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ADAP Waiting List Exceeds 1000; Drug Companies Agree to Price Freezes and Expanded Patient Assistance Programs

As waiting lists for AIDS Drug Assistance Programs (ADAPs) have grown larger during a prolonged economic crisis, advocates with the National Alliance of State and Territorial AIDS Directors (NASTAD) ADAP Crisis Task Force have worked with pharmaceutical companies to control price increases and provide additional patient assistance to avoid draining limited ADAP funds. The task force this week announced agreements with 3 companies -- Abbott, Merck, and Tibotec -- and hopes for more in the near future.

According to NASTAD's latest ADAP Watch, as of May 6, 2010 there were 1056 individuals on waiting lists in 10 states. The states with the longest lists were North Carolina (506 people), Kentucky (200 people), Utah (97 people), South Carolina (81 people), and Iowa (77 people).

Another 10 states have instituted new cost-containment strategies since the last report in April, including reduced formularies, lower financial eligibility thresholds, and cost-sharing. Several states anticipate further measures will be needed by March 2011.

The ADAP Crisis Task Force negotiates with drug manufacturers for reduced drug prices on behalf of all ADAPs. According to NASTAD's latest National ADAP Monitoring Project Annual Report, ADAP spending increased by more than 600% since 1996 -- more than twice the rate of client growth during this period.

The task force met with pharmaceutical companies earlier this month to develop agreements to freeze price increases and provide additional rebates and discounts. It also has asked the federal government to allocate more money. (ADAPs are funded jointly by federal and state governments.)

Merck -- which has faced pressure from activists who believe the price for the first integrase inhibitor, raltegravir (Isentress), was set too high -- agreed to freeze the ADAP price for raltegravir and indinavir (Crixivan) and speed up rebates to states. A press release from Merck about the changes can be found online.

Abbott (maker of lopinavir/ritonavir [Kaletra]), Heinz Family Philanthropies, and Welvista (a non-profit pharmacy) announced a joint plan to provide medications to people on state ADAP waiting lists. A press release describing this initiative is available online.

In related news, ViiV Healthcare -- the HIV specialty company formed last year by GlaxoSmithKline and Pfizer -- reminded community members in March that its Bridges to Access patient assistance program is available to help eligible individuals obtain HIV medications marketed by either company. More information about the program is available at www.bridgestoaccess.com.

Below is the text of a NASTAD press release describing the agreements hammered out to date.

ADAP Crisis Task Force Reaches Agreements with Three Pharmaceutical Companies to Assist Struggling ADAPs; Additional Federal and State Funding Required

Washington, DC -- May 11, 2001 -- With 1,056 people on waiting lists and many other access restrictions in place for individuals to receive consistent access to their HIV-related medications through AIDS Drug Assistance Programs (ADAPs), the ADAP Crisis Task Force (ACTF) announced that it has reached agreements with Abbott Laboratories, Merck and Co., Inc. and Tibotec Therapeutics to bring fiscal relief to the nation's state-administered ADAPs. The agreements are enhancements of long-term, existing partnerships and will help achieve savings through a mix of program adjustments including price freezes and increased discounts and rebates for HIV antiretroviral treatments as well as improved access to pharmaceutical Patient Assistance Programs (PAPs) for clients on ADAP waiting lists.
"Abbott, Merck and Tibotec's willingness to help with this crisis demonstrates that they are fully carrying their share of the burden, strengthening the case for further assistance from the federal and state governments at this critical time of unprecedented need for ADAPs," stated Jennifer Brown, Director of the Bureau of Epidemiology at the Utah Department of Health and spokesperson for the ACTF.
"The ADAP Crisis Task Force and these companies have come together to find ways to bridge the gap that ADAPs are experiencing in providing life-saving medicines to our most disadvantaged and underserved populations," added Brown.
The ACTF, convened by the National Alliance of State and Territorial AIDS Directors (NASTAD), met last week with all eight companies that manufacture HIV antiretroviral treatments in an effort to provide additional rebates and discounts as well as multiple year cost protections for ADAPs which will allow increased state and federal revenues to go toward eliminating waiting lists, providing medications to new clients, and maintaining formularies.
In addition to the agreements already reached, favorable negotiations continue with Boehringer Ingelheim, Bristol-Myers Squibb, Genentech, Gilead Sciences and ViiV Healthcare. "We are hopeful that agreements similar to these newly announced ones can be completed soon with the remaining manufacturers," noted Dwayne Haught, Manager of the HIV Medication Program for the Texas Department of State Health Services and a member of the ACTF. "Abbott, Merck and Tibotec have a keen understanding of the ADAP crisis and demonstrated strong leadership by coming to the table with significant financial commitments to assist ADAPs during this crisis. They have gone far beyond the mandated discounts to develop solutions for ADAPs that will help meet the needs of nearly 200,000 HIV-positive Americans," added Haught.
NASTAD routinely monitors the status of ADAP program needs on a continual basis. While the program will yield a savings from price freezes and increased discounts and rebates in drug prices, the trend of a deteriorating situation in both state government budgets and increasing demands on ADAP program enrolment continues to accelerate, resulting in a net additional need. NASTAD and other partners estimate the program is in need of an additional $126 million in FY2010 emergency federal funding as well as critical state funding. Increased funds from the federal and state governments in addition to price freezes and increased discounts and rebates from companies are all necessary to sustain ADAPs until health reform is fully implemented in 2014.
"We believe we have reached the perfect storm where the federal and state governments and our pharmaceutical partners must step up and ensure that eligible ADAP clients have access to their medications," remarked Julie Scofield, NASTAD's Executive Director. "With company agreements in place and others at the table demonstrating their commitment, we again call upon President Obama to provide sufficient funding to ease access restrictions in ADAPs nationwide. We also urge state legislatures to maintain and increase their support of ADAPs during this critical period," she added.
The nation's current economic situation, increased HIV testing efforts and more individuals living longer have resulted in a "perfect storm" that has rapidly resulted in swelling ADAP rolls. During FY2009, clients utilizing ADAP services increased by an average of 1,271 individuals per month. This is an unprecedented increase of 80 percent from FY2008 when ADAPs experienced an average monthly growth of 706 clients. ADAPs are the safety net under other public programs, such as Medicare and Medicaid. Over seventy-five percent of ADAP clients earn less than 200 percent of the federal poverty level, which is $22,000 for an individual.
As of May 6, there were 1,056 individuals in ten states on waiting lists for ADAP. ADAP waiting lists have increased more than ten-fold in the last year (99 individuals were on ADAP waiting lists in May 2009). In addition to waiting lists, 16 states have implemented other access restrictions such as lowering financial eligibility criteria, removing drugs from their formulary and capping expenditures. To see a list of states with access restrictions please visit NASTAD's website at www.NASTAD.org.
The ADAP Crisis Task Force (ACTF) was formed in December 2002 by a group of state AIDS/ADAP directors concerned about the nationwide fiscal crisis facing ADAPs. The ACTF works with pharmaceutical manufacturers of antiretroviral medications to determine solutions to the nation's ADAP fiscal crises. NASTAD provides logistical support for the ACTF. Founded in 1992, NASTAD is a nonprofit national association of state and territorial health department HIV/AIDS program directors who have programmatic responsibility for administering HIV/AIDS and viral hepatitis health care, prevention, education, and supportive services programs funded by state and federal governments. For more information, visit www.NASTAD.org.

5/14/2010

Sources

National Alliance of State and Territorial AIDS Directors (NASTAD). ADAP Crisis Task Force Reaches Agreements with Three Pharmaceutical Companies to Assist Struggling ADAPs; Additional Federal and State Funding Required. Press release. May 11, 2010.

NASTAD. ADAP Crisis Deepens; 1,001 Individuals Now on Waiting Lists. Press release. April 30, 2010.

NASTAD. 2010 National ADAP Monitoring Project Annual Report. May 3, 2010.

NASTAD. ADAP Watch. May 10, 2010.

AIDS Healthcare Foundation. AIDS Drug Company Price Cuts Validated By New Data, Says AHF. Press release. May 4, 2010.

Merck & Co. Merck and the ADAP Crisis Task Force Announce Key Initiatives to Help Provide Funding Relief to AIDS Drug Assistance Programs (ADAPs) across the U.S. Press release. May 5, 2010.

Heinz Family Philanthropies. Heinz Family Philanthropies, Welvista and Abbott Announce Solution to Help Patients on State ADAP Waiting Lists for No-Cost HIV Medications. Press release. May 7, 2010.

ViiV Healthcare. ViiV Healthcare Responds to Growing ADAP Patient Waiting Lists. Community announcement (undated).