VIRGINIA ADAP DATA REPORT JANUARY 2013

Anne Giuranna Rhodes, Services AnalystHIV Care Services, Division of Disease Prevention

Virginia Department of Health

VA ADAP 2010-2012

•Began 11/2010, ended 8/2012

•Highest number was 1,112 in 12/2011

Waitlist

•Significant drop in cost per person in early 2011 due to NASTAD agreements

Direct ADAP

•Began collecting rebates in 2011

•Served 387 persons in 2012

Medicare D

ADAP Waitlist History

Virginia ADAP expanded ADAP enrollment criteria and reduced the wait list throughout 2011 and 2012

November 2011: CD4 count at or below 200 December 2011: CD4 count at or below 350 April 2012: CD4 count at or below 500 July 2012: removal of clinical criteria August 2012: began immediate processing of new

applications (no longer placed any new persons on waitlist)

Eliminated the wait list as of August 30, 2012.

CD4 Count Distribution of VA Waitlist

Data Source: AIDS Drug Assistance Program Waitlist DataDivision of Disease Prevention, Office of Epidemiology, Virginia Department of Health, December 2012

Nov 2011 (n=1,091)

Dec 2011 (n=1,104)

April 2012 (n=946)

Jul-2012 (n=570)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

>500201-500< 200

VA ADAP Wait List Removals

4054440575

4060540640

4066840696

4072540756

4078740817

4084840878

4090940940

4096941000

4103041061

4109141123

411530

200

400

600

800

1000

1200

Nu

mb

er

of

Clien

ts

Virginia AIDS Drug Assistance Program Waitlist2011 to 2012

Data Source: AIDS Drug Assistance Program Waitlist DataDivision of Disease Prevention, Office of Epidemiology, Virginia Department of Health, December 2012

Direct ADAP Summary: 2012

Active Clients December 31, 2012: 3,613 (2,276)

Clients Served Jan-Dec 2012: 4,001 (3,008)

Avg. Persons Served Per Month 2012: 2,118 (1,816)

Avg. Total Cost per Month 2012: $1.86M ($1.65M)

Avg. Cost Per Person Per Month 2012: $881 ($913)

Avg. New Clients Per Month 2012: 101 (14)

*Numbers in parentheses are from 1 year ago (January to December 2011)

Direct ADAP: Persons per MonthJanuary 2010 to December 2012

2010

01

2010

02

2010

03

2010

04

2010

05

2010

06

2010

07

2010

08

2010

09

2010

10

2010

11

2010

12

2011

01

2011

02

2011

03

2011

04

2011

05

2011

06

2011

07

2011

08

2011

09

2011

10

2011

11

2011

12

2012

01

2012

02

2012

03

2012

04

2012

05

2012

06

2012

07

2012

08

2012

09

2012

10

2012

11

2012

121000

1500

2000

2500

3000

3500

4000

Persons with an Rx Active Clients

Num

ber

of

Clients

Ended Waitlist

Began waitlist

Data Source: AIDS Drug Assistance Program DataDivision of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013

Direct ADAP Demographics: 2012

64.811.4

10.3

7.16.4

Clients by Federal Poverty Level:

Total Clients = 4,001< 100%101-138% 139-200% 201 or moreUnknown

Data Source: AIDS Drug Assistance Program DataDivision of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013

Direct ADAP Demographics: 2012

20.9

4.7

36.9

19.5

5.7

2.6 9.9

Clients by Gender/Race:Total Clients = 4,001

White Males White Females Black Males Black Females

Hispanic Males Hispanic Females Other Gender/Race

Data Source: AIDS Drug Assistance Program DataDivision of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013

Direct ADAP Demographics: 2012

14.1

15

17.341.7

11.9

Clients by Current CD4 Count

< 200 201-350 351-500 > 500

Unknown

Clients by Gender/Race

75

15.5

9.5

Clients by Current Viral Load

< 200 200 or above Unknown

Lab results are from 2010 and later, from Ryan White and the Electronic HIV/AIDS Reporting System (eHARS), Division of Disease Prevention, Virginia Department of Health

Total Clients =4,001

Medicare Part D Demographics: 2012

51.4

5.2

21.6

11.6

1.6 0.3 3.4

Clients by Gender/Race

White Males White FemalesBlack Males Black FemalesHispanic Males Hispanic FemalesOther Gender/Race

2.6

22.7

39.5

14.2

20.9

Clients by Age

< 40 40 to 49 50 to 59 60 to 64

65 or older

Data Source: Medicare Part D Assistance Program Data (MPAP)Division of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013

Total Clients = 387

Medicare Part D: Rebate Revenue

Paid by Rx Companies to rebate to 340B

price for any co-pay paid on retail

Rx

VDH able to capture rebates for Medicare Part

D starting in 1/2011

Projections of amount of revenue

generated are often not feasible

VDH sends list of co-pays by drug

to companies and receives one

check from each company

Rebates

Rebates allow Virginia to recoup the cost differential between the price paid for the medication at point-of-sale and the 340B price, when ADAP pays for any part of the drug cost.

Drug Cost$100

$150

$200

340B; $185

Rebate; $15

Dollars

Full Retail Price = $200

Copay$5

Profit$10

Medicare Part D: Rebate Revenue2011-2012

Jan-June 2011

July-Dec 2011

Jan-June 2012

$0

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000

$700,000

$800,000

$900,000

$1,000,000

$307,330

$155,538

$339,279

$608,252

$870,934

$519,279

Copays billed Rebates

Dollars

Data Source: AIDS Drug Assistance Program, Financial Tracking DataDivision of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013

VA-ADAP Value of Dispensed Drugs: Direct ADAP Only

RW09

10

RW10

11

RW11

12

RW12

13(p

roje

cted

)0

5

10

15

20

25

30 28 27.6

19.5

24.2

Million

s o

f D

ollars

Value of dispensed drug is the sum of all filled prescriptions for direct ADAP

Does not include any returned medication, increases in drug inventory levels, or revenue generated from ADAP (Medicaid backbilling, Rebates)

Data Source: AIDS Drug Assistance Program DataDivision of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013

Pre-Existing Condition Insurance Program: VA-ADAP 2013

Covers medications and

medical care (through Dec

2013)

Enrollment of 350-450 in 2013

Average Annual Premiums are

$2,748 per client

Can Collect Rebates on Medications

Cap on annual costs of $6,250 (in-network), $10K (out of

network)

ADAP Costs by Program: Projections April 2013 to March 2014

Jul-1

2

Aug-1

2

Sep-

12

Oct-1

2

Nov-1

2

Dec-1

2

Jan-

13

Feb-

13

Mar-1

3

Apr-1

3

May-1

3

Jun-

13

Jul-1

3

Aug-1

3

Sep-

13

Oct-1

3

Nov-1

3

Dec-1

3

Jan-

14

Feb-

14

Mar-1

4$0.0

$500,000.0

$1,000,000.0

$1,500,000.0

$2,000,000.0

$2,500,000.0

$3,000,000.0

$3,500,000.0

$4,000,000.0

$4,500,000.0

$5,000,000.0

Cost for Direct ADAP Total PCIP/Exchanges Cost Total MPAP Cost

Cost

Per

Month

Assumptions: Enrollment of Eligible Clients in Health Care Exchanges in January 2014Rebate Total Estimates for Year = $6.8M

Net Expenditures Estimate = $34.7 M

Division of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013

$41.6M

$13.2M

$27.2M

$1.2M

Exchanges