--
0%
--
--
--
0%
--
--
--
100%
--
3%
--
--
--
46%
--
--
--
0%
--
100%
--
--
--
0%
--
--
--
0%
0%
--
1%
57%
0%
--
0.5%
0.2%
0%
--
--
35%
--
--
--
37%
--
--
--
0%
0%
--
28%
7%
0.1%
--
0%
0%
0%
--
0%
--
10%
33%
0%
--
0%
0%
0%
---
--
--
--
--
--
--
--
--
--
0%
--
15%
15%
0%
--
0.1%
0.1%
2%
--
--
0%
--
--
--
36%
--
--
--
12%
0.1%
--
0.04%
55%
0%
--
0%
1%
0%
--
4%
--
0%
0%
0%
--
42%
18%
6%
-0%
--
100%
--
--
--
0%
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
0%
--
24%
15%
0%
--
3%
2%
0%
--
--
1%
--
--
--
14%
--
--
--
0%
--
0.3%
--
--
--
39%
--
--
--
0.02%
--
0%
--
--
--
0%
--
--
--
100%
0%
--
17%
13%
0.2%
--
0.2%
0%
0%
--
--
--
--
--
--
--
--
--
--
---
--
--
--
--
--
--
--
--
--
0.2%
--
12%
24%
3%
--
0.05%
0%
0%
--
--
34%
--
--
--
60%
--
--
--
0%
--
1%
--
--
--
43%
--
--
--
0%
--
0%
--
--
--
58%
--
--
--
0%
--
--
--
--
--
--
--
--
--
--
14%
15%
13%
21%
14%
10%
3%
2%
11%
9%
53
Table 13: ADAP Clients by CD4 Count, Enrolled During 12-Month Period, June 2014
CD4 ≤200 State/Territory
June 2014 Clients Served Full-Pay Medications Only
Alabama
ADAPFunded Insurance Only 2
CD4 between 201-350
Full-Pay Medications and ADAPFunded Insurance 3
All Clients Served
Full-Pay Medications Only
Full-Pay ADAP-Funded Medications and Insurance Only ADAP-Funded Insurance
All Clients Served
1,893
--
--
--
72%
--
--
--
15%
Alaska
95
--
--
--
0%
--
--
--
0%
American Samoa
--
--
--
--
--
--
--
--
--
1,244
5%
13%
0%
--
6%
14%
0%
--
Arkansas
783
13%
1%
0%
--
13%
1%
0%
--
California
20,392
4%
3%
0%
--
7%
6%
0%
--
Colorado
1,763
2%
6%
0%
--
3%
11%
0%
--
Connecticut
Arizona
1,433
--
--
--
11%
--
--
--
14%
Delaware
703
--
--
--
26%
--
--
--
14%
District of Columbia
944
--
--
--
8%
--
--
--
13%
--
--
--
--
--
--
--
--
--
Florida
13,187
8%
1%
0%
--
12%
2%
0%
--
Georgia
Federated States of Micronesia
5,902
10%
0.1%
0%
--
17%
0.2%
0%
--
Guam
--
--
--
--
--
--
--
--
--
Hawaii
226
0%
4%
0%
--
4%
22%
0%
--
Idaho
137
--
--
--
7%
--
--
--
15%
Illinois
5,003
8%
1%
13%
1%
1%
Indiana
1%
--
2,566
--
--
--
14%
--
--
--
12%
Iowa
253
--
--
--
5%
--
--
--
12%
--
Kansas
689
4%
13%
0%
--
4%
10%
0%
--
Kentucky
--
--
--
--
--
--
--
--
--
Louisiana
2,811
--
--
--
--
--
--
--
0%
386
0.3%
8%
0%
--
1%
15%
0.3%
--
--
--
--
--
--
--
--
--
--
Maine Marshall Islands Maryland
3,374
4%
5%
0%
--
6%
9%
0%
--
Massachusetts
3,703
1%
6%
0%
--
1%
12%
0%
--
Michigan
2,419
--
--
--
6%
--
--
--
8%
533
--
--
--
10%
--
--
--
14%
Minnesota
--
--
--
--
--
--
--
--
Missouri
Mississippi
2,497
3%
6%
4%
--
4%
8%
5%
--
Montana
119
--
--
--
4%
--
--
--
15%
--
Nebraska
387
--
--
--
0%
--
--
--
0%
Nevada
671
--
--
--
0%
--
--
--
0%
New Hampshire
285
--
--
--
6%
--
--
--
14% 100%
New Jersey
3,489
--
--
--
0%
--
--
--
New Mexico
406
1%
9%
0%
--
0%
15%
0%
--
New York
17,114
--
--
--
7%
--
--
--
12%
North Carolina
5,033
9%
1%
0.02%
--
12%
2%
0.04%
--
North Dakota
82
2%
5%
0%
--
2%
9%
0%
--
Northern Mariana Islands
--
--
--
--
--
--
--
--
--
1,928
6%
4%
1%
--
7%
6%
1%
--
--
10%
--
12%
Ohio Oklahoma
1,143
--
--
--
Oregon
2,785
0.04%
6%
0%
--
0%
12%
0%
--
Pennsylvania
5,085
4%
2%
--
1%
--
7%
4%
1%
--
Puerto Rico
0%
6,947
--
--
--
0%
--
--
--
Republic of Palau
--
--
--
--
--
--
--
--
--
Rhode Island
--
--
--
--
--
--
--
--
--
South Carolina
3,488
7%
2%
0%
--
10%
5%
0.1%
--
South Dakota
165
--
--
--
16%
--
--
--
13%
Tennessee
4,917
--
--
--
0%
--
--
--
0%
Texas
12,213
--
--
--
0%
--
--
--
0%
Utah
458
4%
2%
0%
--
4%
4%
0.2%
--
--
--
--
--
--
--
--
--
--
Vermont Virgin Islands (U.S.)
--
--
--
--
--
--
--
--
Virginia
4,115
5%
5%
1%
--
5%
8%
1%
--
Washington
2,163
--
--
--
7%
--
--
--
14%
--
West Virginia
274
--
--
--
8%
--
--
--
35%
Wisconsin
669
--
--
--
6%
--
--
--
13%
Wyoming Total
-146,872
-5%
-4%
-7%
-3%
-8%
-7%
-10%
-5%
1 Reported using the most recent CD4 count recorded as of June 30, 2014 for each client who was served by the ADAP program in June 2014. If a client did not receive a CD4 count during June 2014, was reported based on the last CD4 count recorded for that individual prior to June 30, 2014. 2
Individuals who had an insurance (i.e., Medicare Part D, Medicaid, private insurance) payment (premium, co-payment/co-insurance, and/or deductible) paid on their behalf using ADAP funds, either fully or in part.
3
This includes clients who enrolled in an insurance plan mid-year and those who were enrolled in an insurance plan that did not cover one or more medically necessary medications such that the ADAP’s fullpay prescription program did instead. Note: 47 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont, Virgin Islands (U.S.) and Wyoming did not respond. Data reflect clients enrolled in ADAPs over the past 12 months or the most recent 12 months for which data are available. A dash (--) indicates the ADAP did not report data. A zero (0%) indicates the ADAP responded zero (0%) to the question. In some cases, an ADAP was able to report data though was unable to distinguish between clients served by the full-pay medications program only, the ADAP-funded insurance program only, and the full-pay medications and ADAP-funded insurance programs. Note: Many ADAPs were unable to report CD4 Count separately for: clients served by a full-pay prescription program only; clients served by an ADAP-funded insurance program only; and clients served by a fully-pay prescription program and ADAP-funded insurance program. As such, the percentage of clients that fall into each CD4 Count category are reported under "All Clients Served" for each state for which this is the case.
54
Table 13: ADAP Clients by CD4 Count, Enrolled During 12-Month Period, June 2014
CD4 > 500
CD4 between 351-500
Full-Pay Medications Only
ADAP-Funded Insurance Only
Full-Pay Medications and ADAPFunded Insurance
(continued)
All Clients Served
Full-Pay Medications Only
ADAPFunded Insurance Only
Unknown
Full-Pay Medications and ADAPFunded Insurance
All Clients Served
Full-Pay Medications Only
ADAPFunded Insurance Only
Full-Pay Medications and ADAPFunded Insurance
All Clients Served
--
--
--
9%
--
--
--
3%
--
--
--
1%
--
--
--
0%
--
--
--
0%
--
--
--
100% --
--
--
--
--
--
--
--
--
--
--
--
4%
10%
0%
--
15%
33%
0%
--
0%
0%
0%
--
54%
10%
0%
--
6%
3%
0%
--
0%
0%
0%
--
10%
9%
0%
--
29%
27%
0%
--
2%
2%
0%
--
5%
18%
0.1%
--
6%
46%
0.1%
--
0.4%
2%
0%
--
--
--
--
19%
--
--
--
57%
--
--
--
0%
--
--
--
15%
--
--
--
45%
--
--
--
0%
--
--
--
17%
--
--
--
47%
--
--
--
16%
--
--
--
--
--
--
--
--
--
--
--
--
17%
3%
0%
--
48%
9%
0.01%
--
0%
0%
0%
--
21%
0.2%
0.1%
--
43%
1%
0.1%
--
7%
1%
0%
--
--
--
--
--
--
--
--
--
--
--
--
--
5%
17%
0%
--
21%
22%
0.4%
--
0%
4%
0%
--
--
--
--
19%
--
--
--
60%
--
--
--
0%
18%
2%
2%
--
45%
5%
6%
--
0%
0%
0%
--
--
--
--
16%
--
--
--
42%
--
--
--
16%
--
--
--
19%
--
--
--
59%
--
--
--
4%
3%
18%
0%
--
9%
38%
0%
--
0%
0.4%
0%
--
--
--
--
--
--
--
--
--
--
--
--
-100%
--
--
--
0%
--
--
--
0%
--
--
--
1%
18%
0%
--
2%
52%
1%
--
0%
2%
1%
--
--
--
--
--
--
--
--
--
--
--
--
---
7%
12%
0%
--
19%
37%
0%
--
0.2%
0.1%
0%
1%
18%
0.03%
--
1%
61%
0.03%
--
0.1%
0.03%
0%
--
--
--
--
12%
--
--
--
35%
--
--
--
39% 0%
--
--
--
18%
--
--
--
57%
--
--
--
--
--
--
--
--
--
--
--
--
--
--
5%
11%
5%
--
7%
24%
16%
--
1%
1%
1%
--
--
--
--
18%
--
--
--
50%
--
--
--
13%
--
--
--
0%
--
--
--
0%
--
--
--
100% 100%
--
--
--
--
0%
--
--
--
0%
--
--
--
--
--
--
18%
--
--
--
54%
--
--
--
8%
--
--
--
0%
--
--
--
0%
--
--
--
0%
0.2%
17%
0%
--
1%
57%
0%
--
0.5%
0%
0%
--
--
--
--
18%
--
--
--
61%
--
--
--
2%
18%
3%
0.02%
--
49%
7%
0.04%
--
0.3%
0.1%
0%
--
2%
15%
0%
--
11%
38%
0%
--
5%
11%
0%
---
--
--
--
--
--
--
--
--
--
--
--
10%
9%
1%
--
23%
29%
3%
--
0%
0%
0%
--
--
--
--
17%
--
--
--
43%
--
--
--
18%
0%
19%
0%
--
0.04%
57%
0%
--
0.04%
5%
0%
--
10%
6%
2%
--
34%
18%
6%
--
4%
1%
0.3%
--
--
--
--
0%
--
--
--
0%
--
--
--
100%
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
11%
6%
0.03%
--
35%
22%
0.03%
--
1%
0.5%
0%
--
--
--
--
22%
--
--
--
48%
--
--
--
0%
--
--
--
0%
--
--
--
0%
--
--
--
100%
--
--
--
0%
--
--
--
0%
--
--
--
100%
8%
8%
0.4%
--
22%
28%
1%
--
12%
7%
0.2%
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
6%
12%
2%
--
14%
36%
4%
--
0.5%
1%
0.05%
--
--
--
--
22%
--
--
--
56%
--
--
--
1%
--
--
--
--
25%
--
--
--
32%
--
--
--
0%
--
--
--
19%
--
--
--
62%
--
--
--
0.4%
-11%
-11%
-14%
-4%
-29%
-32%
-41%
-12%
-44%
-1%
-1%
-21%
55
Table 14: ADAP Clients by Viral Load, Enrolled During 12-Month Period, June 2014
Viral Load ≤200 State/Territory
June 2014 Clients Served Full-Pay Medications Only
Alabama
--
Full-Pay Medications and ADAPFunded Insurance 3
All Clients Served
Full-Pay Medications Only
Full-Pay ADAP-Funded Medications and Insurance Only ADAP-Funded Insurance
Unknown
All Clients Served
Full-Pay Medications Only --
ADAPFunded Insurance Only
Full-Pay Medications and ADAPFunded Insurance
All Clients Served
--
--
83%
--
--
--
16%
--
--
2%
Alaska
95
--
--
--
0%
--
--
--
0%
--
--
--
100%
American Samoa
--
--
--
--
--
--
--
--
--
--
--
--
--
Arizona
1,893
ADAPFunded Insurance Only 2
Viral Load >200
1,244
17%
48%
0%
--
13%
22%
0%
--
0.1%
0%
0%
--
Arkansas
783
77%
11%
0%
--
9%
2%
0%
--
0%
0%
0%
--
California
20,392
42%
41%
0%
--
10%
4%
0%
--
1%
1%
0%
Colorado
1,763
0%
0%
0%
--
0%
0%
0%
--
17%
83%
0.1%
--
Connecticut
1,433
--
--
--
90%
--
--
--
10%
--
--
--
0%
703
--
--
--
66%
--
--
--
34%
--
--
--
0%
--
72%
--
13%
Delaware District of Columbia
--
16%
--
--
--
--
--
--
--
--
--
--
--
--
--
Florida
13,187
74%
14%
0.01%
--
12%
1%
0%
--
0%
0%
0%
Georgia
Federated States of Micronesia
944
--
--
--
--
--
--
--
--
5,902
35%
0.1%
0.1%
--
13%
0.1%
0.1%
--
49%
2%
0%
--
Guam
--
--
--
--
--
--
--
--
--
--
--
--
--
Hawaii
226
21%
62%
0.4%
--
4%
4%
0%
--
4%
4%
0%
--
Idaho
137
--
--
--
96%
--
--
--
4%
--
--
--
Illinois
5,003
74%
8%
9%
--
8%
1%
1%
--
0%
0%
0%
--
Indiana
2,566
--
--
--
42%
--
--
--
18%
--
--
--
40%
0%
Iowa
253
--
--
--
93%
--
--
--
4%
--
--
--
3%
Kansas
689
17%
71%
0%
--
3%
9%
0%
--
0.1%
0.4%
0%
--
Kentucky
--
--
--
--
--
--
--
--
--
--
--
--
--
Louisiana
2,811
--
--
--
0%
--
--
--
0%
--
--
--
100%
386
3%
83%
1%
--
1%
8%
0%
--
1%
4%
1%
--
--
--
--
--
--
--
--
--
--
--
--
--
--
3,374
29%
56%
0%
--
7%
7%
0%
--
0.1%
0.1%
0%
Massachusetts
3,703
2%
88%
0.1%
--
1%
9%
0%
--
0.1%
0.03%
0%
--
Michigan
2,419
--
--
--
51%
--
--
--
9%
--
--
--
40%
533
--
--
--
75%
--
--
--
12%
--
--
--
13% --
Maine Marshall Islands Maryland
Minnesota Mississippi Missouri
--
--
--
--
--
--
--
--
--
--
--
--
2,497
14%
42%
27%
--
4%
6%
4%
--
1%
1%
1%
--
--
Montana
119
--
--
--
81%
--
--
--
7%
--
--
--
13%
Nebraska
387
--
--
--
0%
--
--
--
0%
--
--
--
100%
671
--
--
--
--
100%
285
--
--
--
84%
--
--
--
8%
--
--
--
8%
New Jersey
Nevada
3,489
--
--
--
72%
--
--
--
28%
--
--
--
New Mexico
406
0.5%
79%
0%
--
1%
19%
0%
--
0.5%
0%
0%
--
17,114
--
--
--
85%
--
--
--
12%
--
--
--
3%
North Carolina
5,033
71%
11%
0.1%
--
16%
1%
0.02%
--
0.3%
0.1%
0%
North Dakota
82
16%
61%
0%
--
4%
9%
0%
--
4%
7%
0%
--
Northern Mariana Islands
--
--
--
--
--
--
--
--
--
--
--
--
--
1,928
36%
44%
5%
--
10%
5%
1%
--
0%
0%
0%
--
--
14%
New Hampshire
New York
Ohio
--
0%
--
--
--
0%
--
--
Oklahoma
1,143
--
--
--
52%
--
--
--
34%
--
Oregon
2,785
0.04%
89%
0.1%
--
0.04%
11%
0%
--
0.04%
0%
0%
Pennsylvania
5,085
38%
22%
7%
--
7%
3%
1%
--
13%
6%
2%
--
Puerto Rico
6,947
--
--
--
0%
--
--
--
0%
--
--
--
100%
Republic of Palau Rhode Island South Carolina South Dakota Tennessee
--
--
--
--
--
--
--
0%
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
3,488
50%
32%
0.1%
--
11%
3%
0%
--
2%
1%
0%
--
165
--
--
--
84%
--
--
--
15%
--
--
--
1%
4,917
--
--
--
0%
--
--
--
0%
--
--
--
100% 100%
Texas
12,213
--
--
--
0%
--
--
--
0%
--
--
--
Utah
458
27%
31%
1%
--
4%
3%
0.4%
--
19%
15%
0.4%
--
--
--
--
--
--
--
--
--
--
--
--
--
--
Vermont
--
--
--
--
--
--
--
--
--
--
--
--
Virginia
4,115
20%
46%
5%
--
8%
11%
2%
--
2%
5%
0.3%
--
Washington
Virgin Islands (U.S.)
2,163
--
--
--
93%
--
--
--
6%
--
--
--
1%
274
--
--
--
77%
--
--
--
23%
--
--
--
0%
West Virginia
--
Wisconsin
669
--
--
--
90%
--
--
--
9%
--
--
--
0.4%
Wyoming Total
-146,872
-24%
-18%
-1%
-19%
-5%
-2%
-0.2%
-4%
-3%
-2%
-0.1%
-21%
1
Reported using the most recent viral load recorded for each client as of June 30, 2014 among those served by the ADAP program in June 2014 (including those clients on ARVs and those clients not on ARVs). If a client did not receive a viral load during June 2014, reported based on the last viral load recorded for that individual prior to June 30, 2014. 2
Individuals who had an insurance (i.e., Medicare Part D, Medicaid, private insurance) payment (premium, co-payment/co-insurance, and/or deductible) paid on their behalf using ADAP funds, either fully or in part.
3
This includes clients who enrolled in an insurance plan mid-year and those who were enrolled in an insurance plan that did not cover one or more medically necessary medications such that the ADAP’s full-pay prescription program did instead.
Note: 47 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont, Virgin Islands (U.S.) and Wyoming did not respond. Data reflect clients enrolled in ADAPs over the past 12 months or the most recent 12 months for which data are available. A dash (--) indicates the ADAP did not report data. A zero (0%) indicates the ADAP responded zero (0%) to the question. In some cases, an ADAP was able to report data Note: Many ADAPs were unable to report Viral Load separately for: clients served by a full-pay prescription program only; clients served by an ADAP-funded insurance program only; and clients served by a fully-pay prescription program and ADAP-funded insurance program. As such, the percentage of clients that fall into each Viral Load category are reported under "All Clients Served" for each state for which this is the case.
56
Table 15: ADAP Client Enrollment Processes, as of June 30, 2014
State/Territory
Intake at Local ASOs, Intake at Local ASOs, CBOs, and Local Health CBOs, and Local Health 1 Department (ADAP Funds Department (ADAP Used All or In Part) Funds Not Used)
Intake at ADAP Office
Intake at Private Clinical Settings
Online Application
Application Over the Phone
Faxed Application Mailed Application
Other State Programs
Other Enrollment Processes
Alabama
Yes
No
No
Yes
No
No
Yes
Yes
No
No
Alaska
Yes
Yes
Yes
No
No
Yes
Yes
Yes
No
No
--
--
--
--
--
--
--
--
--
--
Yes
Yes
Yes
No
No
No
Yes
Yes
No
Yes
American Samoa Arizona Arkansas
Yes
No
No
No
No
Yes
Yes
Yes
No
No
California
Yes
Yes
No
No
No
No
No
No
No
Yes
No
Yes
Yes
Yes
No
No
Yes
Yes
No
No
Connecticut
No
No
Yes
No
No
No
Yes
Yes
No
No
Delaware
Colorado
Yes
No
No
No
No
No
No
No
No
No
District of Columbia
Yes
No
Yes
No
No
No
Yes
Yes
No
No
Federated States of Micronesia
--
--
--
--
--
--
--
--
--
--
Florida
No
Yes
Yes
No
No
No
No
No
No
No
Georgia
No
Yes
No
No
No
Yes
No
No
Yes
No
Guam
--
--
--
--
--
--
--
--
--
Hawaii
Yes
No
No
Yes
No
No
No
No
No
No
Idaho
Yes
No
No
No
No
No
No
No
No
Yes
Illinois
Yes
No
No
No
Yes
No
Yes
Yes
No
No
Indiana
Yes
No
No
No
No
No
No
No
No
No
Iowa
No
Yes
No
No
No
No
No
No
No
No
Kansas
Yes
No
No
No
No
No
No
No
No
No
--
--
--
--
--
--
--
--
--
Kentucky
--
--
Louisiana
Yes
No
Yes
Yes
No
Yes
Yes
Yes
No
No
Maine
Yes
No
Yes
Yes
No
No
Yes
Yes
No
No
Marshall Islands Maryland
--
--
--
--
--
--
--
--
--
--
Yes
No
Yes
Yes
No
No
Yes
Yes
No
No
Massachusetts
Yes
No
Yes
Yes
No
No
Yes
Yes
No
No
Michigan
Yes
No
No
Yes
No
No
Yes
Yes
No
No
Minnesota
No
Yes
No
Yes
Yes
No
Yes
Yes
No
No
Mississippi
--
--
--
--
--
--
--
--
--
--
Missouri
No
Yes
No
Yes
No
No
No
No
No
No
Montana
Yes
No
No
Yes
No
No
No
Yes
No
No
Nebraska
Yes
No
Yes
Yes
No
No
Yes
Yes
No
No
Nevada
No
Yes
No
No
No
Yes
No
Yes
No
Yes No
New Hampshire
Yes
Yes
No
Yes
No
No
Yes
Yes
No
New Jersey
Yes
No
Yes
Yes
No
No
Yes
Yes
No
No
New Mexico
No
Yes
No
No
No
No
No
No
No
No
New York
No
No
No
No
No
No
Yes
Yes
No
No
North Carolina
Yes
No
No
Yes
No
No
No
Yes
No
No
North Dakota
Yes
No
No
No
No
No
No
No
No
No
Northern Mariana Islands
--
--
--
--
--
--
--
--
--
--
Ohio
No
No
Yes
No
No
No
No
No
No
No
Oklahoma
No
No
No
No
Yes
No
No
No
No
Yes
Oregon
No
No
Yes
No
No
No
Yes
Yes
No
No
Pennsylvania
No
No
No
No
No
No
Yes
Yes
No
No
Puerto Rico
Yes
No
No
No
No
No
Yes
Yes
No
No
Republic of Palau
--
--
--
--
--
--
--
--
--
--
Rhode Island
--
--
--
--
--
--
--
--
--
--
Yes
No
No
Yes
No
No
Yes
Yes
Yes
Yes
South Dakota
No
No
Yes
No
No
No
No
No
No
No
Tennessee
Yes
No
No
No
No
No
No
No
No
No
Texas
Yes
No
No
No
No
No
Yes
Yes
No
No
Utah
No
Yes
No
Yes
No
No
Yes
Yes
No
No
Vermont
--
--
--
--
--
--
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
--
--
--
--
--
--
Yes
No
Yes
Yes
No
Yes
Yes
Yes
No
No
Washington
No
No
No
No
No
No
Yes
Yes
No
No
West Virginia
Yes
No
Yes
Yes
No
Yes
Yes
Yes
No
Wisconsin
Yes
No
Yes
Yes
No
No
Yes
Yes
No
No
Wyoming
No
No
No
No
No
No
No
No
No
Yes
Total
31
12
18
20
4
6
28
32
1
7
South Carolina
Virginia
1
No
ASOs=AIDS Service Organizations; CBOs=Community-Based Organizations.
Note: 48 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont and Virgin Islands (U.S.) did not respond. A dash (--) indicates the ADAP did not report data.
57
Table 16: ADAP Client Financial Eligibility Requirements, as of June 30, 2014 Financial Eligibility State/Territory
2
Calculation Basis Net Income
Household Income
Family Income
No
Yes
Yes
No
No
No
No
Yes
No
Yes
Yes
--
--
--
--
--
--
No
Yes
No
No
No
No
Yes
Yes
No
No
No
No
No
Yes
Yes
No
No
Yes
No
No
Yes
No
Yes
No
No
No
No
Yes
No
No
Yes
No
Yes
No
No
Yes
No
No
Yes
No
Yes
Yes
No
No
Yes
No
No
Yes
Gross Income Yes
No
300% FPL
Yes
--
--
300% FPL 400% FPL
500% FPL
500% FPL
500% FPL
400% FPL
Connecticut
400% FPL
400% FPL
Delaware
500% FPL
500% FPL
District of Columbia
500% FPL
500% FPL
ADAP-Funded Insurance Program
Alabama
250% FPL
250% FPL
Alaska
300% FPL --
Arizona
300% FPL
Arkansas
400% FPL
California Colorado
American Samoa
Federated States of Micronesia
Recognition of Domestic Partnerships/Same-Sex
Individual Income
Modified Adjusted Gross Income (MAGI)
Full-Pay Medications (Uninsured)
--
--
--
--
--
Marriages
Yes
--
--
--
Florida
400% FPL
400% FPL
Yes
No
No
No
No
No
No
Georgia
300% FPL
300% FPL
Yes
Yes
No
No
No
No
No
--
Guam
--
--
--
--
--
--
--
--
--
Hawaii
400% FPL
400% FPL
Yes
No
No
No
No
No
Yes
Idaho
200% FPL
NA
Yes
No
No
Yes
No
Yes
No
Illinois
300% FPL
450% FPL
No
Yes
No
No
Yes
No
Yes
Indiana
300% FPL
300% FPL
No
Yes
No
No
No
No
Yes
Iowa
200% FPL
400% FPL
Yes
No
No
No
Yes
300% FPL
300% FPL
Yes
No 3 No
No
Kansas
No
Yes
Yes
Yes
Yes
Kentucky
--
--
--
--
--
--
--
--
--
Louisiana
300% FPL
300% FPL
Yes
No
No
No
No
No
No
Maine
500% FPL
500% FPL
Yes
No
Yes
No
Yes
Marshall Islands Maryland
No
Yes
--
--
--
--
--
--
--
--
--
500% FPL
500% FPL
Yes
No
No
No
Yes
No
Yes
No
4
4
500% FPL 450% FPL
500% FPL 400% FPL
Yes
No
No
Yes
No
Yes
Yes
No
No
Yes
No
No
Minnesota
300% FPL
300% FPL
No
Yes
No
No
No
No
Yes
Mississippi
--
--
--
--
--
--
--
--
--
300% FPL
300% FPL
Yes
No
No
No
No
Yes
No
Massachusetts Michigan
Missouri Montana
No
No
Nebraska
200% FPL
200% FPL
Yes
No
No
Yes
No
No
No
400% FPL
400% FPL
Yes
No
No
No
No
Yes
Yes
No
Yes
400% FPL
430% FPL
400% FPL
Yes
Yes
No
No
No
No
Yes
No
Nevada New Hampshire
430% FPL
No
No
Yes
New Jersey
500% FPL
500% FPL
Yes
No
No
No
No
No
Yes
New Mexico
400% FPL
400% FPL
Yes
No
No
No
No
No
Yes
New York
435% FPL
435% FPL
Yes
No
No
No
No
No
Yes
North Carolina
300% FPL
300% FPL
Yes
No
No
No
No
No
Yes
North Dakota
300% FPL
300% FPL
Yes
No
No
No
Yes
No
--
--
--
--
--
--
--
--
--
300% FPL
300% FPL
Yes
No
No
No
No
No
No
Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico
200% FPL
No
400% FPL
Yes
Yes
No
Yes
Yes
Yes
No
400% FPL
400% FPL
Yes
No
No
No
No
No
Yes
500% FPL 5 200% FPL
500% FPL 5 200% FPL
Yes
No
No
No
Yes
No
Yes
No
No
Yes
No
No
No
No
Republic of Palau
--
--
--
--
--
--
--
--
Rhode Island
--
--
--
--
--
--
--
--
--
300% FPL
550% FPL
Yes
No
No
No
Yes
No
Yes
South Carolina South Dakota
300% FPL
NA
--
Yes
No
No
No
No
No
No
Tennessee
300% FPL
300% FPL
Yes
Yes
No
Yes
Yes
Yes
No
Texas
200% FPL
200% FPL
Yes
No
No
No
No
Yes
No
Utah
250% FPL
250% FPL
Yes
No
No
No
Yes
No
--
--
--
---
---
---
---
---
--
--
--
---
Virginia
400% FPL
400% FPL
Yes
No
No
No
No
No
Yes
Washington
400% FPL
400% FPL
Yes
Yes
Yes
Yes
No
Yes
Yes
Vermont Virgin Islands (U.S.)
--
West Virginia
400% FPL
400% FPL
No
Yes
No
No
No
No
No
Wisconsin
300% FPL
300% FPL
Yes
No
No
No
No
No
No
Wyoming
350% FPL
350% FPL
Yes
No
No
Yes
No
No
No
1
1
“Recognized” defined as legal domestic partnerships/same-sex marriages in each jurisdiction and/or acceptance of legal domestic partnerships/same-sex marriages that were granted outside of the jurisdiction.
2
In 2014, the ACA expands Medicaid eligibility to most people with income up to 133% of the federal poverty level (FPL). However, in addition to new income counting rules for most Medicaid populations (called “Modified Adjusted Gross Income”), there is an additional 5% disregard of income, effectively bumping the Medicaid income eligibility threshold to 138% FPL. 3
Iowa's ADAP will be moving from gross income calculation to modified adjusted gross income (MAGI) calculation for clients beginning in 2014.
4
In Massachusetts, the 500% FPL income eligibilty requirement also includes a $5,060 allowance for each dependent.
5
In Pennsylvania, clients at >500% FPL who have dependents have an allowance for those dependents that account for income over the determined limit.
Note: 48 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont and Virgin Islands (U.S.) did not respond. A dash (--) indicates the ADAP did not report data. The 2014 Federal Poverty Level (FPL) was $11,670 (slightly higher in Alaska and Hawaii) for a household of one.
58
Table 17: ADAP Client Medical Eligibility Requirements, as of June 30, 2014 Medical Eligibility State/Territory
Alabama Alaska American Samoa
Proof of HIV Status
CD4 Count
Full-Pay Medications (Uninsured) Yes
ADAP-Funded Insurance Program Yes
No
No
No
Yes
Yes
No
No
No
--
--
--
--
No
No
Arizona
Yes
Yes
Arkansas
Yes
Yes
California
Yes
Yes
Full-Pay Medications (Uninsured)
1
Viral Load
ADAP-Funded Insurance Program
Prescription for ARV
No
Full-Pay Medications (Uninsured) Yes
ADAP-Funded Insurance Program Yes
No
No
No
--
--
--
No
No
Full-Pay Medications (Uninsured)
ADAP-Funded Insurance Program
No No No No Current within 6 months of Current within 6 months of Current within 6 months of Current within 6 months of enrollment enrollment enrollment enrollment No No No No Current within 12 months Current within 12 months Current within 12 months Current within 12 months of enrollment of enrollment of enrollment of enrollment No No No No
--
Other Full-Pay ADAP-Funded Medications Insurance Program (Uninsured) No No Rx for med on ADAP Rx for med on ADAP formulary formulary ---
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Colorado
Yes
Yes
Connecticut
Yes
Yes
Delaware
Yes
Yes
District of Columbia
Yes
Yes
No
No
No
No
No
No
No
No
--
--
--
Yes
Yes
Yes
No
No
Yes
Yes
-Most recent laboratory tests obtained during enrollment or recertification No
--
Yes
-Most recent laboratory tests obtained during enrollment or recertification No
--
Georgia
-Most recent laboratory tests obtained during enrollment or recertification No
--
Florida
-Most recent laboratory tests obtained during enrollment or recertification No
No
No
No
No
Federated States of Micronesia
Guam
--
--
--
--
--
--
--
--
--
Hawaii
Yes
Yes
No
No
No
No
No
No
No
No
Idaho
Yes
NA
No
NA
No
NA
No
NA
No
NA
No
No
No
No
Current within 6 months of Current within 6 months of Current within 6 months of Current within 6 months of enrollment unless new enrollment unless new enrollment unless new enrollment unless new client to the program or client to the program or client to the program or client to the program or out of care for over 12 out of care for over 12 out of care for over 12 out of care for over 12 consecutive months then consecutive months then consecutive months then consecutive months then you have a 90 day you have a 90 day you have a 90 day you have a 90 day temporary approval to get temporary approval to get temporary approval to get temporary approval to get labs into the program labs into the program labs into the program labs into the program
--
Illinois
Yes
Yes
Indiana
Yes
Yes
No
No
No
No
No
No
Iowa
Yes
Yes
No
No
No
No
Yes
Yes
Physician certification No
Physician certification No
Kansas
No
Yes
Yes
No
No
No
No
No
No
No
Kentucky
--
--
--
--
--
--
--
Yes
Yes
No
No
Yes
No
No
Maine
Yes
Yes
No
-Current within 6 months of enrollment No
--
Louisiana
-Current within 6 months of enrollment No
No
Marshall Islands Maryland
No
No
No
No
--
--
--
--
--
--
--
--
Yes
Yes
No
No
No
No
No
No
No
No
No
-Physician certification No
-Physician certification No
Massachusetts
Yes
Yes
Michigan
Yes
Yes
Current at enrollment
Current at enrollment
Current at enrollment
Current at enrollment
No
No
No
No
Minnesota
No
No
Current within 12 months
Current within 12 months
Current within 12 months
Current within 12 months
No
No
No
No
Mississippi
No
No
No
No
--
--
--
--
--
--
--
--
--
--
Missouri
Yes
Yes
No
No
No
No
No
No
No
No
Montana
Yes
Yes
No
No
No
No
No
No
No
No
Nebraska
Yes
No
No
No
No
No
Nevada
Yes
Yes
No
Yes
No
No
Yes
Yes
No Current at enrollment and re-enrollment No
Yes
New Jersey
No Current at enrollment and re-enrollment No
No
Yes
No Current at enrollment and re-enrollment No
No
Yes
No Current at enrollment and re-enrollment No
No
New Hampshire
Yes
No
No
No
No
Yes
No
Must be enrolled in Health Services Provider (HSP, state grantee)
New Mexico
Yes
Yes
New York
Yes
Yes
Updated annually
No
Updated annually
Yes
No
No
No
No
No
No
No
No
No
No
No
No
Yes
Yes
No
No
North Dakota
Yes
Yes
Current within 6 months
Current within 6 months
Current within 6 months
Current within 6 months
Yes
Yes
No
--
--
--
--
--
--
--
--
--
--
Ohio
Yes
Yes
No
No
No
No
No
No
No
No
Oklahoma
Yes
Yes
No
No
No
No
No
No
No
No
Yes
Yes
No
No
No
No
No
No
No
No
Oregon
No
Updated annually
No
North Carolina Northern Mariana Islands
No
Updated annually
No
No
Pennsylvania
Yes
Yes
No
No
No
No
No
No
No
No
Puerto Rico
Yes
Yes
No
No
No
No
No
No
No
No
--
--
--
--
--
--
--
--
--
Republic of Palau Rhode Island
--
--
--
--
--
--
--
--
--
--
--
South Carolina
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
South Dakota
Yes
NA
Yes
NA
Yes
NA
No
NA
No
NA
Tennessee
Yes
Yes
No
No
No
No
Texas
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
Utah
Yes
Yes
No
No
No
No
Yes
Yes
No
No
--
--
--
--
--
--
--
--
--
Vermont Virgin Islands (U.S.)
No
No
No
No
--
--
--
--
--
--
--
--
--
--
--
Virginia
Yes
Yes
No
No
No
No
No
No
No
No
Washington
Yes
Yes
No
No
No
No
No
No
No
No
West Virginia
Yes
Yes
No
No
No
No
No
No
No
No
Wisconsin
Yes
Yes
No
No
No
No
No
No
No
No
Wyoming
Yes
Yes
No
No
No
No
No
No
No
No
1
CD4=CD4 cell count; VL = Viral load.
Note: 48 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont and Virgin Islands (U.S.) did not respond. A dash (--) indicates the ADAP did not report data.
59
Table 18: ADAP Client Eligibility Requirements, as of June 30, 2014 State/Territory
Asset Limits ADAP-Funded Insurance Full-Pay Medications Program (Uninsured)
State Residency Requirement Full-Pay Medications (Uninsured) ADAP-Funded Insurance Program
Case Management Requirement ADAP-Funded Insurance Full-Pay Medications Program (Uninsured)
Other Requirement ADAP-Funded Insurance Program
Alabama
No
No
Proof of state residency required
Proof of state residency required
Ongoing
Ongoing
No
Alaska
No
No
Must be a resident for at least 30 days with proof and intent to stay
Must be a resident for at least 30 days with proof and intent to stay
Ongoing
Ongoing
No
American Samoa
--
--
--
--
--
--
--
Arizona
No
No
Proof of state residency required
Proof of state residency required
No
Ongoing
No
Arkansas
No
No
Proof of state residency required
Proof of state residency required
Ongoing
Ongoing
No
California
No
No
Proof of state residency required
Proof of state residency required
No
No
Cannot be enrolled in fullscope Medi-Cal
Colorado
No
No
Proof of state residency required
Proof of state residency required
No
No
No
Connecticut
No
No
Self-attestation required
Self-attestation required
No
No
No
Delaware
No
No
Proof of state residency required
Proof of state residency required
Ongoing
Ongoing
No
$25,000
$25,000
Proof of state residency required
Proof of state residency required
No
No
No
Federated States of Micronesia
--
--
--
--
--
--
--
Florida
No
No
Proof of state residency required
Proof of state residency required
Initial
Initial
No
Georgia
No
District of Columbia
$10,000
$10,000
Proof of state residency required
Proof of state residency required
As needed
As needed
Guam
--
--
--
--
--
--
--
Hawaii
No
No
Ongoing
Ongoing
No
Proof of state residency required
1
Proof of state residency required
1
Idaho
No
No
Proof of state residency required
N/A
Ongoing
No
Yes
Illinois
No
No
Proof of state residency required
Proof of state residency required
No
No
No
Indiana
No
No
Proof of state residency required
Proof of state residency required
Ongoing
Ongoing
No
Iowa
No
No
Proof of state residency required
Proof of state residency required
Ongoing
Ongoing
No No
Kansas
No
No
Proof of state residency required
Proof of state residency required
Ongoing
Ongoing
Kentucky
--
--
--
--
--
--
--
Louisiana
No
No
Proof of state residency required
Proof of state residency required
No
No
No No
Maine
No
No
Proof of state residency required
Proof of state residency required
No
No
Marshall Islands
--
--
--
--
--
--
--
Maryland
No
No
Proof of state residency required
Proof of state residency required
No
No
Yes
Massachusetts
No
No
Proof of state residency required
Proof of state residency required
No
No
No
Michigan
No
No
Self-attestation required
Self-attestation required
No
No
Yes
Minnesota
No
No
Self-attestation required
Self-attestation required
No
No
No
Mississippi
--
--
--
--
--
--
--
Missouri
No
No
Proof of state residency required
Proof of state residency required
Ongoing
Ongoing
No
No
No
Self-attestation required
Montana Nebraska Nevada New Hampshire
No No $10,000 in liquid assets with $10,000 in liquid assets with specific exlcusions specific exlcusions No
No
No $9,999 in checking and savings $25,000 in liquid assets, excluding federally recognized retirement account
No $9,999 in checking and savings $25,000 in liquid assets, excluding federally recognized retirement account
North Carolina
No
North Dakota
No
Northern Mariana Islands
New Jersey
Self-attestation required
Initial
Initial
No
Self-attestation required
Self-attestation required
As needed
As needed
No
Proof of state residency required
Self-attestation required
As needed
As needed
No
Proof of state residency required
Proof of state residency required
Ongoing
Ongoing
No
Self-attestation required
Self-attestation required
No
No
No
Self-attestation required
Self-attestation required
Initial
Ongoing
No
Proof of state residency required
Proof of state residency required
No
No
No
No
Proof of state residency required
Proof of state residency required
No
No
No
No
Proof of state residency required
Proof of state residency required
Ongoing
Ongoing
No
--
--
--
--
--
--
--
Ohio
No
No
Proof of state residency required
Proof of state residency required
As needed
As needed
No
Oklahoma
No
No
Proof of state residency required
Proof of state residency required
Ongoing
Ongoing
No
Oregon
No
No
Proof of state residency required
Proof of state residency required
No
No
No
New Mexico
New York
Pennsylvania
No
No
Puerto Rico
No
No
Republic of Palau
--
--
Proof of state residency required
Proof of state residency required
Must be a resident for at least 60 days with proof --
Must be a resident for at least 60 days with proof --
No
No
No
Ongoing
Ongoing
No
--
--
--
Rhode Island
--
--
--
--
--
--
--
South Carolina
No
$10,000
Self-attestation required
Self-attestation required
As needed
As needed
No No
South Dakota
No
N/A
Proof of state residency required
N/A
Ongoing
N/A
$8,000
$8,000
Proof of state residency required
Proof of state residency required
Ongoing
Ongoing
No
Texas
No
No
Proof of state residency required
Proof of state residency required
No
No
No
Utah
Tennessee
$5,000
$5,000
Proof of state residency required
Proof of state residency required
As needed
As needed
No
Vermont
--
--
--
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
--
--
--
Virginia
No
No
Proof of state residency required
Proof of state residency required
No
No
No
Washington
No
No
Proof of state residency required
Proof of state residency required
No
No
No
West Virginia
No
No
Proof of state residency required
Proof of state residency required
Ongoing
Ongoing
No
Wisconsin
No
No
Proof of state residency required
Proof of state residency required
No
No
No
Wyoming
No
No
Proof of state residency required
Proof of state residency required
Ongoing
Ongoing
No
7
9
48
46
48
48
48
Total 1
With provisions for individuals who are physically present and live in the state but lack any documentation to that effect, such as homeless persons.
Note: 48 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont and Virgin Islands (U.S.) did not respond. A dash (--) indicates the ADAP did not report data.
60
Table 19: ADAP Drug Purchasing, June 2014 State/Territory
Purchasing Mechanism
Participates in 340B Drug Discount Program
Participates in HRSA Prime Vendor Program
Average Dispensing Fee Per Prescription 1
Dual
Yes
Yes
$6.95
Direct purchase
Yes
Yes
$25
--
--
--
--
Dual
Yes
Yes
$10
Arkansas
Dual
Yes
Yes
$5
California
Rebate
Yes
No
$4
Colorado
Dual
Yes
Yes
$6
Connecticut
Rebate
Yes
No
Delaware
Hybrid
Yes
Yes
$3
Direct purchase
No
No
$11
Alabama Alaska American Samoa Arizona
District of Columbia
$2
--
--
--
--
Florida
Dual
Yes
Yes
$0
Georgia
$12
Federated States of Micronesia
Dual
Yes
No
Guam
--
--
--
Hawaii
Dual
Yes
Yes
Idaho
Rebate
Yes
No
$0
Illinois
Dual
Yes
Yes
$13
Indiana
Rebate
Yes
No
$2
Dual
Yes
Yes
$11 $3
Iowa
-$13.50
Rebate
Yes
No
Kentucky
--
--
--
--
Louisiana
Dual
Yes
Yes
$0
Rebate
Yes
No
$3
--
--
--
--
Rebate
Yes
No
$3
Massachusetts
Rebate
Yes
No
$3.40
Michigan
Rebate
Yes
Yes
$7
Minnesota
Rebate
Yes
No
$0
Mississippi
Direct purchase
Yes
--
--
Missouri
Rebate
Yes
Yes
$2
Montana
Dual
Yes
Yes
$6
Nebraska
Dual
Yes
No
$2
Nevada
Hybrid
Yes
No
$19
New Hampshire
Rebate
Yes
No
$2
New Jersey
Rebate
Yes
No
$4
New Mexico
Direct purchase
Yes
Yes
$1
Rebate
Yes
No
$3.50
North Carolina
Dual
Yes
Yes
$14
North Dakota
Rebate
Yes
No
$5
--
--
--
--
Hybrid
Yes
Yes
$13
Oklahoma
Dual
Yes
Yes
$6
Oregon
Dual
Yes
Yes
$25
Rebate
Yes
Yes
$4
Dual
Yes
Yes
$3
--
--
--
--
Rebate
Yes
--
--
South Carolina
Dual
Yes
Yes
$14
South Dakota
Rebate
Yes
No
$5 $15
Kansas
Maine Marshall Islands Maryland
New York
Northern Mariana Islands Ohio
Pennsylvania Puerto Rico Republic of Palau Rhode Island
Direct purchase
Yes
Yes
Texas
Hybrid
Yes
Yes
$0
Utah
Dual
Yes
No
$20
Rebate
Yes
--
--
--
--
--
-$0
Tennessee
Vermont Virgin Islands (U.S.)
Dual
Yes
Yes
Washington
Rebate
Yes
No
$5
West Virginia
Rebate
Yes
No
$2.50
Wisconsin
Rebate
Yes
No
$4
Wyoming
Rebate
Yes
No
$5
50
25
Virginia
Total
2
Direct Purchase states – ADAPs using this model centrally purchase and dispense medications through their own pharmacy or a single contract pharmacy service provider. Rebate states – These are ADAPs who pay retail pharmacies a pre-determined amount at the point of sale for drugs dispensed to ADAP clients. ADAP then bills drug manufacturers for the 340b Unit Rebate amount for the number of units dispensed. Hybrid states – A direct purchase state that utilizes an existing entity (e.g., University Hospital) to purchase and distribute ADAP drugs. The entity maintains a single drug inventory purchased at 340B prices. To secure the additional supplemental discounts negotiated by the ADAP Crisis Task Force, these ADAPs must submit rebate claims for the supplemental discount amount. Dual Purchaser – ADAPs that purchase and dispense medications through their own pharmacy or a single contract pharmacy service provider AND pay retail pharmacies for some clients and file rebate claims including partial pay claims. 340B Drug Pricing Program – requires drug manufacturers to provide outpatient drugs to eligible health care organizations for eligible patients at significantly reduced prices. The 340B program is designed to provide a pricing benefit to safety-net providers. The 340B program is administered by the Office of Pharmacy Affairs. HRSA Prime Vendor Program – Participants in the 340B Program may also participate in the 340B Prime Vendor Program. A “prime vendor” is an entity that negotiates with manufacturers on behalf of a group of drug purchasers, in order to obtain reduced drug prices. HRSA has chosen a prime vendor to negotiate additional discounts (i.e., lower than the 340B ceiling price or sub-340B ceiling price) for participants, including ADAPs. 1
Note: States may pay a different dispensing fee for generic vs. brand name medications.
2
The prescription dispensing fee in Hawaii (of $13.50) is paid for those medications purchased for full-pay prescription clients only.
Note: 48 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont and Virgin Islands (U.S.) did not respond. A dash (--) indicates the ADAP did not report data.
61
Table 20: ADAP Drug Expenditures (Including Purchases and Co-payments), June 2014
State/Territory
Alabama Alaska American Samoa Arizona
June 2014 Drug Purchases
Drug Purchases % of Total Expenditures
June 2014 CoPayment Expenditures
Co-Payment % of Total Expenditures
June 2014 Total Drug Expenditures (Including Purchases and Co-payments)
$1,401,102 $93,018
100% 100%
$0 $0
0% 0%
$1,401,102 $93,018
--
--
--
--
--
$377,594
58%
$276,415
42%
$654,009
Arkansas
$310,335
100%
$0
0%
$310,335
California
$28,494,106
100%
$0
0%
$28,494,106
Colorado Connecticut Delaware District of Columbia Federated States of Micronesia
$391,166
59%
$273,786
41%
$664,952
$1,746,698
89%
$217,496
11%
$1,964,194
$82,164
100%
$0
0%
$82,164
$904,798
97%
$27,232
3%
$932,030
--
--
--
--
--
Florida
$18,345,026
97%
$616,335
3%
$18,961,361
Georgia
$4,558,356
$4,558,356
100%
$0
0%
Guam
--
--
--
--
--
Hawaii
$89,209
78%
$25,620
22%
$114,829
Idaho
$239,686
100%
$0
0%
$239,686
Illinois
$2,898,838
89%
$347,929
11%
$3,246,767
Indiana
$578,932
96%
$27,176
4%
$606,108
$39,445
59%
$27,477
41%
$66,922
$241,215
30%
$573,992
70%
$815,207
Iowa Kansas Kentucky
--
--
--
--
--
Louisiana
$2,161,730
90%
$243,325
10%
$2,405,055
$40,984
59%
$28,180
41%
$69,164
--
--
--
--
--
$2,428,981
82%
$538,047
18%
$2,967,028
Maine Marshall Islands Maryland Massachusetts
$252,759
60%
$171,881
40%
$424,640
$2,884,729
100%
$0
0%
$2,884,729
Minnesota
$417,888
100%
$0
0%
$417,888
Mississippi
--
--
--
--
--
$1,446,374
65%
$775,189
35%
$2,221,563
Michigan
Missouri Montana
$77,184
54%
$64,636
46%
$141,820
Nebraska
$239,512
100%
$0
0%
$239,512
Nevada
$428,630
86%
$72,213
14%
$500,843
New Hampshire
$220,905
89%
$28,586
11%
$249,491
$5,104,516
71%
$2,083,723
29%
$7,188,239
New Jersey New Mexico
$75,098
100%
$0
0%
$75,098
$27,006,223
100%
$0
0%
$27,006,223
North Carolina
$3,791,311
97%
$115,625
3%
$3,906,936
North Dakota
$0
0%
$51,881
100%
$51,881
Northern Mariana Islands
--
--
--
--
--
$777,282
53%
$689,780
47%
$1,467,062
$79,725
38%
$131,889
62%
$211,614
$1,129,918
100%
$0
0%
$1,129,918
New York
Ohio Oklahoma Oregon Pennsylvania
$8,125,647
95%
$449,444
5%
$8,575,091
$15,679,326
98%
$289,833
2%
$15,969,159
Republic of Palau
--
--
--
--
--
Rhode Island
--
--
--
--
--
$2,047,031
85%
$372,919
15%
$2,419,950
Puerto Rico
South Carolina South Dakota
$64,291
25%
$190,416
75%
$254,707
Tennessee
$1,193,340
100%
$0
0%
$1,193,340
Texas
$8,304,186
96%
$302,222
4%
$8,606,408
Utah
$297,492
90%
$32,483
10%
$329,975
Vermont
--
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
--
$1,292,952
44%
$1,622,842
56%
$2,915,794
Washington
$229,203
30%
$524,080
70%
$753,283
West Virginia
$262,222
90%
$27,719
10%
$289,941
Wisconsin
$1,037,386
100%
$0
0%
$1,037,386
Wyoming Total
-$147,888,513
-93%
-$11,220,371
-7%
-$159,108,884
Virginia
Note: 47 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont, Virgin Islands (U.S.) and Wyoming did not respond. A zero ($0) indicates the ADAP responded zero ($0) to the question.
62
Table 21: ADAP Drug Expenditures (Including Purchases and Co-payments), by Drug Category, June 2014
State/Territory Alabama Alaska American Samoa Arizona
June 2014 Total Expenditures
June 2014 ARV Total Expenditures 1
ARV % of Total Expenditures 1
June 2014 "A1" OI Total Expenditures 2
"A1" OI % of Total Expenditures 2
June 2014 All Other Total Expenditures
All Other % of Total Expenditures
$1,401,102
$1,401,102
100%
$0
0%
$0
0%
$93,018
$91,336
98%
$1,632
2%
$50
0.1%
--
--
--
--
--
--
--
$654,009
$601,995
92%
$6,119
1%
$45,895
7% 0%
Arkansas
$310,335
$300,000
97%
$10,000
3%
$335
California
$28,494,106
$27,381,433
96%
$236,305
1%
$876,368
3%
Colorado
$664,952
$511,506
77%
$6,257
1%
$147,189
22%
$1,964,194
$1,800,970
92%
$40,087
2%
$123,137
6%
$82,164
$74,038
90%
$475
1%
$7,651
9%
$932,030
$899,045
96%
$12,258
1%
$20,727
2%
--
--
--
--
--
--
--
Florida
$18,961,361
$18,757,957
99%
$203,404
1%
$0
0%
Georgia
0.03%
Connecticut Delaware District of Columbia Federated States of Micronesia
$4,558,356
$4,499,282
99%
$57,653
1%
$1,421
Guam
--
--
--
--
--
--
--
Hawaii
$114,829
$84,351
73%
$260
0.2%
$30,218
26% 0%
Idaho
$239,686
$235,283
98%
$4,403
2%
$0
Illinois
$3,246,767
$3,151,804
97%
$31,394
1%
$63,569
2%
Indiana
$606,108
$378,488
62%
$14,024
2%
$213,596
35%
Iowa
$66,922
$66,263
99%
$370
1%
$289
0.4%
$815,207
$657,492
81%
$9,208
1%
$148,507
18%
Kentucky
--
--
--
--
--
--
--
Louisiana
$2,405,055
$1,912,660
80%
$436,500
18%
$55,895
2%
$69,164
$63,444
92%
$306
0%
$5,414
8%
--
--
--
--
--
--
--
$2,967,028
$2,882,548
97%
$43,523
1%
$40,957
1%
Kansas
Maine Marshall Islands Maryland Massachusetts
$424,640
$313,731
74%
$7,262
2%
$103,647
24%
$2,884,729
$2,788,654
97%
$27,750
1%
$68,325
2%
Minnesota
$417,888
$417,888
100%
$0
0%
$0
0%
Mississippi
--
--
--
--
--
--
--
Missouri
$2,221,563
$1,546,475
70%
$10,838
0%
$664,250
30%
Montana
$141,820
$140,237
99%
$156
0.1%
$1,427
1%
Nebraska
$239,512
$230,889
96%
$3,000
1%
$5,623
2%
Nevada3
$500,843
$486,432
97%
$14,411
3%
$0
0% 13%
Michigan
New Hampshire
$249,491
$212,069
85%
$4,989
2%
$32,433
New Jersey
$7,188,239
$7,188,239
100%
$0
0%
$0
0%
New Mexico
$75,098
$73,849
98%
$1,057
1%
$192
0.3%
New York
$27,006,223
$25,016,294
93%
$575,797
2%
$1,414,132
5%
North Carolina
$3,906,936
$3,769,444
96%
$40,365
1%
$97,127
2%
North Dakota
$51,881
$49,749
96%
$0
0%
$0
0%
--
--
--
--
--
--
--
$1,467,062
$1,414,455
96%
$10,064
1%
$42,543
3%
Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania
$211,614
$194,159
92%
$2,311
1%
$15,144
7%
$1,129,918
$857,174
76%
$30,168
3%
$242,576
21%
$8,575,091
$7,700,942
90%
$74,871
1%
$799,278
9%
$15,969,159
$15,913,485
100%
$14,381
0.1%
$41,293
0.3%
Republic of Palau
--
--
--
--
--
--
--
Rhode Island
--
--
--
--
--
--
--
$2,419,950
$2,357,917
97%
$17,513
1%
$44,520
2%
Puerto Rico
South Carolina South Dakota
$254,707
$243,038
95%
$2,706
1%
$8,963
4%
Tennessee
$1,193,340
$1,178,408
99%
$14,669
1%
$263
0.02%
Texas
$8,606,408
$8,532,259
99%
$73,629
1%
$520
0.01%
Utah
$329,975
$326,445
99%
$3,530
1%
$0
0%
Vermont
--
--
--
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
--
--
--
$2,915,794
$2,831,834
97%
$31,502
1%
$52,458
2%
Washington
$753,283
$736,192
98%
$640
0.1%
$16,451
2%
West Virginia
$289,941
$277,382
96%
$6,287
2%
$6,272
2%
Wisconsin
$1,037,386
$1,013,623
98%
$21,055
2%
$2,708
0.3%
Wyoming Total
-$159,108,884
-$151,562,260
-95%
-$2,103,129
-1%
-$5,441,363
-3%
Virginia
1 2
ARV=Antiretrovirals. "A1" OI=Drugs recommended ("A1") for the prevention and treatment of opportunistic infections (OIs).
Note: 47 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont, Virgin Islands (U.S.) and Wyoming did not respond. A dash (--) indicates the ADAP did not report data. A zero ($0) indicates the ADAP responded zero ($0) to the question.
63
Table 22: ADAP Prescriptions Filled (Including Purchases and Co-payments), June 2014
State/Territory Alabama
June 2014 Drug Drug Purchases Rx % of Total Rx Purchases Rx 1
June 2014 CoPayment Rx
Co-Payment Rx % of Total Rx
June 2014 Total Rx
2,974
100%
0
0%
2,974
Alaska
75
31%
167
69%
242
American Samoa
--
--
--
--
--
1,872
32%
4,060
68%
5,932
Arizona Arkansas
1,051
100%
0
0%
1,051
California
68,737
100%
0
0%
68,737 5,973
Colorado
838
14%
5,135
86%
2,303
51%
2,224
49%
4,527
82,164
100%
0
0%
82,164
1,687
78%
478
22%
2,165
--
--
--
--
--
Florida
25,545
85%
4,340
15%
29,885
Georgia
12,798
Connecticut Delaware District of Columbia Federated States of Micronesia
12,798
100%
0
0%
Guam
--
--
--
--
--
Hawaii
201
32%
437
68%
638
Idaho
281
100%
0
0%
281
Illinois
7,605
83%
1,528
17%
9,133
Indiana
3,106
1,121
36%
1,985
64%
Iowa
104
19%
458
81%
562
Kansas
306
17%
1,472
83%
1,778
Kentucky
--
--
--
--
--
Louisiana
4,695
42%
6,450
58%
11,145
Maine
41
4%
1,018
96%
1,059
Marshall Islands
--
--
--
--
--
3,597
37%
6,088
63%
9,685
Maryland Massachusetts
655
5%
12,369
95%
13,024
Michigan
8,145
100%
0
0%
8,145
Minnesota
2,510
100%
0
0%
2,510
Mississippi
--
--
--
--
--
3,343
45%
4,057
55%
7,400
Missouri Montana
75
23%
254
77%
329
Nebraska
1,103
100%
0
0%
1,103
Nevada
818
48%
880
52%
1,698
New Hampshire
529
43%
710
57%
1,239
20,692
75%
7,026
25%
27,718
New Jersey New Mexico
378
100%
0
0%
378
New York
59,461
100%
0
0%
59,461
North Carolina
13,069
86%
2,157
14%
15,226
North Dakota
0
0%
160
100%
160
Northern Mariana Islands
--
--
--
--
--
1,424
54%
1,212
46%
2,636
352
11%
2,720
89%
3,072
10,937
100%
0
0%
10,937
Ohio Oklahoma Oregon Pennsylvania
12,378
56%
9,647
44%
22,025
Puerto Rico
39,306
94%
2,373
6%
41,679
Republic of Palau
--
--
--
--
--
Rhode Island
--
--
--
--
--
6,165
32%
12,945
68%
19,110
South Carolina South Dakota
395
100%
0
0%
395
2,793
100%
0
0%
2,793
Texas
22,021
85%
3,750
15%
25,771
Utah
638
81%
148
19%
786
Vermont
--
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
--
Tennessee
Virginia
3,781
38%
6,219
62%
10,000
Washington
392
12%
2,954
88%
3,346
West Virginia
563
59%
386
41%
949
1,776
100%
0
0%
1,776
-431,694
-80%
-105,807
-20%
-537,501
Wisconsin Wyoming Total 1 Rx=Prescription
Note: 47 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont, Virgin Islands (U.S.) and Wyoming did not respond. A dash (--) indicates the ADAP did not report data. A zero (0) indicates the ADAP responded zero (0) to the question.
64
Table 23: ADAP Prescriptions Filled (Including Purchases and Co-payments), by Drug Category, June 2014
State/Territory
Alabama Alaska American Samoa Arizona
June 2014 Total Rx 1
June 2014 ARV Total Rx 2
ARV % of Total Rx 2
June 2014 "A1" OI Total Rx 3
"A1" OI % of Total Rx 3
2,974
2,974
100%
0
0%
0
0%
242
193
80%
24
10%
25
10%
June 2014 All Other Total Rx
All Other Rx % of Total Rx
--
--
--
--
--
--
--
5,932
2,446
41%
254
4%
3,232
54%
Arkansas
1,051
1,000
95%
26
2%
25
2%
California
68,737
42,433
62%
5,137
7%
21,167
31%
Colorado
5,973
3,615
61%
381
6%
1,977
33%
Connecticut
4,527
2,254
50%
391
9%
1,882
42%
82,164
74,038
90%
475
1%
7,651
9%
2,165
1,729
80%
127
6%
309
14%
Delaware District of Columbia
--
--
--
--
--
--
--
Florida
Federated States of Micronesia
29,885
27,527
92%
2,358
8%
0
0%
Georgia
0%
12,798
11,123
87%
1,675
13%
0
Guam
--
--
--
--
--
--
--
Hawaii
638
433
68%
35
5%
170
27%
Idaho
281
244
87%
37
13%
0
0%
Illinois
9,133
7,664
84%
414
5%
1,055
12%
Indiana
3,106
786
25%
74
2%
2,246
72%
562
471
84%
35
6%
56
10%
1,778
1,311
74%
85
5%
382
21%
Kentucky
--
--
--
--
--
--
--
Louisiana
11,145
7,861
71%
2,784
25%
500
4%
1,059
521
49%
42
4%
496
47%
--
--
--
--
--
--
--
9,685
6,406
66%
340
4%
2,939
30%
Iowa Kansas
Maine Marshall Islands Maryland Massachusetts
13,024
4,251
33%
286
2%
8,487
65%
Michigan
8,145
4,690
58%
517
6%
2,938
36%
Minnesota
2,510
2,510
100%
0
0%
0
0%
Mississippi
--
--
--
--
--
--
--
7,400
3,116
42%
182
2%
4,102
55%
Montana
329
308
94%
16
5%
5
2%
Nebraska
1,103
772
70%
67
6%
264
24%
Nevada4
1,698
1,241
73%
457
27%
0
0%
New Hampshire
1,239
1,053
85%
25
2%
161
13%
New Jersey
27,718
27,718
100%
0
0%
0
0%
New Mexico
378
325
86%
1
0.3%
52
14%
Missouri
New York
59,461
30,278
51%
4,155
7%
25,028
42%
North Carolina
15,226
9,876
65%
1,368
9%
3,982
26%
North Dakota
160
130
81%
8
5%
22
14%
--
--
--
--
--
--
--
2,636
1,823
69%
298
11%
515
20%
Northern Mariana Islands Ohio Oklahoma
3,072
1,804
59%
174
6%
1,094
36%
Oregon
10,937
3,467
32%
683
6%
6,787
62%
Pennsylvania
22,025
8,700
40%
1,021
5%
12,304
56%
Puerto Rico
41,679
34,653
83%
1,827
4%
5,199
12%
Republic of Palau
--
--
--
--
--
--
--
Rhode Island
--
--
--
--
--
--
--
South Carolina
19,110
7,534
39%
2,336
12%
9,240
48%
South Dakota
395
395
100%
0
0%
0
0%
2,793
2,337
84%
272
10%
184
7%
Texas
25,771
24,794
96%
943
4%
34
0.1%
Utah
0%
Tennessee
786
695
88%
91
12%
0
Vermont
--
--
--
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
--
--
--
10,000
6,133
61%
849
8%
3,018
30%
3,346
2,244
67%
117
3%
985
29%
949
726
77%
69
7%
154
16%
1,776
1,459
82%
184
10%
133
7%
-6%
-128,800
-24%
Virginia Washington West Virginia Wisconsin
Wyoming ----Total 537,501 378,061 70% 30,640 1 Rx=Prescription. 2 ARV=Antiretrovirals. 3 "A1" OI=Drugs recommended ("A1") for the prevention and treatment of opportunistic infections (OIs).
Note: 47 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont, Virgin Islands (U.S.) and Wyoming did not respond. A dash (--) indicates the ADAP did not report data. A zero (0) indicates the ADAP responded zero (0) to the question.
65
Table 24: ADAP Prescription Distribution, June 2014 Mail Order Delivered to Client's Home
Mail Order Delivered to Client's Clinic
Central Pharmacy Pick-up
State/Territory Full-Pay Rx
Insurance
Full-Pay Rx
Insurance
Full-Pay Rx
Insurance
Alabama
No
No
Yes
Yes
No
No
Alaska
Yes
Yes
Yes
Yes
Yes
Yes
American Samoa Arizona
--
--
--
--
--
--
Yes
Yes
Yes
Yes
Yes
Yes Yes
Arkansas
Yes
Yes
No
No
Yes
California
Yes
Yes
No
No
No
No
Colorado
Yes
Yes
Yes
Yes
Yes
Yes
Connecticut
No
No
No
No
No
No
Delaware
No
Yes
No
No
Yes
Yes
District of Columbia
No
Yes
No
No
No
No
Federated States of Micronesia
--
--
--
--
--
--
Florida
No
Yes
No
No
No
No No
Yes
No
No
No
No
Guam
--
--
--
--
--
--
Hawaii
Yes
Yes
Yes
Yes
Yes
Yes
Georgia
Idaho
No
No
Yes
No
No
No
Illinois
Yes
Yes
Yes
Yes
Yes
Yes
Indiana
Yes
Yes
No
No
No
No
Iowa
Yes
Yes
Yes
Yes
Yes
Yes
Kansas
No
No
No
No
No
No
Kentucky
--
--
--
--
--
--
Louisiana
No
Yes
No
Yes
No
No
Maine
No
No
No
No
No
No
Marshall Islands
--
--
--
--
--
--
No
No
No
No
No
No
Maryland Massachusetts
No
No
No
No
No
No
Michigan
Yes
Yes
Yes
Yes
Yes
Yes
Minnesota
Yes
Yes
No
No
No
No
Mississippi
--
--
--
--
--
--
Missouri
No
Yes
No
No
No
No
Montana
Yes
Yes
Yes
Yes
No
No
Nebraska
Yes
Yes
No
No
Yes
Yes Yes
Nevada
Yes
Yes
Yes
Yes
Yes
New Hampshire
Yes
Yes
Yes
Yes
No
No
New Jersey
Yes
Yes
Yes
No
No
No Yes
New Mexico
Yes
Yes
Yes
Yes
Yes
New York
No
No
No
No
No
No
North Carolina
Yes
Yes
Yes
Yes
Yes
Yes
North Dakota
Yes
Yes
Yes
Yes
No
No
--
--
--
--
--
--
Yes
Yes
Yes
Yes
No
No Yes
Northern Mariana Islands Ohio Oklahoma
Yes
Yes
Yes
Yes
Yes
Oregon
Yes
Yes
No
No
No
No
Pennsylvania
Yes
Yes
Yes
No
No
No
Puerto Rico
No
No
No
No
No
No
Republic of Palau
--
--
--
--
--
--
Rhode Island
--
--
--
--
--
--
South Carolina
Yes
Yes
Yes
Yes
No
No
South Dakota
Yes
Yes
No
No
No
No
Tennessee
Yes
Yes
Yes
No
Yes
Yes
Texas
No
No
No
No
No
No
Utah
Yes
Yes
No
No
No
No
Vermont
--
--
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
--
--
Virginia
No
Yes
No
No
No
No
Washington
No
Yes
No
No
No
No
West Virginia
Yes
Yes
No
No
No
No
Wisconsin
Yes
Yes
Yes
Yes
No
No
Wyoming
No
No
No
No
No
No
Total
30
36
22
19
15
15
Note: 48 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont and Virgin Islands (U.S.) did not respond. A dash (--) indicates the ADAP did not report data.
66
Table 24: ADAP Prescription Distribution, June 2014 Central Pharmacy Distribution
Client Choice of Pharmacy or Mail Order
Full-Pay Rx
Insurance
Full-Pay Rx
Insurance
Yes
Yes
No
Yes
Yes
Yes
No
No
--
--
--
--
Yes
Yes
Yes
Yes
Yes
No
No
Yes
Yes
No
(continued)
Designated ADAP Pharmacy(ies) for Pick-up
Full-Pay Rx
Other
Insurance
Full-Pay Rx
Insurance
No
No
No
No
Yes
Yes
No
No
--
--
--
--
Yes
Yes
No
No
No
No
No
Yes
Yes
No
No
Yes
Yes
Yes
Yes
No
No
Yes
Yes
Yes
Yes
No
No
No
Yes
Yes
No
No
No
No
Yes
Yes
No
No
Yes
Yes
No
No
No
No
No
No
Yes
Yes
No
No
--
--
--
--
--
--
--
--
Yes
No
No
Yes
Yes
Yes
No
No
Yes
Yes
Yes
No
--
--
--
--
--
--
No Pharmacy delivery service --
No Pharmacy delivery service --
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes
Yes
No
No
No
No
Yes
Yes
No
No
No
No
No
No
No
No
No
No
Yes
Yes
No
No
--
--
--
--
--
--
--
--
Yes
No
No
Yes
No
No
No
No
No
No
Yes
Yes
No
No
No
No
--
--
--
--
--
--
No
No
No
No
No
No
-Medicaid certified pharmacies No
-Medicaid certified pharmacies No
No
No
Yes
Yes
No
No
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
Yes
Yes
No
No
No
No
--
--
--
--
--
--
--
--
No
No
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Yes
Yes
No
No
No
No
No
Yes
No
Yes
No
No
Yes
No
Yes
Yes
Yes
No
No
No
No
No
No
No
Yes
Yes
No
No
No
No
Yes
No
Yes
No
No
No
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Yes
Yes
Yes
Yes
No
No
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
Yes
Yes
Yes
Yes
No
No
--
--
--
--
--
--
--
--
No
No
No
No
No
No
No
No
No
No
Yes
Yes
Yes
Yes
No
No
No
No
Yes
Yes
Yes
Yes
No
No
No
No
Yes
Yes
No
No
No
No
Yes
No
No
No
Yes
Yes
No
No
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
-No
No
No
No
No
No
Yes
No
Yes
Yes
No
No
No
No
No
No
Yes
Yes
No
Yes
Yes
Yes
No
No
Yes
No
No
No
Yes
Yes
No
No
No
No
No
No
Yes
Yes
No
No
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
Yes
Yes
No
Yes
Yes
No
No
No
No
No
No
No
Yes
Yes
No
No
No
No
Yes
Yes
Yes
Yes
No
No
No
No
Yes
Yes
No
No
No
No
No
No
Yes
Yes
No
No
No
No
19
14
24
29
29
26
--
--
67
Table 25: Clients Served Through Insurance Purchasing and Continuation, 2014 State/Territory
June 2014 Clients Served ADAP-Funded Insurance
Premium Only
1
Deductible / Co-pay / Co-insurance Only
Premium and Deductible / Co-pay / Co-insurance
Alabama
90
0
0
90
Alaska
72
26
0
46
American Samoa
--
--
--
--
870
128
462
280
Arizona Arkansas
108
0
108
0
California
9,618
238
7,234
2,146
Colorado
1,464
915
21
528
Connecticut
724
51
673
0
Delaware
621
0
621
0
District of Columbia
311
186
125
0
--
--
--
--
Federated States of Micronesia Florida
1,896
0
1,895
1
Georgia
118
118
0
0
Guam
--
Hawaii
158
-14
-127
-17
Idaho
0
0
0
0
Illinois
878
242
409
227
Indiana
2,203
0
433
1,770
Iowa
203
6
171
26
Kansas
552
--
--
--
Kentucky
--
--
--
--
Louisiana
1,273
0
1,273
0
371
43
289
39
Maine
--
--
--
--
2,127
702
1,145
280
Massachusetts
3,594
758
2,192
644
Michigan
1,514
0
927
587 408
Marshall Islands Maryland
Minnesota
408
0
0
Mississippi
--
--
--
--
2,005
774
72
1,159
Montana
95
2
28
65
Nebraska
198
0
108
90
Nevada
320
0
0
320
New Hampshire
194
0
194
0
New Jersey
140
140
0
0
Missouri
397
332
32
33
9,515
0
0
9,515
North Carolina
639
0
639
0
North Dakota
63
0
61
2
Northern Mariana Islands
--
--
--
--
New Mexico New York
Ohio
1,051
75
895
81
Oklahoma
1,063
236
280
547
Oregon
2,782
1,340
430
1,012
Pennsylvania
2,107
9
1,283
815
490
0
490
0
--
--
--
--
--
--
--
--
1,261
0
1,116
145
Puerto Rico Republic of Palau Rhode Island South Carolina
0
0
0
0
Tennessee
2,376
418
912
1,046
Texas
1,789
21
1,737
31
Utah
233
164
46
23
Vermont
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
Virginia
2,871
1,060
291
1,520
Washington
2,048
51
16
1,981
West Virginia
192
0
151
41
Wisconsin
454
215
0
0
Wyoming Total
-61,456
--
--
--
8,264
26,886
25,515
South Dakota
1
Clients for whom multiple months’ premiums (e.g. a payment was made in April for premium payments for April, May, and June) were paid should only be counted as one individual. Note: 46 ADAPs reported data. American Samoa, Federated States of Micronesia, Kansas, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont, Virgin Islands (U.S.) and Wyoming did not respond. A dash (--) indicates the ADAP did not report data.
68
Table 26: ADAP Funds Used and Clients Served Through Insurance Purchasing and Continuation, 2014
State/Territory
FY2014 Estimated Expenditures
Insurance Premiums
Alabama
$300,000
$8,136
Alaska
$500,000
$156,945
American Samoa Arizona
June 2014 Expenditures Insurance Copayments/Coinsurance $0 $54,707
Insurance Deductibles $0
$0
Other $0 $0
--
--
--
--
--
$2,459,274
$87,973
$0
$302,749
$0
Arkansas
$300,000
$0
$12,000
$160,000
$0
California
$53,503,388
$995,457
$0
$1,436,584
$0
Colorado
$10,455,066
$211,586
$78,117
$287,406
$0
$4,500,000
$60,718
$72,505
$217,496
$0
$104,000
$0
$0
$0
$0
$1,000,000
$66,598
$0
$0
$22,018
--
--
--
--
--
Florida
$13,000,000
$740,446
$0
$616,335
$3,689
Georgia
$5,500,416
$154,107
$0
$0
$0
-$700,000
-$12,567
-$3,316
-$22,381
-$0
Connecticut Delaware District of Columbia Federated States of Micronesia
Guam Hawaii Idaho
$0
$0
$0
$0
$0
Illinois
$20,500,000
$356,040
$0
$0
$347,930
Indiana
$28,167,911
$2,034,988
$306,191
$0
$175,419
$750,000
$16,238
$0
$0
$21,469
$2,522,384
$96,604
$0
$732,474
$0
Kentucky
--
--
--
--
--
Louisiana
$28,082,807
$0
$0
$564,846
$0
$450,000
$16,429
$7,406
$25,315
$1,850
--
--
--
--
--
Maryland
$30,000,000
$861,839
$0
$538,047
$0
Massachusetts
$246,572
Iowa Kansas
Maine Marshall Islands
$10,000,000
$585,709
$0
$196,284
Michigan
$2,000,000
$144,186
$0
$915,414
$0
Minnesota
$3,586,978
$128,270
$0
$0
$0
--
--
--
--
--
$7,366,914
$572,565
$36,478
$777,660
$0
Montana
$260,000
$260,000
$0
$700,000
$0
Nebraska
$1,500,000
$45,452
$0
$67,000
$0
Nevada
$1,400,000
$24,969
$0
$72,213
$0
$649,721
$0
$0
$649,721
$0 $0
Mississippi Missouri
New Hampshire New Jersey
$14,000,000
$627,409
$538,630
$0
New Mexico
$1,841,358
$144,017
$11,364
$0
$0
$84,000,000
$52,000,000
$0
$0
$32,000,000
North Carolina
$3,000,000
$0
$0
$164,084
$0
North Dakota
$200,000
$0
$0
$0
$83,704
New York
--
--
--
--
--
Ohio
$2,721,785
$453,583
$282
$60,166
$0
Oklahoma
$5,100,000
$285,129
$0
$132,521
$66,365
Oregon
$5,679,260
$205,891
$0
$228,205
$0
$400,000
$22,834
$0
$0
$568,499 $0
Northern Mariana Islands
Pennsylvania
$4,000,000
$0
$0
$319,901
Republic of Palau
--
--
--
--
--
Rhode Island
--
--
--
--
--
South Carolina
$5,500,000
$143,942
$90,634
$174,409
$12,889
South Dakota
$0
$0
$0
$0
$0
$12,985,930
$304,819
$188,730
$324,405
$0
Texas
$7,469,568
$13,072
$0
$26,614
$0
Utah
$0
Puerto Rico
Tennessee
$1,460,000
$56,922
$104,333
$34,715
Vermont
--
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
--
$31,564,713
$794,675
$0
$1,557,845
$0
$9,512,565
$1,397,987
$0
$91,031
$0
$400,000
$10,009
$0
$52,560
$0
Wisconsin
$1,575,000
$133,010
$0
$0
$0
Wyoming Total
--
--
--
--
--
$420,969,038
$64,231,121
$1,449,986
$11,503,088
$33,550,404
Virginia Washington West Virginia
Note: 47 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont, Virgin Islands (U.S.) and Wyoming did not respond. A dash (--) indicates the ADAP did not report data.
69
Table 27: ADAP Policies Related to Insurance Purchasing as of June 30, 2014 ADAP Pays Premiums State/Territory Alabama Alaska
ADAP Pays Deductibles
Below 100% FPL No
100-138% FPL No
138-250% FPL No
250-400% FPL No
400% FPL and higher No
Below 100% FPL No
100-138% FPL No
138-250% FPL No
250-400% FPL No
400% FPL and higher No No
Yes
Yes
Yes
No
No
Yes
Yes
Yes
No
American Samoa
--
--
--
--
--
--
--
--
--
--
Arizona
No
No
Yes
Yes
No
No
No
Yes
Yes
No
Arkansas
No
No
No
No
Yes
Yes
Yes
Yes
Yes
California
Yes
Yes
Yes
Yes
Yes
Colorado
No
No
Yes
No
Yes
No
Yes 3 No
Yes 3 No
Yes 3 Yes
Yes 3 Yes
Yes 3 Yes
Connecticut
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Delaware
No
No
Yes
Yes
Yes
No
No
Yes
Yes
Yes
District of Columbia
No
No
Yes
Yes
Yes
No
No
Yes
Yes
Yes
Federated States of Micronesia
--
--
--
--
--
--
--
--
--
--
Florida
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Georgia
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Guam
--
--
--
--
--
--
--
--
--
--
Hawaii
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Idaho
No
No
No
No
No
No
No
No
No
No
Illinois
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Indiana
Yes
Yes
No
No
Yes
Yes
Yes
No
Iowa
No
No
Yes
Yes
No
No
No
Yes
Yes
No
Kansas
Yes
No
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Kentucky
--
--
--
--
--
--
--
--
--
--
Louisiana
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Maine
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
--
--
--
--
--
--
--
--
--
--
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Marshall Islands Maryland
No
No
Michigan
Massachusetts
No
No
Yes
Yes
Yes
No
No
Yes
Yes
Yes
Minnesota
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Mississippi Missouri
Yes
Yes
Yes
Yes
Yes
No
No
No
--
--
--
--
--
--
--
--
--
--
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No Yes
Montana
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Nebraska
Yes
Yes
Yes
No
No
Yes
Yes
Yes
No
No
Nevada
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
New Hampshire
No
No
No
No
No
Yes
Yes
Yes
Yes
No
New Jersey
No
No
No
No
No
No
No
No
No
No
New Mexico
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
New York
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
North Carolina
No
No
No
No
No
Yes
Yes
Yes
Yes
No
North Dakota
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Northern Mariana Islands
--
--
--
--
--
--
--
--
--
Ohio
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Oklahoma
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
--
Oregon
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Pennsylvania
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Puerto Rico
No
No
No
No
No
Yes
Yes
Yes
No
No
Republic of Palau
--
--
--
--
--
--
--
--
--
--
Rhode Island
--
--
--
--
--
--
--
--
--
--
South Carolina
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
South Dakota
No
No
No
No
No
No
No
No
No
No
Tennessee
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Texas
Yes
Yes
Yes
No
No
Yes
Yes
Yes
No
No
Utah
No
Yes
Yes
Yes
No
No
Yes
Yes
Yes
No
Vermont
--
--
--
--
--
--
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
--
--
--
--
--
--
Virginia
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Washington
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
West Virginia
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Wisconsin
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Wyoming
No
No
No
No
No
Yes
Yes
Yes
Yes
No
Total
31
33
39
35
13
33
34
40
35
14
1
Federal ADAP funds cannot be used to pay for medical co-payments/co-insurance.
2 The Affordable Care Act provides a new tax credit to help individuals afford health coverage purchased through the Marketplace. If a person qualifies, they may choose how much advance credit payments to apply to premiums each month, up to a maximum amount. 3
California's ADAP assists enrolled clients in paying insurance deductibles for prescriptions only.
4
California's ADAP only requires a copy of clients' tax return be submitted as documentation of an advance tax credit within the ACA marketplace for clients enrolled in Covered California only.
Note: 48 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont and Virgin Islands (U.S.) did not respond. A dash (--) indicates the ADAP did not report data or responded "no."
70
Table 27: ADAP Policies Related to Insurance Purchasing as of June 30, 2014 ADAP Pays Co-payments / Co-insurance (prescription only)
ADAP Pays Co-payments / Co-insurance (medical only 1)
Below 100% FPL No
100-138% FPL No
138-250% FPL No
250-400% FPL No
400% FPL and higher No
Below 100% FPL No
100-138% FPL No
138-250% FPL No
250-400% FPL No
400% FPL and higher No
Yes
Yes
Yes
No
No
No
No
No
No
No
(continued)
ADAP Requires Advance Tax Credit 2 100-138% 138-250% FPL FPL NA NA Yes
Yes
ADAP Requires Tax Return Submission 138-250% 100-138% FPL FPL NA
NA
Yes
Yes
--
--
--
--
--
--
--
--
--
--
--
--
--
--
No
No
Yes
Yes
No
No
No
Yes
Yes
No
No
Yes
NA
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
NA
Yes
NA
No
No
Yes
Yes
Yes
No
No
Yes
Yes
No
Yes
Yes
Yes
Yes 4 Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Yes
Yes
NA
NA
No
No
Yes
Yes
Yes
No
No
Yes
Yes
Yes
No
Yes
Yes
Yes
No
No
Yes
Yes
Yes
No
No
Yes
Yes
Yes
No
No
NA
NA
--
--
--
--
--
--
--
--
--
--
--
--
--
--
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
Yes
Yes
No
No
Yes
Yes
Yes
No
No
No
No
No
Yes
Yes
--
--
--
--
--
--
--
--
--
--
--
--
--
--
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Yes
Yes
NA
NA
No
No
No
No
No
No
No
No
No
No
NA
NA
NA
NA
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
Yes
Yes
Yes
Yes
No
No
Yes
Yes
Yes
Yes
Yes
No
Yes
No
No
No
NA
NA
No
No
Yes
Yes
No
No
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
--
--
--
--
--
--
--
--
--
--
--
--
--
--
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Yes
Yes
NA
NA
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
Yes
Yes
No
No
--
--
--
--
--
--
--
--
--
--
--
--
--
--
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
No
No
No
No
Yes
Yes
Yes
No
No
Yes
Yes
Yes
No
No
Yes
Yes
Yes
No
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Yes
NA
Yes
--
--
--
--
--
--
--
--
--
--
--
--
--
--
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
No
No
Yes
Yes
Yes
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
Yes
No
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
NA
NA
NA
NA
Yes
Yes
Yes
Yes
No
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
NA
NA
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
NA
NA
Yes
Yes
Yes
Yes
No
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
--
--
--
--
--
--
--
--
--
--
--
--
--
--
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
No
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
NA
NA
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
NA
NA
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Yes
NA
No
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
NA
NA
Yes
Yes
Yes
No
No
No
No
No
No
No
Yes
Yes
No
No
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Yes
Yes
No
No
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Yes
Yes
NA
NA
--
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
NA
NA
37
38
44
39
16
12
14
19
19
4
28
37
23
27
71
Table 28: ADAP Policies Related to Medicare Part D, as of June 30, 2014 ADAP Pays Premiums State/Territory Alabama Alaska
Partial Subsidy Clients No No
ADAP Pays Deductibles
Yes
Partial Subsidy Clients No
No
Yes
Standard Clients
ADAP Pays Co-payments
Yes
Dually Eligible Clients No
Yes
No
Standard Clients
Yes
Partial Subsidy Clients No
Yes
Yes
Full Subsidy Clients
Eligible for ADAP
Yes
Dually Eligible Clients No
Yes
No
Standard Clients
Yes
Partial Subsidy Clients No
Yes
Yes
Full Subsidy Clients
Standard Clients
Provide Medications During the Donut Hole
Yes
Yes
Yes
Yes
American Samoa
--
--
--
--
--
--
--
--
--
--
--
--
--
Arizona
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Arkansas
Yes
No
Yes
No
No
No
Yes
No
No
No
No
No
No
California
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Colorado
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Connecticut
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Delaware
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
District of Columbia
No
No
No
No
No
No
No
No
No
No
No
No
No
Federated States of Micronesia
--
--
--
--
--
--
--
--
--
--
--
--
--
Florida
No
No
Yes
Yes
Yes
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Georgia
Yes
Yes
Yes
No
No
No
No
No
No
No
No
Yes
Yes
Guam
--
--
--
--
--
--
--
--
--
--
--
--
--
Hawaii
No
No
Yes
Yes
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Idaho
No
No
No
No
No
No
No
No
No
No
No
No
Yes
Illinois
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Indiana
No
No
Yes
Yes
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Iowa
No
No
Yes
Yes
Yes
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Kansas
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Kentucky
--
--
--
--
--
--
--
--
--
--
--
--
--
Louisiana
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Maine
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Marshall Islands
--
--
--
--
--
--
--
--
--
--
--
--
--
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
Maryland Massachusetts
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Michigan
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Minnesota
No
Yes
Yes
Yes
No
Yes
No
No
Yes
Yes
No
No
Yes
Yes
Yes
Mississippi
--
--
--
--
--
--
--
--
--
--
--
--
--
Missouri
No
No
No
No
No
No
No
No
No
No
No
No
Yes
Montana
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Nebraska
No
No
No
No
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Nevada
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
Yes
New Hampshire
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
New Jersey
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
Yes
New Mexico
No
No
No
No
No
No
No
No
No
No
No
No
No
New York
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
North Carolina
No
No
Yes
Yes
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
North Dakota
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
--
--
--
--
--
--
--
--
--
--
--
--
--
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Northern Mariana Islands Ohio Oklahoma
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Oregon
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Pennsylvania
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Puerto Rico
No
No
Yes
Yes
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Republic of Palau
--
--
--
---
--
--
--
--
--
--
--
--
--
Rhode Island
--
--
--
--
--
--
--
--
--
--
--
--
--
South Carolina
No
No
Yes
Yes
No
No
Yes
Yes
No
No
Yes
Yes
Yes
South Dakota
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Tennessee
No
No
No
No
No
No
No
No
No
No
No
No
No
Texas
No
No
Yes
Yes
No
No
Yes
Yes
No
No
No
No
Yes
Utah
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Vermont
--
--
--
--
--
--
--
--
--
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
--
--
--
--
--
--
--
--
--
Virginia
Yes
Yes
Yes
Yes
No
No
Yes
Yes
No
No
Yes
Yes
Yes
Washington
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
West Virginia
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Wisconsin
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Wyoming
No
No
Yes
Yes
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Total
23
25
37
36
23
34
40
40
23
33
38
39
44
Note: 48 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont and Virgin Islands (U.S.) did not respond. A dash (--) indicates the ADAP did not report data.
72
73
Table 29: ADAP Management Practices in Place, as of June 30, 2014 Client Cost-Sharing
Overall Program Enrollment Cap
Drug Specific Enrollment Cap
Maximum Cost Per Client
Alabama
State/Territory
No
No
No
No
Alaska
No
No
No
No
American Samoa
--
--
--
--
Arizona
No
No
No
No
Arkansas
No
No
No
No
California
Yes
No
No
No
Colorado
No
No
No
No
Connecticut
No
No
No
No
Delaware
No
No
No
No
District of Columbia
No
No
No
No
Federated States of Micronesia
--
--
--
--
Florida
No
No
No
No
Georgia
No
No
Yes
No
Guam
--
--
--
--
Hawaii
No
No
Yes
No
Idaho
No
Yes
Yes
No Yes
Illinois
No
No
Yes
Indiana
No
Yes
No
No
Iowa
No
No
No
No
Kansas
No
No
No
No
Kentucky
--
--
--
--
Louisiana
No
No
No
No
Maine
No
No
No
No
Marshall Islands
--
--
--
--
Maryland
No
No
No
No
Massachusetts
No
No
No
No
Michigan
No
No
No
No
No
No
Minnesota
No
No
Mississippi
--
--
--
--
Missouri
No
No
No
No
Montana
No
No
Yes
No
Nebraska
No
No
No
No
Nevada
No
No
No
No
New Hampshire
No
No
No
No
New Jersey
No
No
No
No
New Mexico
Yes
No
No
No
New York
No
No
No
No
North Carolina
No
No
No
No
North Dakota
No
Yes
No
No
Northern Mariana Islands
--
--
--
--
Ohio
No
No
No
No
Oklahoma
No
No
No
No
Oregon
Yes
No
No
No
Pennsylvania
No
No
No
No
Puerto Rico
No
No
No
No
Republic of Palau
--
--
--
--
Rhode Island
--
--
--
--
South Carolina
No
No
No
No Yes
South Dakota
No
No
No
Tennessee
No
No
No
Texas
No
No
No
No
Utah
No
Yes
No
No
No
Vermont
--
--
--
--
Virgin Islands (U.S.)
--
--
--
--
Virginia
No
No
No
No
Washington
Yes
No
No
No
West Virginia
No
No
No
Wisconsin
No
No
No
No
Wyoming
No
No
No
No
4
4
5
2
Total
No
1
ADAP practices are defined as those dictated by the ADAP, not inclusive of those required by individual insurance plans through which the ADAP may provide insurance coverage to clients.
2
Step therapy - The practice of beginning drug therapy for a medical condition with the most cost-effective and safest drug therapy and progressing to other more costly or risky therapy, only if necessary. The aims are to control costs and minimize risks. Also called step protocol. Step therapy does not apply to antiretrovirals. Note: 48 ADAPs reported data. American Samoa, Federated States of Micronesia, Kentucky, Marshall Islands, Mississippi, Northern Mariana Islands, Republic of Palau, Rhode Island, Vermont and Virgin Islands (U.S.) did not respond. A dash (--) indicates the ADAP did not report data.
74
Table 29: ADAP Management Practices in Place, as of June 30, 2014 Maximum Number of Prescriptions Per Client Per Month No
(continued)
Drug(s) with Prior Authorization
Drug(s) with Clinical Criteria
Drug(s) with Required Resistance Testing
Yes
Yes
Yes
No
No
No
No
No
No
No
No
--
--
--
--
--
--
No
Yes
Yes
No
No
Yes
No
Yes
No
No
No
No
No
Yes
Yes
No
Yes
No
Yes
No
No
No
No
No
Yes
Yes
No
No
No
No
No
Yes
No
No
No
No
Yes
No
No
No
No
--
--
--
--
--
--
No
Yes
Yes
No
No
No
No
Yes
Yes
Yes
No
No
Step Therapy
2
Other
No
--
--
--
--
--
--
No
No
Yes
No
No
No
No
Yes
No
No
No
No
No
Yes
No
Yes
No
No
No
Yes
No
No
No
No
No
No
No
No
No
No
No
Yes
Yes
No
No
No
--
--
--
--
--
--
No
No
No
No
No
No
No
Yes
Yes
No
No
No
--
--
--
--
--
--
No
Yes
Yes
No
No
No
No
Yes
No
No
No
No
No
Yes
No
No
Yes
No
No
Yes
No
No
No
No
--
--
--
--
--
--
No
No
No
No
No
No
No
Yes
Yes
Yes
No
No
No
Yes
No
No
No
No
No
Yes
No
No
No
No
No
Yes
Yes
No
Yes
No
No
Yes
Yes
No
No
No
No
No
No
No
No
No
No
Yes
Yes
No
Yes
No
No
No
No
No
No
No
No
No
No
No
No
--
--
--
--
--
--
No
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes
No
Yes
Yes
No
No
No
--
--
--
--
--
--
--
--
--
--
--
--
No
No
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes
No
No
No
No
No
No
No
No
No
No
No
--
--
--
--
--
--
--
--
--
--
--
--
No
No
No
No
No
No
No
No
Yes
Yes
No
No
No
Yes
Yes
No
Yes
No
No
No
No
No
No
No
No
Yes
No
No
Yes
1
27
20
7
No 3
75
Table 30: Key Dates in the History of ADAP
76
1987
First antiretroviral (AZT, an NRTI) approved by the FDA; Federal government provides grants to states to help them purchase AZT, marking beginning of federally funded, state-administered “AZT Assistance Programs.”
1990
ADAPs incorporated into Title II of the newly created Ryan White CARE Act.
1995
First protease inhibitor approved by FDA, and the highly active antiretroviral therapy (HAART) era begins.
1996
First reauthorization of CARE Act—federal ADAP earmark created; first non-nucleoside reverse transcriptase inhibitor (NNRTI) approved by FDA.
2000
Second reauthorization of CARE Act. Changes for ADAPs include: allowance of insurance purchasing and maintenance; flexibility to provide other limited services (e.g., adherence support and outreach); and creation of ADAP supplemental grants program.
2003
NASTAD’s ADAP Crisis Task Force formed to negotiate with pharmaceutical companies on pricing of antiretroviral medications; first fusion inhibitor approved by FDA.
2004
President’s ADAP Initiative (PAI) announced, allocating $20 million in one-time funding outside of the ADAP system to reduce ADAP waiting lists in 10 states.
2006
Third reauthorization of the CARE Act, now called, “Title XXVI of the PHS Act as amended by the Ryan White HIV/AIDS Treatment Modernization Act of 2006” or the “Ryan White Program.” Changes for ADAP include: new formula for determining state awards, which incorporates living HIV and AIDS cases; new minimum formulary requirement; and an increase in the ADAP Supplemental setaside and changes in eligibility and matching requirements.
2007
New minimum formulary requirement effective July 1; first CCR5 antagonist and integrase inhibitor approved by FDA.
2009
Fourth reauthorization of the Ryan White Program. The reauthorization was for four years and included several technical changes.
2010
Patient Protection and Affordable Care Act (PPACA) signed into law. ADAP emergency funding announced by the Obama Administration, allocating $25 million in funding to address ADAP waiting lists and cost-containment measures.
2011
ADAP emergency funding continued at $40 million. In December 2011, President Obama announced an additional $35 million for ADAPs to address ADAP waiting lists and cost containment measures. Awards from this funding will be available to states based on a competitive application.
2012
ADAP emergency funding awarded at $75 million, including the continuation of FY2011 funding the allocation of an additional $35 million announced by President Obama in December 2011.
2013
Open enrollment for insurance through the insurance marketplace established under the Affordable Care Act begins on October 1.
2014
The first open enrollment period for insurance through the insurance marketplace established under the Affordable Care Act ends on March 31, 2014.
Table 31: HIV/AIDS Antiretroviral and Opportunistic Infection Medications FDA-Approved Antiretroviral Medications GENERIC NAME
BRAND NAME
CYP34A Inhibitors (Pharmocokinetic Boosters) cobicistat
Tybost
Multi-Class Combination Products efavirenz, emtricitabine, and tenoforvir disoproxil fumarate
Atripla
rilpivirine, emtricitabine, and tenoforvir disoproxil fumarate
Complera
elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate
Stribild
NRTIs abacavir sulfate, ABC
Ziagen
abacavir, zidovudine, and lamivudine
Trizivir
abacavir and lamivudine
Epzicom
didanosine, dideoxyinosine, ddL
Videx
emtricitabine, FTC
Emtriva
lamivudine and zidovudine
Combivir
lamivudine, 3TC
Epivir
stavudine, d4T
Zerit
tenofovir, disoproxil fumarate, TDF
Viread
tenofovir disoproxil fumarate and emtricitabine
Truvada
zidovudine, azidothymidine, AZT, ZDV
Retrovir
NNRTIs delavirdine, DLV
Rescriptor
efavirenz, EFV
Sustiva
etravirine
Intelence
nevirapine, NVP
Viramune
rilpivirine
Edurant
Protease Inhibitors amprenavir, APV atazanavir sulfate, ATV
Agenerase Reyataz
darunavir
Prezista
fosamprenavir calcium, FOS-APV
Lexiva
indinavir, IDV
Crixivan
lopinavir and ritonavir, LPV/RTV
Kaletra
nelfinavir mesylate, NFV
Viracept
ritonavir, RTV
Norvir
saquinavir mesylate, SQV
Invirase
tipranavir, TPV
Aptivus
1
Fusion Inhibitors enfuvirtide, T-20
Fuzeon
Entry Inhibitors - CCR5 Co-Receptor Antagonist maraviroc
Selzentry
HIV Integrase Strand Transfer Inhibitors dolutegravir
Tivicay
elvitegravir
Vitekta
raltegravir
Isentress
HIV Integrase Strand Transfer Inhibitor and NRTI Combinations abacavir/lamivudine, dolutegravir
Triumeq
1
The manufacturer of Agenerase (amprenavir) discontinued the sale and distribution of the drug in capsule form, used for adult dosing, after 2004 and is instead manufacturing fosamprenavir (Lexiva), a "prodrug" of Agenerase (a prodrug is an inactive precursor of a drug, converted into its active form in the body). Agenerase is still availabe in pediatric dosing. Source: FDA, "Drugs Used in the Treatment of HIV Infection": http://www.fda.gov/oashi/aids/virals.html. Also see: DHHS, "Guidelines for the Use of Antiretroviral Agents in HIV-1Infected Adults and Adolescents," December 16, 2013: http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf.
"A1" Medications for the Prevention & Treatment of Opportunistic Infections (Highly Recommended) 1 GENERIC NAME
BRAND NAME
acyclovir
Zovirax
amphotericin B
Fungizone
azithromycin
Zithromax
cidofovir
Vistide
clarithromycin
Biaxin
clindamycin
Cleocin
ethambutol
--
famciclovir
Famvir
fluconazole
Diflucan
flucytosine
Ancobon
foscarnet
Foscavir
ganciclovir
Cytovene
isoniazid (INH)
Lanizid, Nydrazid
itraconazole
Sporonox
leucovorin calcium
Wellcovorin
liposomal amphotericin B
--
peg-interferon alfa-2a
PEG-Intron
peg-interferon alfa-2b
--
pentamidine
Nebupent
prednisone
Deltasone, Liquid Pred, Metocorten, Orasone, Panasol, Prednicen-M, Sterapred
probenecid
--
pyrazinamide (PZA)
--
pyrimethamine
Daraprim, Fansidar
ribavirin
Virazole, Rebetol, Copegus
rifabutin
Mycobutin
rifampin (RIF)
Rifadin, Rimactane
sulfadiazine (oral generic)
Microsulfon
trimethoprim- sulfamethoxazole (TMP/SMX)
Bactrim, Septra
valacyclovir
Valtrex
valganciclovir
Valcyte
1
"A" = "should always be offered"; "1" = "evidence from at least one properly randomized, controlled trial"
Sources: CDC, "Guidelines for the Prevention of Opportunistic Infections in Persons Infected with Human Immunodeficiency Virus." MMWR, 51 (No. RR08),1-46; 2002; CDC, "Treating Opportunistic Infections Among HIV-Infected Adults and Adolescents." MMWR, 53 (No. RR15), 1-112; 2004. Also see: DHHS, "Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents," December 16, 2013: http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf.
77
