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Part B - AIDS Drug Assistance Program

Part B of the Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87) provides grants to States and U.S. Territories to improve the quality, availability, and organization of HIV/AIDS health care and support services. Part B grants include a base grant; the AIDS Drug Assistance Program (ADAP) award; ADAP Supplemental Drug Treatment Program funds; and supplemental grants to States with "emerging communities," defined as jurisdictions reporting between 500 and 999 cumulative AIDS cases over the most recent 5 years.

Eligibility

All 50 States, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, and the five U.S. Pacific Territories or Associated Jurisdictions are eligible for funding. Emerging Communities are defined as those reporting between 500 and 999 cumulative reported AIDS cases over the most recent 5 years.

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Funding Considerations

• Congress designates, or "earmarks," a portion of the Part B appropriation for ADAP. This distinction is important because other Part B spending decisions are made locally. Five percent of the total earmark, however, is reserved for supplemental grants to States and Territories that have demonstrated severe need that prevents them from providing medications consistent with Public Health Service guidelines. Before the 2006 reauthorization, estimated living cases of AIDS was used in determining the formula, and three percent was reserved for supplemental grants.
• A formula based on the number of reported living HIV/AIDS cases in the most recent calendar year is used to award ADAP funds to States and Territories.

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Services

ADAP provides medications for the treatment of HIV disease. Program funds may also be used to purchase health insurance for eligible clients and for services that enhance access to, adherence to, and monitoring of drug treatments.

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Implementation

Each grantee establishes its own ADAP eligibility criteria. All grantees, however, are required to implement an ADAP recertification process every 6 months to ensure that only eligible clients are served. All grantees require that program participants document their HIV status, and nine programs require a CD4 count of 500 or less. Fifteen States have established income eligibility at 200 percent or less of the Federal Poverty Level (FPL).

The ADAP in each State and Territory is unique in that it decides which medications will be included in its formulary and how those medications will be distributed. However, current legislation requires that each grantee must cover all classes of approved HIV antiretrovirals on their ADAP formulary.

• Many States and Territories provide medications through a pharmacy reimbursement model. Patients show enrollment cards at participating pharmacies to receive their medications, and the pharmacy invoices the ADAP for payment.
• Some ADAPs use pharmacies located within public health clinics to distribute drugs.
• A few ADAPs purchase drugs and mail them to clients directly.

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Grantees

Grants are awarded to all 50 States, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, and a few Pacific jurisdictions.

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Increasing Demand

Pressure on ADAP resources has increased substantially:

• Highly active antiretroviral therapy (HAART) is the standard of care for a majority of people living with HIV disease. Its cost may be $12,000 or more per year. In addition, people living with HIV/AIDS face costs of treating opportunistic infections, managing side effects, and addressing other treatment issues.
• AIDS mortality has decreased dramatically in the United States since 1995, and an estimated 56,000 new infections occur annually. Therefore, the total number of people living with HIV disease continues to climb.
• The epidemic is growing rapidly among minorities, who have historically experienced higher risk for poverty, lack of health insurance, comorbidity, and disenfranchisement from the health care system. The result is a growing number of people living with HIV disease who require public support.