State-operated AIDS Drug Assistance Programs (ADAPs) were established in 1987 to pay for HIV-related medications in the United States and to help provide prescription medicines for HIV-infected patients who had no private insurance and were ineligible for Medicaid. However, the availability of costly antiretroviral medications, a tendency for patients to live longer, and increased numbers of people who are infected with HIV have led to skyrocketing medication costs for ADAPs. As a result, ADAPs have increasingly been operating under emergency measures, with coverage limitations and eligibility restrictions, note researchers supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00020).
Since late 1995, ADAPs have struggled with explosive growth in budgets, expenditures, and numbers of clients served. The national ADAP budget increased almost four-fold from $188.5 million in FY 1996 to $724.5 million in FY 2000, with combination antiretroviral drug regimens accounting for about 90 percent of total ADAP spending. Meanwhile, ADAPs have failed to realize the savings associated with reduced HIV-related hospital expenditures. By 1997, 35 of 54 ADAPs were operating under emergency measures: transferring funds from other health programs, instituting waiting lists for medication access, restricting eligibility, and limiting the number of drugs covered.
Increased survival of HIV-infected patients, growing inequities in ADAP coverage between States, and emerging infections (such as hepatitis C) will exacerbate difficulties faced by ADAPs in the next several years. States could use cost-effectiveness analyses, in conjunction with input from representative populations of infected people, to confer the maximum possible benefit to needy patients, suggest the researchers. They caution, however, that the greater issue is that the ADAP allowance appears to be altogether too small.
More details are in "AIDS Drug Assistance Programs: Highlighting inequities in human immunodeficiency virus-infection health care in the United States," by Rochelle P. Walensky, M.D., A. David Paltiel, Ph.D., and Kenneth A. Freedberg, M.D., in the September 1, 2002 Clinical Infectious Diseases 35, pp. 605-610.