The ADAP Advocacy Association hosted its annual conference in late September, and it covered many subject areas along this year’s official theme, “Mapping a New Course to Protect the Public Health Safety Net.” The AIDS Drug Assistance Program, which was first established by Congress to pay for Retrovir (zidovudine, AZT) in 1987, was then incorporated into the Ryan White Care Act, which passed in 1990.
The session focused on open drug formularies used by state ADAP programs and their effects on health outcomes. A “drug formulary” is an approved list of prescription drugs — both brand name and generic — used by jurisdictions to pinpoint medications having the greatest overall value. Legally, each ADAP formulary must include at least one of each of the seven classes of drugs for HIV antiretroviral therapy. An open formulary is generally more expansive with multiple options in each drug class, whereas a closed formulary may be much smaller and limited. Each state’s ADAP formulary is different.
The Affordable Care Act (ACA) has changed much of the health care landscape, including what kinds of insurance people living with HIV can have. Before the ACA made it illegal to prevent someone from getting insurance due to their having a pre-existing condition, Ryan White coverage was the only option in many states — unless you had an AIDS diagnosis, for which you might then qualify for Medicaid or Medicare. The ADAP formularies paid for prescription drugs, but these programs were underfunded to meet the need, and many states had waiting lists.