NatioNal aDaP MoNitoriNg Project - NASTAD · opyright ree ector aps.com 4 THE fUNDING TO PROVIDE SERVICES u uThe total ADAP budget increased by 1% between FY2014 and FY2015, reaching

NatioNal aDaP MoNitoriNg Project2016 Annual Report

coNteNts

A Model for Optimizing HIV Outcomes Within an Evolving Health System 2

3 Ways ADAP is Improving Health Outcomes 8

Methodology 9

Charts and Tables 10

1 1

acKNoWleDgeMeNts

he National Alliance of State & Territorial AIDS Directors (NASTAD) thanks state ADAP and AIDS program managers and staff for their time and effort in completing the National ADAP Survey which serves as the foundation for this report, and for

providing ongoing updates to inform the National ADAP Monitoring Project. NASTAD also thanks Lanny Cross, NASTAD consultant, for his valuable contributions to NASTAD’s ADAP Monitoring and Technical Assistance Program. Finally, without the guidance and support from Murray Penner, NASTAD’s Executive Director, this report would not be possible.

The National ADAP Monitoring Project is one component of NASTAD’s National ADAP Monitoring and Technical Assistance Program which provides ongoing technical assistance to all state and territorial ADAPs. The program also serves as a resource center, providing timely information on the status of ADAPs, particularly those experiencing resource constraints or other challenges, to national coalitions and organizations, policy makers, industry members, and state and federal government agencies. NASTAD received support for the National ADAP Monitoring and Technical Assistance Program in 2015 from the following companies: AbbVie, Gilead Sciences, Janssen Therapeutics and ViiV Healthcare. NASTAD also receives funding to provide technical assistance to ADAPs through a Training and Technical Assistance Cooperative Agreement with the Health Resources and Services Administration (HRSA).

Amanda Bowes, Ann Lefert and Britten Pund are the authors and editors of this document.

Murray C. Penner, Executive DirectorAndrew Gans, New Mexico, ChairJanuary 2016

2

a MoDel For oPtiMiZiNg HiV oUtcoMes WITHIN AN EVOLVING HEALTH SYSTEM

n July 2015, the National HIV/AIDS Strategy (NHAS): Updated to 2020 was released, outlining the work that had been completed since the release of the original Strategy in 2010 and with a call to action to continue efforts to meet the goals of the Strategy. The

aims remain consistent: 1) reduce new infections; 2) increase access to care and improve health outcomes; and 3) reduce HIV-related disparities and health inequities. The AIDS Drug Assistance Program (ADAP) plays an integral role in the achievement of these aims by ensuring continuous access to life-saving treatment and care for eligible people living with HIV (PLWH).

ADAP is comprised of two main components that work to safeguard access to care and treatment for PLWH: 1) the full price purchase of medications and/or 2) the purchase of insurance coverage or payment of co-pays/coinsurance or deductibles on behalf of eligible individuals. Full-pay medication program clients are defined as those individuals who receive medications paid in full by ADAP with no coordination of insurance or benefits. Insurance program clients are defined as those who have some type of coverage other than full-pay prescription ADAP (i.e., Qualified Health Plans, employer-based coverage, Medicaid, Medicare) and for whom ADAP pays the premiums, deductibles and/or co-payments/co-insurance. The information contained in this Report outlines how ADAP has evolved as a result of these growths and health care system changes.

ADAP clients achieve optimal health outcomes at a rate higher than

among all PLWH.

ADAPs play a critical role in efforts to end the HIV epidemic nationally by having a measurable impact on multiple “bars” within the HIV prevention to care continuum, most notably linkage to and retention in care and treatment as well as viral load suppression. ADAPs’ support of insurance and direct provision of ARV therapy and other medications for PLWH is necessary in order for clients to achieve optimal health outcomes including viral load suppression. Viral load suppression in turn greatly reduces HIV transmission and rates for new infections. In addition to viral load suppression, improved access to care and treatment is associated with increased CD4 counts and reductions in PLWH’s progression to CDC-defined AIDS.1 The NHAS emphasizes the need for “seamless systems to link people to care immediately after diagnosis and support retention in care to achieve viral suppression that can maximize the benefits of early treatment and reduce transmission risk.” ADAP is exactly one of those systems.

I

1The AIDS case definition used as part of the National ADAP Monitoring Survey may be found here and is consistent with the most recent ADAP Data Report (ADR) submission. The ADR is the reporting system through which ADAP grantees must submit quarterly reports to HRSA as part of the funding requirements. More information on the ADR may be found here. CDC released an updated case definition in April 2014 (located here).

https://www.aids.gov/federal-resources/national-hiv-aids-strategy/overview/

http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm

http://hab.hrsa.gov/manageyourgrant/adr.html

www.cdc.gov/mmwr/preview/mmwrhtml/rr6303a1.htm%3Fs_cid%3Drr6303a1_e

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6303a1.htm?s_cid=rr6303a1_e

Copyright © Free Vector Maps.com

3

The majority (72%) of all clients served by ADAPs in June 2015 were reported as virally suppressed, defined as having a viral load that is less than or equal to 200 copies/mL (see table 13). By comparison, 63% of all clients served by ADAPs in June 2014 were reported as virally suppressed. Rates for viral load suppression were calculated based on the most recent viral load recorded for each client as of June 30, 2015 among those served by the ADAP program in June 2015 (including those clients not on ARV medications). If a client did not receive a viral load during June 2015, ADAPs reported based on the last viral load recorded for that individual prior to June 30, 2015. Nationally, 30% of all people living with HIV are estimated to be virally suppressed.2 Fifteen percent of clients served in June 2015 were reported as having had a viral load recorded as greater than 200 cells/mL while 13% were reported as having an unknown viral load (see table 13).

ADAP client enrollmentThe number of clients enrolled by ADAP in FY2014

ADAP client utilizationThe number of clients served by ADAP (receiving medications) in FY2014

ADAP client retentionThe number of clients who were successfully recertified twice in a 12-month period of time by ADAP

ADAP client health outcomeThe number of clients served by ADAP who reported a suppressed viral load in June 2015.

Client Engagement in ADAP

ADAP clientenrollment

ADAP clientutilization

ADAP clientretention

ADAP clientoptimal health

outcome

100%87% 84%

72%

u Introduced as a line item in the then Title II (now Part

B) of the federal Ryan White Program appropriation

in 1996; for the first time, provided access to HIV

antiretroviral (ARV) medications for low-income, under-

and un-insured individuals.

u Provides access to critical, life-saving treatments,

including ARV medications, for low income, under- and

un-insured individuals living with HIV/AIDS.

u Available in all 50 states, the District of Columbia, the

Commonwealth of Puerto Rico, the U.S. Virgin Islands,

American Samoa, the Federated States of Micronesia,

Guam, the Northern Mariana Islands, Republic of Palau

and the Republic of the Marshall Islands.

OVERVIEW | AIDS DRUG ASSISTANCE PROGRAM

u ADAPs served over 139,000 clients in June 2015,

representing a 5% decrease overall from June 2014.

u Twenty (20) ADAPs reported increases of 5% or more

clients served between June 2014 and June 2015 while

16 reported decreases of 5% or more in the number of

clients served between June 2014 and June 2015.

u Among the 20 ADAPs that reported increases in the

number of clients served of 5% or more between June

2014 and June 2015, half of those are states in which

Medicaid eligibility has not been expanded.

u Total ADAP drug expenditures were $130,921,720 in

June 2015.

2 Rates for viral load suppression across the Ryan White program are available here.

http://hab.hrsa.gov/deliverhivaidscare/coremeasures.pdf

https://www.aids.gov/federal-resources/policies/care-continuum/

http://hab.hrsa.gov/data/reports/continuumofcare/viralloadsuppression.html


4

THE fUNDING TO PROVIDE SERVICES

u The total ADAP budget increased by 1% between FY2014 and FY2015, reaching $2.24 billion.

u In FY2015, the federal ADAP earmark was $784 million.

u The earmark was one-quarter of the total ADAP budget in

FY1996, the year it was created, rose to more than two-

thirds (68%) of the budget in FY2000 and has most recently

declined as a share of the overall budget to 35% in FY2015.

u The ADAP earmark itself increased in FY2015 by 0.3% from FY2014.

u Drug rebates accounted for $1.016 billion, or 45%

of the overall ADAP budget in FY2015. This funding

represents money that is paid to the state by

manufacturers as a result of active filing of rebate

claims based on drug purchases. This represents an

increase of 6% from FY2014.

u State contributions accounted for $189.1 million, or

8%, of the overall ADAP budget in FY2015. This marks

a decrease of 19% from FY2014.

ADAPs have gained the ability to serve more clients through insurance by transforming their

program structures and working to meet the infrastructure needs of supporting an insurance

purchasing program.

In 2015, the number of clients served by the full-pay medication component of ADAPs was 8% less than the number of clients that were served through this approach in 2002. By comparison, the number of clients served by ADAP-funded insurance purchasing increased by 1162% between 2002 and 2015 which now includes more than 70,000 individuals.

ADAP clients are obtaining new forms of coverage.

Following the implementation of the Affordable Care Act (ACA), ADAPs continue to assist clients in transitioning to new forms of coverage such as Medicaid and Qualified Health Plans. As a direct result, national ADAP enrollment has shifted dramatically and continues to trend toward greater numbers of insured clients in the program. Yet individuals’ enrollment in any one insurance coverage is far from static; fluctuations in income and employment status can result in gaps in insurance and in turn, treatment. ADAPs must then act as a safety net to effectively fill these gaps as a payer of last resort for PLWH so as to ensure continuous access to care and treatment as well as viral load suppression.

Over the course of twelve months, ADAPs serve 64% more clients than they do in a single month for various reasons, including 30 vs. 90 day prescription refills, payment of insurance plans (cost-sharing payments decrease after clients meet their out-of-pocket maximum), implementation of Medicare Part D (clients reach the “donut hole” early in the year), and clients churning between payer sources due to fluctuations in income and life circumstances (e.g., income, employment). Each month presents a new number of clients being served by ADAP, working to ensure that individuals always have uninterrupted access to medications.

ADAP Clients Served, FY2014 ADAP Clients Served, June 2015

ADAP clients served by ADAP-funded insurance program only

ADAP clients serviced by full-pay prescription program only

ADAP clients served by ADAP-funded insurance and full-pay prescription programs

ADAP clients served by ADAP-funded insurance program only

ADAP clients serviced by full-pay prescription program only

ADAP clients served by ADAP-funded insurance and full-pay prescription programs

20%

49%48%

3%

48%

32%


5

ADAP remains the primary payer for those

individuals whose insurance cost-sharing

responsibilities (e.g., premium, deductible

and co-payment/co-insurance) are a

barrier to purchasing and maintaining

insurance.

While the ACA has resulted in an unprecedented expansion of access to both private and public health insurance, the cost of insurance remains too high for many individuals, even with the availability of federal subsidies. The Ryan White Program allows states to use ADAP funds to purchase health insurance and pay insurance premiums, co-payments and/or deductibles for individuals eligible for ADAP, provided the insurance has comparable formulary benefits to that of the ADAP and is cost-effective to the ADAP. By purchasing and continuing insurance on behalf of clients, ADAPs have ensured access to treatment and care services beyond the scope of the traditional Ryan White Program.

Private insurance plans (Qualified Health Plans, employer-sponsored plans, and other individual health plans) often place HIV ARVs on a higher tier than other medications, resulting in high cost-sharing for clients. In many cases, when medications are placed on high or specialty tiers, instead of charging a co-payment with a fixed dollar amount, plans will charge a co-insurance, or a percentage of the cost of the drug. This results in much higher cost-sharing responsibilities for clients. To ensure continuous access to treatment, ADAPs purchase or continue insurance by paying for prescription co-payments on behalf of clients, closely interacting with other existing payer sources.

Today, the majority of ADAPs pay premiums (84%), deductibles (83%) and prescription co-payments/co-insurance (90%) on behalf of eligible clients. Half of ADAPs also pay medical co-payments/co-insurance on behalf of clients (see table 27).3 With a significantly lower average cost per client ($444) relative to full-pay prescriptions ($1,678), insurance continuation is cost-effective to the ADAP program.

ADAP SERVICES fOR INCARCERATED INDIVIDUALS

Incarcerated individuals often transition back into communities

— at least 95% of individuals in state prisons will be released

back into their communities at some point. The transition from

“inside the walls” into the broader community often results in

gaps in necessary services such as housing and medical care.

This has an acute impact on PLWH whose access and adherence

to ARVs are critical to their continued survival. ADAPs can sup-

port justice-involved individuals’ access to care and treatment

by providing medications immediately upon release for eligible

clients and linking them to other payer sources (e.g., Medicaid).

In September 2007, the HIV/AIDS Bureau (HAB) updated their

policy describing the use of Ryan White HIV/AIDS Program funds

for transitional social support and primary care services for

incarcerated persons.

The policy supports the use of Ryan White HIV/AIDS Program

funds for incarcerated persons as they prepare to exit the cor-

rectional system as part of effective discharge planning or when

they are in the correctional system for a brief period, which

would not include any discharge planning.

Nineteen ADAPs (37%) report they provided services to individ-

uals incarcerated in county or city jails as of June 30, 2015.

ADAP Clients Served by Insurance Payment Type

Premiums only

Deductible/co-payments/co-insurance only

Premiums and deductible/co-payments/co-insurance

44%

38%

18%

3 Federal ADAP funds cannot be used to pay for medical co-payments/co-insurance.

https://csgjusticecenter.org/reentry/facts-trends/

http://hab.hrsa.gov/manageyourgrant/pinspals/incarceratedpersons0704.html


6

Forty-seven ADAPs reported using funds for insurance purchasing/continuation in 2015 representing an estimated $395 million in expenditures in FY2015. ADAPs reported spending over $31 million on insurance purchasing/continuation in June 2015 (see Table 25). In June 2015, 71,682 ADAP clients were covered by ADAP insurance coordination (see CharT 21 and Table 24); clients served through this mechanism increased 17% from June 2014 (61,456 clients served).

Health reform throughout the U.S.

has been implemented unequally

across states, creating new disparities

and illuminating further stressors on the public health system.

Medicaid expansion under the ACA allows states to extend eligibility to individuals with income up to 138% FPL regardless of traditional Medicaid categories of eligibility, such as disability and pregnancy.4 On June 28, 2012, the U.S. Supreme Court issued a decision giving states the discretion to expand or not expand Medicaid eligibility under the ACA, causing a significant gap in access to care among non-Medicaid expansion states. This “Medicaid Gap” has likely exacerbated health disparities among states and placed a significant burden on ADAPs in non-Medicaid expansion states to continue to provide a safety net for low-income clients left out of reform. With this burden, ADAPs in non-expansion states may be hindered in expanding and strengthening the program in new and innovative ways (e.g., expanding formulary access).

The ACA established Marketplaces that allow eligible individuals to shop for health

insurance coverage.

Marketplaces utilize outreach and enrollment staff and streamlined application processes that screen for Medicaid eligibility and eligibility for premium tax credits and cost-sharing reductions for Qualified Health Plans (QHPs). Marketplaces may be: federally-facilitated5; state-based6; state-federal partnership7; or federally-supported state-based8. ADAPs have assisted tens of thousands of individuals by paying for premiums and other cost sharing associated with QHP coverage.

ADAP Clients Served, by Other Payers, June 2015

Medicaid

Medicaid and Medicare

Medicare Part D Full Subsidy

Medicare Part D Partial Subsidy

Medicare Part D Standard Benefit

Private Insurance Coverage

No Form of Insurance

Unknown

43%

29%

9%

4% 7%2%

4% 2%

4 In 2014, the ACA expanded Medicaid eligibility to most people with income up to 133% of the federal poverty level (FPL). However, in addition to new income accounting rules for most Medicaid populations (called “Modified Adjusted Gross Income”), there is an additional 5% disregard of income in calculating eligibility, effectively bumping the Medicaid income eligibility threshold to 138% FPL.

5 The U.S. Department of Health and Human Services (HHS) performs all Marketplace functions. Consumers in states with a Federally-facilitated Marketplace apply for and enroll in coverage through healthcare.gov.

6 States are responsible for performing all Marketplace functions. Consumers in these states apply for and enroll in coverage through Marketplace websites established and maintained by the states.

7 States may administer in-person consumer assistance functions and HHS will perform the remaining Marketplace functions. Consumers in states with a Partnership Marketplace apply for and enroll in coverage through healthcare.gov.

8 States are responsible for performing all Marketplace functions, except that the state will rely on the Federally-facilitated Marketplace information technology (IT) platform. Consumers in these states apply for and enroll in coverage through healthcare.gov.

http://kff.org/health-reform/issue-brief/a-guide-to-the-supreme-courts-decision/

http://kff.org/health-reform/state-indicator/state-health-insurance-marketplace-types/#map


7

ADAP Clients Served, by ACA Marketplace Type

Insured ADAP Clients Served, by Private Plan Type, June 2015

Federally-facilitated Marketplace

State-based Marketplace

State-federal partnership Marketplace

Federally-supported, state-based Marketplace

Enrolled in QHP on the ACA Marketplace

Enrolled in QHP off the ACA Marketplace

Enrolled in Other Private Insurance

Unknown

37%

31%

40%

21%10%

55%

6%2%

Disparities continue to exist among states that have and have not expanded Medicaid.

As of November 2015, 30 states and the District of Columbia have expanded Medicaid; 46% of all ADAP clients reside in the 20 states that have not yet expanded Medicaid. Those states are primarily in the southern region of the U.S., further illuminating inequities in access to care and treatment via public payers.

ADAP Clients by State Medicaid Expansion, June 2015

ADAP clients served with income less than or equal to 138% of FPL

Number of states

33,828 (43%) 45,340 (57%)

30 20

Medicaid expansion states Non-Medicaid expansion states

The majority (60%) of clients served by ADAP in June 2015 had incomes below 138% of the Federal Poverty Line (FPL) 9. Forty-six (46) percent of clients served by ADAPs in June 2015 reside in one of the 20 states in which Medicaid eligibility has not been expanded to 138% FPL. If all 20 of these states were to expand Medicaid eligibility to 138% of FPL, 45,340 (32%) of the ADAP clients served in June 2015 would be eligible to transition into Medicaid coverage. Despite the non-expansion of Medicaid, 17 ADAPs in these states capitalize on other elements of the ACA by purchasing insurance for one or more of their clients. Thirty-nine percent (24,941) of all clients served by a non-Medicaid expansion state received services through an ADAP-funded insurance program.

As our nation’s health care system and public health programs continue to grow and change, ADAPs themselves have undergone and continue to experience significant transformations in their structure and service provision in order to ensure access to care and treatment for PLWH and ultimately viral suppression. This includes assisting clients in accessing new forms of medications and medical coverage as well as maintaining vital services that strengthen those available through the Ryan White Program. ADAPs’ nimble and progressive approach has positioned the program as a sustainable model for optimizing health outcomes for the clients ADAPs serve and as a critical component of the broader health system.

8

ADAP is improving health outcomes in 3 important ways:

1. EngagEmEnt in CarE

2. CliEnt EnrollmEnt & Composition

3. involvEmEnt in nEw hEalth CovEragE

of all clients served reported a suppressed viral load*72%

This means an

OPtimAl health outcome

for clients: 87% of clients served by an ADAP-funded insurance program reported a suppressed viral load.

*over a 12-month period by ADAP

* These clients would be eligible to transition to Medicaid if their state chose to expand Medicaid eligibility.

262,605 clients enrolled

87%client utilization

84%client retention

Clients served by ADAP (receiving medications) in FY2014

Clients successfully recertified twice in a 12-month period by ADAP

2013 2014258,469 clients enrolled

16% were new (40,921)

262,605 clients enrolled

16% were new (42,866)

enrollment enrollment

composition composition

238,253 clients served...

229,672 clients served...

by an ADAP-funded insurance program ONLY:

by an ADAP full-pay prescription program ONLY:

by both:

by an ADAP-funded insurance program ONLY:

by an ADAP full-pay prescription program ONLY:

by both:

33% 32%

60% 48%7% 20%

Improving retention in care

The ACA, including the Marketplace and Medicaid expansion, have enabled

ADAPs to better serve their clients.

ACA CoverAge mediCAid

29,341Enrolled in more comprehensive care through an ACA Marketplace Qualfied Health Plan or Medicaid

45,340Number of clients served in June 2015 with incomes below 138% of FPL who live in a non-Medicaid expansion state*

For more information on ADAP and state-specific ADAP data, please check out

the 2016 National ADAP Monitoring Project Annual Report here.

http://NASTAD.org/ADAPreport

8 9

MetHoDology

ince 1996, NASTAD’s National ADAP Monitoring Project has surveyed all jurisdictions receiving federal ADAP earmark funding through the Ryan White Program. In FY2015, 59 jurisdictions received earmark funding and were surveyed; 52 responded.

American Samoa, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond. This 21st release of the Annual Report updates prior findings with data from ADAP’s fiscal year 2015 as well as a detailed snapshot of data from the month of June 2015. The Annual Report reflects the latest available data and discusses recent policy and programmatic changes affecting ADAPs.

The annual survey requests data and other program information for a one-month period (June), the current fiscal year, and other periods as specified. After the survey is distributed, NASTAD conducts extensive follow-up to ensure completion by as many ADAPs as possible. Data used in this report are from June 2015 and FY2015, unless otherwise noted.

All data reflect the status of ADAPs as reported by survey respondents. It is important to note that some program information may have changed between data collection and the Annual Report’s release. Due to differences in data collection and availability across ADAPs, some are not able to respond to all survey questions. Where trend data are presented, only states that provided data in relevant periods are included. In some cases, ADAPs have provided revised program data from prior years and these revised data are incorporated where possible. Therefore, data from prior year reports may not be comparable for assessing trends. It is also important to note that data from a one-month snapshot may be subject to one-time only events or changes that could in turn appear to impact trends; these are noted where information is available. Data exceptions specific to a particular jurisdiction are provided in the notes section on relevant charts and tables.

s

10

Charts for each major finding, tables, with data provided by state, and a complete ADAP glossary are included in the full report. State-level data from this report are available on the NASTAD website.

Charts

Chart 1 Total ADAP Budget, FY1996-FY2015 ..................................................................................................................................................13

Chart 2 Total ADAP Budget, by Source, FY1996-FY2015 ..........................................................................................................................13

Chart 3 Total ADAP Budget, by Source, FY2015 .............................................................................................................................................14

Chart 4 Part B ADAP Earmark, FY1996-FY2015 ..............................................................................................................................................14

Chart 5 Part B ADAP Supplemental Funding, FY2001-FY2015 ..............................................................................................................15

Chart 6 Part B Base Contribution Directed to ADAP, FY1996-FY2015................................................................................................15

Chart 7 Part A Contribution Directed to ADAP, FY1996-FY2015 ...........................................................................................................15

Chart 8 State Contribution, FY1996-FY2015 ..................................................................................................................................................16

Chart 9 Estimated Drug Rebates, FY1996-FY2015 ......................................................................................................................................16

Chart 10 ADAP Client Enrollment, June 2003-2015 ......................................................................................................................................16

Chart 11 ADAP Client Utilization, June 1996-2015 ........................................................................................................................................17

Chart 12 ADAP Clients Served and Top Ten States, by Clients Served, June 2015.........................................................................17

Chart 13 ADAP Clients Served, by Other Payers, June 2015 ......................................................................................................................18

Chart 14 ADAP Clients Served, by Race/Ethnicity, June 2015 ..................................................................................................................18

Chart 15 ADAP Clients Served, by Gender, June 2015 ..................................................................................................................................19

Chart 16 ADAP Clients Served, by Age, June 2015 .........................................................................................................................................19

Chart 17 ADAP Clients Served, by Income Level, June 2015 .....................................................................................................................19

Chart 18 ADAP Drug Expenditures and Top 10 States, by Drug Expenditures, June 2015 ........................................................20

Chart 19 ADAP Drug Expenditures and Prescriptions Filled (Including Drug Purchases and Co-Payments), June 2015 ...............................................................................................................................................................20

Chart 20 ADAP Drug Expenditures and Prescriptions Filled (Including Drug Purchases and Co-Payments), by Drug Category, June 2015 ........................................................................................................................21

Chart 21 Clients Served and Estimated Expenditures in Insurance Purchasing and Continuation, 2015..........................21

Chart 22 Insured ADAP Clients Served, by Private Plan Type, June 2015 ...........................................................................................22

Chart 23 ADAP Premium Assistance, by Income Level, FY2015 ...............................................................................................................22

Chart 24 ADAP Deductible Assistance, by Income Level, FY2015 ..........................................................................................................22

Chart 25 ADAP Co-Payments/Co-Insurance (prescription only) Assistance, by Income Level, FY2015 ...............................23

Chart 26 ADAP Co-Payments/Co-Insurance (medical only) Assistance, by Income Level, FY2015 ........................................23

Chart 27 ADAP Requires Client Takes Advance Tax Credit, by Income Level, FY2015 ..................................................................24

Chart 28 ADAP Requires Client Tax Return Submission, by Income Level, FY2015 .......................................................................24

Chart 29 ADAP Medicare Part D Premium Assistance, by Income Medicare Benefit Level, FY2015 ......................................25

Chart 30 ADAP Medicare Part D Deductible Assistance, by Income Medicare Benefit Level, FY2015 .................................25

Chart 31 ADAP Co-Payments Assistance, by Medicare Benefit Level, FY2015 .................................................................................25

Chart 32 ADAP Medicare Part D Donut Hole Assistance, FY2015 ...........................................................................................................26

Chart 33 ADAP Eligibility, by Medicare Benefit Level, FY2015 .................................................................................................................26

Chart 34 ADAP Provision of Services for Incarcerated Individuals, FY2015 ......................................................................................26

Chart 35 ADAP Income Eligibility (Full-Pay Medications), as of June 30, 2015 ...............................................................................27

Chart 36 ADAP Income Eligibility (Insurance), as of June 30, 2015 .......................................................................................................27

cHarts aND tables

http://nastad.org/ADAPreport

11

tablEs

table 1 Total Budget, FY2014 and FY2015 ......................................................................................................................................................29

table 2 Total ADAP Budget, by State and by Source, FY2015 .................................................................................................................30

table 3 Major FY2015 Budget Categories Compared with FY2014 ....................................................................................................32

table 4 Cost Recovery and Other Cost-Saving Mechanisms (Excluding Drug Rebates), FY2014 .........................................36

table 5 Total Clients Enrolled/Served and Program Expenditures, FY2014 ...................................................................................37

table 6 Total Clients Enrolled and Served, June 2014 and June 2015 .............................................................................................39

table 7 ADAP Clients Served by Other Payers, June 2015 .......................................................................................................................40

table 8 ADAP Clients Served, by Race/Ethnicity, June 2015 ..................................................................................................................41

table 9 ADAP Clients Served, by Gender, June 2015 ..................................................................................................................................42

table 10 ADAP Clients Served, by Age, June 2015 .........................................................................................................................................43

table 11 ADAP Clients Served, by Income Level, June 2015 .....................................................................................................................44

table 12 ADAP Clients Served, by HIV/AIDS Status, June 2015 ...............................................................................................................45

table 13 ADAP Clients by Viral Load, Enrolled During 12-Month Period, June 2015 ...................................................................47

table 14 ADAP Client Enrollment Processes, as of June 30, 2015 ..........................................................................................................49

table 15 ADAP Client Financial Eligibility Requirements, as of June 30, 2015 ...............................................................................50

table 16 ADAP Client Medical Eligibility Requirements, as of June 30, 2015 ..................................................................................51

table 17 ADAP Client Eligibility Requirements, as of June 30, 2015 ....................................................................................................53

table 18 ADAP Drug Purchasing, June 2015 ......................................................................................................................................................55

table 19 ADAP Drug Expenditures (Including Purchases and Co-payments), June 2015 ...........................................................56

table 20 ADAP Drug Expenditures (Including Purchases and Co-payments), by Drug Category, June 2015 ...................57

table 21 ADAP Prescriptions Filled (Including Purchases and Co-payments), June 2015 .........................................................58

table 22 ADAP Prescriptions Filled (Including Purchases and Co-payments), by Drug Category, June 2015 ..................59

table 23 ADAP Prescription Distribution, June 2015 ....................................................................................................................................60

table 24 Clients Served Through Insurance Purchasing and Continuation, 2015 ..........................................................................62

table 25 ADAP Funds Used and Clients Served Through Insurance Purchasing and Continuation, 2015 .........................63

table 26 Clients Served Through Insurance Purchasing and Continuation, by Insurance Plan Enrollment, 2015 ........64

table 27 ADAP Policies Related to Insurance Purchasing as of June 30, 2015 ................................................................................65

table 28 ADAP Policies Related to Medicare Part D, as of June 30, 2015 ..........................................................................................67

table 29 ADAP Management Practices in Place, as of June 30, 2015 ...................................................................................................68

table 30 Key Dates in the History of ADAP .........................................................................................................................................................70

table 31 HIV/AIDS Antiretroviral and Opportunistic Infection Medications ......................................................................................71

glossary

A glossary of key ADAP terms can be found on the NASTAD website.

http://bit.ly/1by7nrV

cHarts

13

$200

$413 $544

$712 $779

$870 $962

$1,071 $1,187

$1,299 $1,418 $1,428

$1,515 $1,584

$1,789 $1,887

$2,032 $2,010

$2,212 $2,239

$0

$500

$1,000

$1,500

$2,000

$2,500

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Mil

lion

s of

Dol

lars

106%

32% 31%

9%

12% 11% 11% 11% 9%1%

6%

5%13%

5%8% 10%

1%-1%9%

Note: The total FY2015 budget includes federal and state allocations as well as drug rebate dollars. Cost recovery funds, with the exception of drug rebate dollars, are not included in the total budget. Percentages noted represent changes between the two years indicated, not aggregate changes since FY1996.

ChArT 1 Total ADAP Budget, FY1996-FY2015

ChArT 2 Total ADAP Budget, by Source, FY1996-FY2015

26%

40%

53%

65% 68% 66% 64% 65% 61% 59% 56% 54% 51% 49% 45% 43% 41% 39% 35% 35%

25%

28%

22%

18% 17% 17% 17% 16% 19%

19% 22% 21%

21%

14% 19% 16%

13% 11%

11% 8%

6%

5%

6%

7% 7% 7% 9% 10% 12% 15% 17%

18% 21%

31% 29% 33%

36% 40%

43% 45%

43%

26% 19%

11% 9% 10% 10% 9% 7% 7% 5% 7% 7% 7% 6% 8% 10% 10% 11% 11%

FY1996 $200 m

FY1997 $413 m

FY1998 $544 m

FY1999 $712 m

FY2000 $779 m

FY2001 $870 m

FY2002 $962 m

FY2003 $1,071 m

FY2004 $1,187 m

FY2005 $1,299 m

FY2006 $1,386 m

FY2007 $1,428 m

FY2008 $1,515 m

FY2009 $1,582 m

FY2010 $1,789 m

FY2011 $1,887 m

FY2012 $2,032 m

FY2013 $2,010 m

FY2014 $2,212 m

FY2015 $2,239 m

Other (includes Part B ADAP Supplemental, Part B Base directed to ADAP, Part B Supplemental directed to ADAP, ADAP Emergency Funding, Part A directed to ADAP)

Rebates

State

ADAP Earmark

Other (includes Part B ADAP Supplemental, Part B Base directed to ADAP, Part B Sup-plemental directed to ADAP, ADAP Emergency Funding, Part A directed to ADAP)

Rebates States ADAP Earmark

14

ChArT 3 Total ADAP Budget, by Source, FY2015

ChArT 4 Part B ADAP Earmark, FY1996-FY2015

total

$2.24 billion

$781,180,379(35%)

$74,547,006(3%)

$41,313,113(2%)

$22,856,340(1%)

$75,000,000(3%)

$10,982,615(0.5%)

$189,069,556(8%)

$25,630,189(1%)

$1,016,307,741(45%)

Part B ADAP Earmark

Part B ADAP Supplemental

Part B Base Contribution Directed to ADAP

Part B Supplemental Directed to ADAP

ADAP Emergency Funding

Part A Contribution Directed to ADAP

State Contribution

Estimated Drug Rebates

Other State or Federal

Note: 52 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond, but their federal ADAP earmark and ADAP supplemental awards were known and incorporated. The total FY2015 budget does not include cost recovery funds, with the exception of drug rebate dollars.

Note: ADAP earmark does not include ADAP Supplemental Fund set-aside from FY2001-2015. Percentages noted represent changes between the two years indicated, not aggregate changes since FY1996.

$52

$167

$286

$461 $528

$571 $620

$693 $728

$765 $780 $775 $774 $779 $800 $813 $826 $782 $782 $784

$0

$100

$200

$300

$400

$500

$600

$700

$800

$900

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Mil

lion

s of

Dol

lars

222%

71% 61%

15%

8% 8% 5% 5% -1% 0% 0.3%0%-5%1%2%3%1%2%12%

15

$26 $24

$27

$23

$18 $25 $20

$18

$21

$18 $18

$12 $15 $13

$15

$17 $16

$11.6 $12.2

$11.0

$0

$5

$10

$15

$20

$25

$30

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Mil

lion

s of

Dol

lars

ChArT 5 Part B ADAP Supplemental Funding, FY2001-FY2015

ChArT 6 Part B Base Contribution Directed to ADAP, FY1996-FY2015

ChArT 7 Part A Contribution Directed to ADAP, FY1996-FY2015

Note: All Part B ADAP supplemental funds are reported. Percentages noted represent changes between the two years indicated, not aggregate changes since FY2001. The 2006 reauthorization of the Ryan White Program raised the percentage allocated to the ADAP supplemental from three percent to five percent of the ADAP Earmark, beginning in FY2007.

Note: Percentages noted represent changes between the two years indicated, not aggregate changes since FY1996.


$50

$68 $72

$51

$39

$29

$29 $22 $22 $23

$29 $25 $34

$28 $21 $22

$33

$24 $22

$26

$0

$10

$20

$30

$40

$50

$60

$70

$80

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Mil

lion

s of

Dol

lars

35%

-6%

10%

-13%

-25%

41%

-20% -15%

20%

-15%

3%

-33%

20%

-10%

14%

4%-7%

-28%

5%-10%

6%

-30%-24%

-24%

-1%

-23%

-2%

6%

24%

39%

-19%-26% -28%

-6%

17%8%

48%

-14%

$18 $19 $21 $21 $20

$10

$40

$40 $42 $42 $42 $43 $38

$41 41.3

$0

$5

$10

$15

$20

$25

$30

$35

$40

$45

$50

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Mil

lion

s of

Dol

lars

8% 11% -2% -3%

-52%

1% 5% 1% 1% 2% -12% 9% -0.2%

303%$

16

128,465 133,572 134,128 141,856 145,799 151,200

168,707 179,009 179,988

195,001 210,411 204,988

197,117

0

50,000

100,000

150,000

200,000

250,000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Cli

ents

Enr

olle

d ChArT 8 State Contribution, FY1996-FY2015

ChArT 9 Estimated Drug rebates, FY1996-FY2015

ChArT 10 ADAP Client Enrollment, June 2003-2015


$50

$117 $119 $126 $129 $150 $160 $172

$227 $253

$305 $294 $311

$215

$275

$309

$274

$224 $233

$189

$0

$50

$100

$150

$200

$250

$300

$350

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Mil

lion

s of

Dol

lars

133%

2% 16% 7% 7%

32% 12% 21%

6%

28% 12%

-11% -18%

4%

-19%-31%

-4%

5% 3%


Note: Includes clients enrolled by ADAPs reporting data for June in a given year. Data on client enrollment in ADAP is not available prior to June 2003. Percentages noted represent changes between the two years indicated, not aggregate since 2003.

$12 $23 $34 $46 $55 $60 $83 $110 $146 $196 $230 $263

$327

$498 $523

$628

$736 $856

$960 $1,016

$0

$200

$400

$600

$800

$1,000

$1,200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Mil

lion

s of

Dol

lars

90%

4%

0%

6%3% 4%

12%

6%

1%

8%

8%

-3%-4%

49%

38%

17% 10%

39%

32% 33%

34%

17% 14% 25%

52%

5%

20% 17% 16% 12%

6%

17

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

Num

ber

of C

lien

ts

Total Clients Served, June 2015

ChArT 11 ADAP Client Utilization, June 1996-2015

ChArT 12 ADAP Clients Served and Top Ten States, by Clients Served, June 2015

Note: 51 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, New Jersey, Northern Mariana Islands and Republic of Palau did not respond.

31,317

43,494

53,765 61,822

69,407 76,743 80,035 85,825

94,577 96,404 96,121 101,987

110,047

125,479 135,596

138,173 144,509

152,487 146,872

139,940

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Cli

ents

Ser

ved

Note: Includes clients served by ADAPs reporting data for June in a given year. Percentages noted represent changes between the two years indicated, not aggregate since 1996.

24%

39%

15% 12%

11% 4% 7%

10%

2%

-0.3%

6%

8%14%

8%2%

5% 6%

-4%

-5%

STATE CLIENTS SERVED, JUNE 2015

California 17,057

New York 16,647

Florida 13,739

Texas 12,016

Puerto Rico 5,668

Georgia 5,294

North Carolina 5,024

Virginia 4,974

Pennsylvania 4,745

Illinois 4,726

Total 89,890

total

139,940

89,890 (64%)

18

43%

29%

4% 4%

9%

2%

2%4%

chart 13 aDaP clients Served, by Other Payers, June 2015

chart 14 aDaP clients Served, by race/Ethnicity, June 2015

1 Asset limits for full- vs. partial-subsidy under Medicare Part D may be found here.

Medicaid

Medicaid and Medicare

Medicare Part D Full Subsidy1

Medicare Part D Partial Subsidy

MedicarePartDStandardBenefit


No Form of Insurance

Unknown

Non-Hispanic Black/African American

Non-Hispanic White

Hispanic

Asian

NativeHawaiian/PacificIslander

American Indian/Alaskan Native

Multi-Racial

Other

Unknown

Note: 49 ADAPs reported data. American Samoa, Connecticut, Guam, Kentucky, Marshall Islands, Nevada, New Jersey, Northern Mariana Islands, Republic of Palau and South Dakota did not respond. Percentages may not total 100% due to rounding.

Note: 51 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, New Jersey, Northern Mariana Islands and Republic of Palau did not respond. Percentages may not total 100% due to rounding.

28%

2%

>1%

>1%

1%

1%2%

31%

35%

31%

http://www.medicarerights.org/fliers/Help-With-Drug-Costs/Extra-Help-Chart.pdf%3Fnrd%3D1

19

≤ 12 Years

13-24 Years

25-44 Years

45-64 Years

> 64 Years

Unknown

40%50%

5%4%

<1%

2%

71%

27%

<1%

2%

ChArT 15 ADAP Clients Served, by Gender, June 2015

ChArT 17 ADAP Clients Served, by Income Level, June 2015

ChArT 16 ADAP Clients Served, by Age, June 2015

Male

Female

Transgender

Unknown

≤ 100% FPL

101-138% 1 FPL

139-200% FPL

201-300% FPL

301-400% FPL

>401% FPL

Unknown

Note: 51 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, New Jersey, Northern Mariana Islands and Republic of Palau did not respond. Percentages may not total 100% due to rounding.

Note: 51 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, New Jersey, Northern Mariana Islands and Republic of Palau did not respond. The 2015 Fed-eral Poverty Level (FPL) was $11,770 (slightly higher in Alaska and Hawaii) for a household of one. Percentages may not total 100% due to rounding.

Note: 51 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, New Jersey, Northern Mariana Islands and Republic of Palau did not respond. A dash (--) indicates the ADAP did not report data. Percentages may not total 100% due to rounding.

45%

11%

18%

16%

6%

2% 0.3%

20

ChArT 18 ADAP Drug Expenditures and Top 10 States, by Drug Expenditures, June 2015

Note: 49 ADAPs reported data. American Samoa, Guam, Idaho, Kansas, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands, Republic of Palau and Wyoming did not respond.

$0

$40,000,000

$80,000,000

$120,000,000

$160,000,000 total

$130,921,720

$102,266,607(78%)

June 2015 Expenditures

STATE DRUG ExPENDITURES, JUNE 2015

New York $26,912,199

California $23,801,636

Florida $14,658,100

Texas $8,875,180

Pennsylvania $7,939,740

New Jersey $6,274,845

Georgia $4,240,166

North Carolina $3,974,402

Puerto Rico $2,965,783

Illinois $2,624,556

Total $102,266,607

ChArT 19 ADAP Drug Expenditures and Prescriptions Filled (Including Drug Purchases and Co-Payments), June 2015

$120,794,583(92%)

$10,127,137(8%)

249,283(65%)

135,034(35%)

June 2015 Drug Purchases

June 2015 Co-Payment Expenditures

June 2015 Drug Purchases Rx

June 2015 Co-Payment Rx

total

$131 million

total

384,317 prescriptions

(rx) filled

21

5,272 7,167 7,277 12,311 13,744

20,960 15,843

30,621 34,341

41,095

46,653

52,568 61,456

71,682

$(20)

$20

$60

$100

$140

$180

$220

$260

$300

$340

$380

$420

$460

$500

-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Esti

mat

ed F

isca

l Yea

r Ex

pend

itur

es (i

n m

illi

ons)

Num

ber

of C

lien

ts (J

une)

ChArT 20 ADAP Drug Expenditures and Prescriptions Filled

(Including Drug Purchases and Co-Payments), by Drug Category, June 2015

ChArT 21 Clients Served and Estimated Expenditures in Insurance Purchasing and Continuation, 2015

June 2015 ARV Total Expenditures

June 2015 “A1” OI Total Expenditures

June 2015 HCV Total Expenditures

June 2015 All Other Total Expenditures

June 2015 ARV Total Rx

June 2015 “A1” OI Total Rx

June 2015 HCV Total Rx

June 2015 All Other Total Rx

Note: 49 ADAPs reported data. American Samoa, Guam, Idaho, Kansas, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands, Republic of Palau and Wyoming did not respond.

Note: 51 ADAPs reported data. American Samoa, Connecticut, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond. A dash (--) indicates the ADAP did not report data. Health insurance programs include purchasing health insurance and paying insurance premiums, co-payments, and/or deductibles. Client data for June 2002 and 2003 represent clients enrolled; June 2004-2015 data represent clients served. All ADAPs that have reported having insurance purchasing/maintenance programs since 2002 are included.

$120,475,526(92%)

27,479(33%)

231,584(60%)

27,479(7%)

total

$131 million

total

384,317prescriptions

filled

$1,692,523(1%)

$899,386(1%)

174(0.05%)

$7,854,284(6%)

$19$30

$38$75 $84 $75 $107

$159$194

$268 $227

$397

$421 $395

22

ChArT 22 Insured ADAP Clients Served, by Private Plan Type, June 2015

ChArT 23 ADAP Premium Assistance, by Income Level, FY2015

ChArT 24 ADAP Deductible Assistance, by Income Level, FY2015

Note: 49 ADAPs reported data. American Samoa, Connecticut, Guam, Kentucky, Marshall Islands, Nevada, New Jersey, Northern Mariana Islands, Republic of Palau and South Dakota did not respond. Percentages may not total 100% due to rounding.

Note: 52 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond.


16%45%

11%18%



Enrolled in Other Private Insurance

Unknown

No

Yes

No

Yes

71% 73% 83%

71%

31%

29% 27% 17%

29%

69%

Below 100% FPL 100-138% FPL 139-250% FPL 251-400% FPL 400%+ FPL

73% 73% 79% 67%

29%

27% 27% 21% 33%

71%


23

ChArT 25 ADAP Co-Payments/Co-Insurance (prescription only) Assistance, by Income Level, FY2015

ChArT 26 ADAP Co-Payments/Co-Insurance (medical only1) Assistance, by Income Level, FY2015

83% 83% 87% 73%

33%

17% 17% 13% 27%

67%


No

Yes

No

Yes


1 Federal ADAP funds cannot be used to pay for medical co-payments/co-insurance.


42% 44% 48% 40%

17%

58% 56% 52% 60%

83%


24

ChArT 28 ADAP requires Client Tax return Submission, by Income Level, FY2015

ChArT 27 ADAP requires Client Takes Advance Tax Credit, by Income Level, FY2015

Note:52 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond.


66%

86%

34%

14%

100-138% FPL 138-250% FPL

57% 68%

43% 32%

100-138% FPL 138-250% FPL

No

Yes

No

Yes

25

58%

77% 92% 92%

42%

23% 8% 8%

Dual Eligible (Medicaid and Medicare)

Full Subsidy (<135%) Partial Subsidy (135-150%) Standard Benefit (>150%)

77% 79%

23% 21%

Partial Subsidy (135-150%) Standard Benefit (>150%)

ChArT 29 ADAP Medicare Part D Premium Assistance, by Medicare Benefit Level, FY2015

ChArT 30 ADAP Medicare Part D Deductible Assistance, by Medicare Benefit Level, FY2015

ChArT 31 ADAP Co-Payments Assistance, by Medicare Benefit Level, FY2015

No

Yes

No

Yes

No

Yes

Note:52 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond.



52% 62%

48% 38%

Partial Subsidy (135-150%) Standard Benefit (>150%)

26

60% 73%

90% 94%

40% 27%

10% 6%

Dual Eligible (Medicaid and Medicare) Full Subsidy (<135%) Partial Subsidy (135-150%) Standard Benefit (>150%)


ChArT 33 ADAP Eligibility, by Medicare Benefit Level, FY2015

ChArT 34 ADAP Provision of Services for Incarcerated Individuals, FY2015

No

Yes

Note: 52 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond. Percentages may not total 100% due to rounding.

Federal funds

State funds

Combination of federal and state funds

ADAP does not provide services to individuals incarcerated in county or city jails

63%

10%0%

27%

ChArT 32 ADAP Medicare Part D, Donut hole Assistance, FY2015

Yes

No

Note: 52 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond. 92%

8%

27

ChArT 35 ADAP Income Eligibility (Full-Pay Medications), as of June 30, 2015

AL

AR GA

ID

IL IN

KY MO

MT

NV

NH

OH

SC

SD

TX

VA

WY

OK

ME

MD

NJ

NY

OR

AK

CO

LA

UT

CA KS

MS

FL

HI

NM AZ

ND MN

IA

WI MI

NE

WA

PA

NC TN

WV

VT

MA

RI

DE

CT

DC

Income eligibility greater than 300% FPL (29 ADAPs)

Income eligibility between 201% FPL and 300% FPL (17 ADAPs)

Income eligibility at 200% FPL or below (5 ADAPs)

Not Reported (8 ADAPs)

American Samoa

Federated States of Micronesia

Guam

Marshall Islands

Note: 51 ADAPs reported data. American Samoa, Federated States of Micronesia, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond. A dash (--) indicates the ADAP did not report data. The 2015 Federal Poverty Level (FPL) was $11,770 (slightly higher in Alaska and Hawaii) for a household of one.

Northern Mariana Islands

Puerto Rico

Republic of Palau

Virgin Islands (U.S.)

ChArT 36 ADAP Income Eligibility (Insurance), as of June 30, 2015

AL

AR GA

ID

IL IN

KY MO

MT

NV

NH

OH

SC

SD

TX

VA

WY

OK

ME

MD

NJ

NY

OR

AK

CO

LA

UT

CA KS

MS

FL

HI

NM AZ

ND MN

IA

WI MI

NE

WA

PA

NC TN

WV

VT

MA

RI

DE

CT

DC

Income eligibility greater than 300% FPL (33 ADAPs)

Income eligibility between 201% FPL and 300% FPL (15 ADAPs)

Income eligibility at 200% FPL or below (3 ADAPs)

Not Reported (8 ADAPs)

American Samoa

Federated States of Micronesia

Guam

Marshall Islands

Note: 51 ADAPs reported data. American Samoa, Federated States of Micronesia, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond. A dash (--) indicates the ADAP did not report data. The 2015 Federal Poverty Level (FPL) was $11,770 (slightly higher in Alaska and Hawaii) for a household of one.

Northern Mariana Islands

Puerto Rico

Republic of Palau

Virgin Islands (U.S.)

KY

KY

tables

2928

table 1 ToTal BudgeT, FY2014 and FY2015

State/TerritoryADAP FY2014 Total Budget

ADAP FY2015 Total Budget

% Change

ADAP Budget (FY2006 – FY2015)

Alabama $19,776,510 $33,580,145 70% Alaska $2,390,836 $1,252,880 -48% American Samoa $1,651 $1,641 -1% Arizona $28,162,067 $22,323,641 -21% Arkansas $5,433,335 $9,421,539 73% California $453,575,244 $396,334,907 -13% Colorado $18,440,295 $26,854,321 46% Connecticut $27,260,304 $25,636,087 -6% Delaware $4,180,084 $7,531,273 80% District of Columbia $9,449,635 $12,946,258 37%

Federated States of Micronesia $0 $0 0% Florida $131,374,926 $172,916,724 32% Georgia $51,358,755 $69,571,721 35% Guam $69,355 $65,659 -5% Hawaii $4,114,682 $4,754,616 16% Idaho $5,371,592 $4,103,812 -24% Illinois $53,939,883 $51,025,197 -5% Indiana $45,773,323 $38,736,256 -15% Iowa $4,830,439 $5,353,017 11% Kansas $22,835,557 $2,514,880 -89% Kentucky $4,830,922 $4,926,866 2% Louisiana $37,362,491 $51,387,340 38% Maine $2,424,065 $2,812,354 16% Marshall Islands $826 $0 -100% Maryland $68,017,127 $74,797,346 10% Massachusetts $24,070,089 $23,735,064 -1% Michigan $41,409,633 $42,591,701 3% Minnesota $10,064,066 $11,195,864 11% Mississippi $7,603,480 $11,564,057 52% Missouri $39,083,769 $43,290,961 11% Montana $1,375,518 $1,331,584 -3% Nebraska $3,470,631 $4,261,893 23% Nevada $11,564,891 $6,135,807 -47% New Hampshire $4,165,194 $3,092,073 -26% New Jersey $93,647,360 $90,426,184 -3% New Mexico $2,303,598 $5,410,727 135% New York $375,444,243 $349,500,000 -7% North Carolina $57,459,630 $56,492,728 -2% North Dakota $1,437,458 $1,127,084 -22% Northern Mariana Islands $9,082 $1,641 -82% Ohio $28,529,871 $25,372,174 -11% Oklahoma $16,013,111 $13,162,698 -18% Oregon $36,315,598 $41,215,004 13% Pennsylvania $95,045,318 $100,200,145 5% Puerto Rico $23,754,044 $37,199,530 57% Republic of Palau $653 $3,283 403% Rhode Island $1,918,436 $8,081,717 321% South Carolina $33,567,631 $34,413,062 3% South Dakota $1,598,316 $2,104,849 32% Tennessee $48,837,811 $53,292,735 9% Texas $120,889,316 $139,554,060 15% Utah $6,360,342 $6,880,135 8%

Vermont $370,720 $1,483,285 300%

Virgin Islands (U.S.) $537,207 $1,494,334 178%

Virginia $49,697,868 $45,943,465 -8%

Washington $38,935,074 $36,870,193 -5%

West Virginia $6,600,315 $7,184,578 9%

Wisconsin $27,812,566 $15,000,181 -46%

Wyoming $1,464,830 $1,425,663 -3%

Total $2,212,331,573 $2,239,886,939 1%

Comparison Total1 $2,178,190,578 $2,192,921,225 1%

1Comparison Totals are based on only those states that reported data for both time periods.

Note: 52 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond. The total FY2015 budget includes federal, state, and drug rebates. Cost recovery funds (see Table 4), with the exception of drug rebates, are not included in the total budget.

30

table 2 total aDap buDgEt, by statE anD by sourCE, Fy2015

State/TerritoryPart B ADAP

Earmark

% of Total

Budget

Part B ADAP

Supple- mental 1

% of Total

Budget

Part B Base Contribution Directed to

ADAP

% of Total

Budget

Part B Supplemental

Directed to ADAP

% of Total

Budget

ADAP Emergency

Funding

% of Total

Budget

Alabama $10,007,209 30% $796,339 2% $7,976,597 24% $0 0% $0 0%Alaska $543,326 43% $0 0% $0 0% $45,852 4% $643,552 51%American Samoa $1,641 100% $0 0% — — — — $0 0%Arizona $10,827,122 49% $0 0% $1,000,000 4% $0 0% $0 0%Arkansas $4,038,832 43% $1,193,875 13% $1,000,000 11% $0 0% $0 0%California $98,618,573 25% $0 0% $0 0% $10,000,000 3% $6,441,447 2%Colorado $9,576,324 36% $0 0% $0 0% $0 0% $0 0%Connecticut $8,886,087 35% $0 0% $0 0% $0 0% $0 0%Delaware $2,631,273 35% $0 0% $0 0% $0 0% $0 0%District of Columbia $12,946,258 100% $0 0% $0 0% $0 0% $0 0%Federated States of Micronesia $0 0% $0 0% $0 0% $0 0% $0 0%Florida $85,677,240 50% $0 0% $3,784,727 2% $4,000,000 2% $8,954,757 5%Georgia $32,093,981 46% $9,486,948 14% $0 0% $6,106,950 9% $10,262,288 15%Guam $65,659 100% $0 0% — — — — $0 0%Hawaii $2,014,081 42% $0 0% $0 0% $0 0% $0 0%Idaho $729,632 18% $215,678 5% $0 0% $0 0% $486,702 12%Illinois $28,691,218 56% $2,669,140 5% $0 0% $0 0% $4,664,839 9%Indiana $7,916,800 20% $2,340,198 6% $1,819,454 5% $0 0% $0 0%Iowa $1,710,410 32% $132,044 2% $0 0% $0 0% $134,158 3%Kansas $2,504,880 100% $0 0% $0 0% $0 0% $0 0%Kentucky $4,926,866 100% $0 0% — — — — $0 0%Louisiana $16,083,103 31% $1,282,605 2% $1,532,132 3% $0 0% $6,625,015 13%Maine $1,016,069 36% $0 0% $246,285 9% $0 0% $0 0%Marshall Islands $0 0% $0 0% — — — — $0 0%Maryland $25,372,991 34% $0 0% $0 0% $0 0% $0 0%Massachusetts $14,171,054 60% $0 0% $0 0% $0 0% $0 0%Michigan $12,591,701 30% $0 0% $0 0% $0 0% $0 0%Minnesota $5,990,537 54% $0 0% $0 0% $451,098 4% $0 0%Mississippi $7,444,057 64% $0 0% $370,000 3% $0 0% $0 0%Missouri $9,866,043 23% $0 0% $0 0% $0 0% $0 0%Montana $363,585 27% $27,917 2% $114,582 9% $0 0% $54,410 4%Nebraska $1,561,036 37% $125,000 3% $50,857 1% $125,000 3% $0 0%Nevada $6,135,807 100% $0 0% — — — — $0 0%New Hampshire $943,844 31% $0 0% $0 0% $0 0% $0 0%New Jersey $30,166,077 33% $0 0% $0 0% $0 0% $5,260,107 6%New Mexico $2,289,027 42% $0 0% $0 0% $0 0% $0 0%New York $107,791,915 31% $0 0% $1,039,594 0.3% $0 0% $0 0%North Carolina $22,508,629 40% $0 0% $0 0% $0 0% $2,691,965 5%North Dakota $177,279 16% $52,404 5% $97,401 9% $0 0% $0 0%Northern Mariana Islands $1,641 100% $0 0% — — — — $0 0%Ohio $15,872,174 63% $0 0% $0 0% $0 0% $0 0%Oklahoma $4,473,000 34% $0 0% $903,698 7% $0 0% $0 0%Oregon $4,588,724 11% $0 0% $0 0% $0 0% $0 0%Pennsylvania $27,514,285 27% $0 0% $100,000 0.1% $0 0% $0 0%Puerto Rico $15,434,723 41% $4,562,488 12% $80,763 0.2% $1,923,247 5% $9,558,425 26%Republic of Palau $3,283 100% $0 0% — — — — $0 0%Rhode Island $1,802,332 22% $0 0% $1,137,973 14% $0 0% $357,275 4%South Carolina $12,754,206 37% $0 0% $0 0% $0 0% $0 0%South Dakota $389,849 19% $0 0% $0 0% $0 0% $0 0%Tennessee $14,127,294 27% $0 0% $0 0% $0 0% $7,423,368 14%Texas $61,591,981 44% $18,206,525 13% $0 0% $0 0% $0 0%Utah $2,110,928 31% $167,772 2% $721,354 10% $204,193 3% $838,539 12%Vermont $372,613 25% $0 0% $0 0% $0 0% $0 0%Virgin Islands (U.S.) $492,440 33% $54,180 4% $0 0% $0 0% $447,714 30%Virginia $17,988,026 39% $0 0% $0 0% $0 0% $10,155,439 22%Washington $9,653,473 26% $0 0% $3,568,711 10% $0 0% $0 0%West Virginia $1,384,578 19% $0 0% $0 0% $0 0% $0 0%Wisconsin $4,518,961 30% $0 0% $0 0% $0 0% $0 0%Wyoming $225,702 16% $0 0% $86,061 6% $0 0% $0 0%

Total $784,180,379 35% $41,313,113 2% $25,630,189 1% $22,856,340 1% $75,000,000 3%

1Part B ADAP supplemental awards were provided to 15 states that met federal eligibility criteria, applied for funding, and were able to meet the mandated matching requirement or receive a waiver.

Note: 52 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond. The total FY2015 budget includes federal, state, and drug rebates. A dash (—) indicates the ADAP did not report data.

31

table 2 total aDap buDgEt, by statE anD by sourCE, Fy2015 (ContInuED)

State/Territory

Part A Contribution Directed to

ADAP

% of Total

BudgetState

Contribution

% of Total

BudgetEstimated

Drug Rebates

% of Total

BudgetOther State or Federal

% of Total

Budget

Total FY2015 Budget

Alabama $0 0% $4,800,000 14% $10,000,000 30% $0 0% $33,580,145Alaska $0 0% $0 0% $20,150 2% $0 0% $1,252,880American Samoa — — — — — — — — $1,641Arizona $0 0% $1,000,000 4% $9,070,000 41% $426,519 2% $22,323,641Arkansas $0 0% $298,469 3% $1,900,500 20% $989,863 11% $9,421,539California $0 0% $18,191,000 5% $263,083,887 66% $0 0% $396,334,907Colorado $0 0% $3,214,455 12% $10,000,000 37% $4,063,542 15% $26,854,321Connecticut $0 0% $0 0% $16,750,000 65% $0 0% $25,636,087Delaware $0 0% $0 0% $4,900,000 65% $0 0% $7,531,273District of Columbia $0 0% $0 0% $0 0% $0 0% $12,946,258Federated States of Micronesia $0 0% $0 0% $0 0% $0 0% $0Florida $0 0% $10,500,000 6% $60,000,000 35% $0 0% $172,916,724Georgia $0 0% $11,555,118 17% $0 0% $66,436 0.1% $69,571,721Guam — — — — — — — — $65,659Hawaii $0 0% $440,535 9% $2,300,000 48% $0 0% $4,754,616Idaho $0 0% $681,800 17% $1,990,000 48% $0 0% $4,103,812Illinois $0 0% $11,000,000 22% $4,000,000 8% $0 0% $51,025,197Indiana $176,400 0.5% $0 0% $26,483,404 68% $0 0% $38,736,256Iowa $0 0% $547,982 10% $2,828,423 53% $0 0% $5,353,017Kansas $0 0% $10,000 0.4% $0 0% $0 0% $2,514,880Kentucky — — — — — — — — $4,926,866Louisiana $864,485 2% $0 0% $25,000,000 49% $0 0% $51,387,340Maine $0 0% $50,000 2% $1,500,000 53% $0 0% $2,812,354Marshall Islands — — — — — — — — $0Maryland $0 0% $0 0% $49,374,355 66% $50,000 0.1% $74,797,346Massachusetts $170,635 1% $1,893,375 8% $7,500,000 32% $0 0% $23,735,064Michigan $0 0% $0 0% $30,000,000 70% $0 0% $42,591,701Minnesota $0 0% $1,063,678 10% $1,742,749 16% $1,947,802 17% $11,195,864Mississippi $0 0% $1,750,000 15% $0 0% $2,000,000 17% $11,564,057Missouri $0 0% $3,566,808 8% $29,858,110 69% $0 0% $43,290,961Montana $0 0% $137,090 10% $634,000 48% $0 0% $1,331,584Nebraska $0 0% $900,000 21% $1,500,000 35% $0 0% $4,261,893Nevada — — — — — — — — $6,135,807New Hampshire $0 0% $0 0% $2,148,229 69% $0 0% $3,092,073New Jersey $0 0% $0 0% $55,000,000 61% $0 0% $90,426,184New Mexico $0 0% $900,000 17% $0 0% $2,221,700 41% $5,410,727New York $8,915,740 3% $28,000,000 8% $187,252,751 54% $16,500,000 5% $349,500,000North Carolina $0 0% $14,336,118 25% $11,866,577 21% $5,089,439 9% $56,492,728North Dakota $0 0% $0 0% $800,000 71% $0 0% $1,127,084Northern Mariana Islands — — — — — — — — $1,641Ohio $0 0% $2,500,000 10% $7,000,000 28% $0 0% $25,372,174Oklahoma $0 0% $786,000 6% $6,000,000 46% $1,000,000 8% $13,162,698Oregon $0 0% $0 0% $6,058,280 15% $30,568,000 74% $41,215,004Pennsylvania $0 0% $10,267,000 10% $62,315,563 62% $3,297 0.003% $100,200,145Puerto Rico $0 0% $1,654,127 4% $3,985,438 11% $319 0.001% $37,199,530Republic of Palau — — — — — — — — $3,283Rhode Island $0 0% $0 0% $4,602,008 57% $182,129 2% $8,081,717South Carolina $0 0% $5,658,856 16% $16,000,000 46% $0 0% $34,413,062South Dakota $0 0% $0 0% $1,715,000 81% $0 0% $2,104,849Tennessee $702,134 1% $7,000,000 13% $15,000,000 28% $9,039,939 17% $53,292,735Texas $153,221 0.1% $35,102,333 25% $24,500,000 18% $0 0% $139,554,060Utah $0 0% $0 0% $2,800,000 41% $37,349 1% $6,880,135Vermont $0 0% $0 0% $750,000 51% $360,672 24% $1,483,285Virgin Islands (U.S.) $0 0% $180,000 12% $320,000 21% $0 0% $1,494,334Virginia $0 0% $2,800,000 6% $15,000,000 33% $0 0% $45,943,465Washington $0 0% $6,611,092 18% $17,036,917 46% $0 0% $36,870,193West Virginia $0 0% $0 0% $5,800,000 81% $0 0% $7,184,578Wisconsin $0 0% $1,306,220 9% $9,175,000 61% $0 0% $15,000,181Wyoming $0 0% $367,500 26% $746,400 52% $0 0% $1,425,663

Total $10,982,615 0.5% $189,069,556 8% $1,016,307,741 45% $74,547,006 3% $2,239,886,939

1Part B ADAP supplemental awards were provided to 15 states that met federal eligibility criteria, applied for funding, and were able to meet the mandated matching requirement or receive a waiver.

Note: 52 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond. The total FY2015 budget includes federal, state, and drug rebates. A dash (—) indicates the ADAP did not report data.

32

table 3 major Fy2015 buDgEt CatEgorIEs ComparED wIth Fy2014

State/Territory

2014 Part B ADAP

Earmark

2015 Part B ADAP

Earmark % Change

2014 Part B ADAP

Supplemental

2015 Part B ADAP

Supplemental 1 % Change

Alabama $10,035,042 $10,007,209 -0.3% $796,339 $796,339 0%Alaska $544,108 $543,326 -0.1% $51,071 $0 -100%American Samoa $1,651 $1,641 -1% $0 $0 0%Arizona $10,822,719 $10,827,122 0.04% $0 $0 0%Arkansas $4,024,255 $4,038,832 0.4% $331,264 $1,193,875 260%California $97,901,516 $98,618,573 1% $9,189,227 $0 -100%Colorado $9,727,071 $9,576,324 -2% $0 $0 0%Connecticut $9,109,479 $8,886,087 -2% $0 $0 0%Delaware $2,680,084 $2,631,273 -2% $0 $0 0%District of Columbia $9,449,635 $12,946,258 37% $0 $0 0%Federated States of Micronesia $0 $0 0% $0 $0 0%Florida $85,493,534 $85,677,240 0.2% $6,681,392 $0 -100%Georgia $31,015,825 $32,093,981 3% $2,911,205 $9,486,948 226%Guam $69,355 $65,659 -5% $0 $0 0%Hawaii $1,974,147 $2,014,081 2% $0 $0 0%Idaho $721,625 $729,632 1% $67,733 $215,678 218%Illinois $28,972,323 $28,691,218 -1% $2,719,398 $2,669,140 -2%Indiana $7,777,694 $7,916,800 2% $730,029 $2,340,198 221%Iowa $1,697,552 $1,710,410 1% $132,044 $132,044 0%Kansas $2,522,384 $2,504,880 -1% $0 $0 0%Kentucky $4,830,922 $4,926,866 2% $0 $0 0%Louisiana $16,057,388 $16,083,103 0.2% $1,282,605 $1,282,605 0%Maine $1,017,210 $1,016,069 -0.1% $0 $0 0%Marshall Islands $826 $0 -100% $0 $0 0%Maryland $25,072,742 $25,372,991 1% $0 $0 0%Massachusetts $14,426,714 $14,171,054 -2% $0 $0 0%Michigan $12,409,633 $12,591,701 1% $0 $0 0%Minnesota $5,979,412 $5,990,537 0.2% $0 $0 0%Mississippi $7,603,480 $7,444,057 -2% $0 $0 0%Missouri $9,872,387 $9,866,043 -0.1% $0 $0 0%Montana $362,464 $363,585 0.3% $27,917 $27,917 0%Nebraska $1,545,631 $1,561,036 1% $125,000 $125,000 0%Nevada $6,118,122 $6,135,807 0.3% $0 $0 0%New Hampshire $965,194 $943,844 -2% $0 $0 0%New Jersey $30,442,819 $30,166,077 -1% $2,449,129 $0 -100%New Mexico $2,299,456 $2,289,027 -0.5% $0 $0 0%New York $111,252,394 $107,791,915 -3% $0 $0 0%North Carolina $22,137,530 $22,508,629 2% $2,077,872 $0 -100%North Dakota $174,214 $177,279 2% $13,856 $52,404 278%Northern Mariana Islands $9,082 $1,641 -82% $0 $0 0%Ohio $15,879,871 $15,872,174 -0.05% $0 $0 0%Oklahoma $4,401,580 $4,473,000 2% $0 $0 0%Oregon $4,645,149 $4,588,724 -1% $0 $0 0%Pennsylvania $28,128,501 $27,514,285 -2% $0 $0 0%Puerto Rico $15,924,457 $15,434,723 -3% $1,304,273 $4,562,488 250%Republic of Palau $653 $3,283 403% $0 $0 0%Rhode Island $1,776,815 $1,802,332 1% $141,621 $0 -100%South Carolina $12,876,129 $12,754,206 -1% $1,032,646 $0 -100%South Dakota $396,316 $389,849 -2% $0 $0 0%Tennessee $14,034,527 $14,127,294 1% $1,317,307 $0 -100%Texas $59,979,065 $61,591,981 3% $5,629,751 $18,206,525 223%Utah $2,104,601 $2,110,928 0.3% $167,772 $167,772 0%Vermont $370,720 $372,613 1% $0 $0 0%Virgin Islands (U.S.) $497,046 $492,440 -1% $40,161 $54,180 35%Virginia $17,906,035 $17,988,026 0.5% $1,680,695 $0 -100%Washington $9,721,292 $9,653,473 -1% $0 $0 0%West Virginia $1,400,315 $1,384,578 -1% $0 $0 0%Wisconsin $4,579,097 $4,518,961 -1% $429,803 $0 -100%Wyoming $236,138 $225,702 -4% $22,165 $0 -100%

Total $781,975,926 $784,180,379 0.3% $41,352,275 $41,313,113 -0.1%

1Part B ADAP Supplemental awards were provided to states that met federal eligibility criteria, applied for funding, and were able to meet the mandated matching requirement or receive a waiver.

Note: 52 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond. This table does not include the “Other State or Federal” category ($68,171,727), which is reported in the total budget in Tables 1 and 2. A dash (—) indicates the ADAP did not report data.

33

table 3 major Fy2015 buDgEt CatEgorIEs ComparED wIth Fy2014 (ContInuED)

State/Territory

2014 Part B Base Contribution

Directed to ADAP

2015 Part B Base Contribution

Directed to ADAP % Change

2014 Part B Supplemental

Directed to ADAP

2015 Part B Supplemental


Alabama $0 $7,976,597 100% $0 $0 0%Alaska $0 $0 0% $8,871 $45,852 417%American Samoa — — — — — —Arizona $0 $1,000,000 100% $0 $0 0%Arkansas $0 $1,000,000 100% $0 $0 0%California $1,500,000 $0 -100% $0 $10,000,000 100%Colorado $0 $0 0% $0 $0 0%Connecticut $0 $0 0% $33,713 $0 -100%Delaware $0 $0 0% $0 $0 0%District of Columbia $0 $0 0% $0 $0 0%Federated States of Micronesia — $0 — — $0 —Florida $2,700,000 $3,784,727 40% $7,615,616 $4,000,000 -47%Georgia $0 $0 0% $0 $6,106,950 100%Guam — — — — — —Hawaii $0 $0 0% $0 $0 0%Idaho $0 $0 0% $0 $0 0%Illinois $0 $0 0% $0 $0 0%Indiana $2,070,600 $1,819,454 -12% $0 $0 0%Iowa $0 $0 0% $28,913 $0 -100%Kansas $0 $0 0% $0 $0 0%Kentucky — — — — — —Louisiana $1,832,193 $1,532,132 -16% $1,459,800 $0 -100%Maine $108,743 $246,285 126% $0 $0 0%Marshall Islands — — — — — —Maryland $0 $0 0% $0 $0 0%Massachusetts $0 $0 0% $0 $0 0%Michigan $0 $0 0% $0 $0 0%Minnesota $20,383 $0 -100% $64,271 $451,098 602%Mississippi — $370,000 — — $0 —Missouri $0 $0 0% $0 $0 0%Montana $114,500 $114,582 0.1% $0 $0 0%Nebraska $0 $50,857 100% $0 $125,000 100%Nevada $1,713,241 — — $0 — —New Hampshire $0 $0 0% $0 $0 0%New Jersey $0 $0 0% $997,282 $0 -100%New Mexico $0 $0 0% $0 $0 0%New York $1,055,757 $1,039,594 -2% $12,179,085 $0 -100%North Carolina $0 $0 0% $1,747,084 $0 -100%North Dakota $49,388 $97,401 97% $0 $0 0%Northern Mariana Islands — — — — — —Ohio $0 $0 0% $0 $0 0%Oklahoma $825,531 $903,698 9% $0 $0 0%Oregon $0 $0 0% $0 $0 0%Pennsylvania $416,817 $100,000 -76% $0 $0 0%Puerto Rico $460,857 $80,763 -82% $1,923,247 $1,923,247 0%Republic of Palau — — — — — —Rhode Island — $1,137,973 — — $0 —South Carolina $0 $0 0% $0 $0 0%South Dakota $22,000 $0 -100% $0 $0 0%Tennessee $5,283,858 $0 -100% $1,268,395 $0 -100%Texas $0 $0 0% $0 $0 0%Utah $779,556 $721,354 -7% $37,904 $204,193 439%Vermont — $0 — — $0 —Virgin Islands (U.S.) — $0 — — $0 —Virginia $2,969,329 $0 -100% $323,524 $0 -100%Washington $0 $3,568,711 100% $0 $0 0%West Virginia $0 $0 0% $0 $0 0%Wisconsin $425,000 $0 -100% $0 $0 0%Wyoming $275,484 $86,061 -69% $0 $0 0%

Total $22,623,237 $25,630,189 13% $27,687,705 $22,856,340 -17%


34


State/Territory2014 ADAP

Emergency Funding2015 ADAP

Emergency Funding % Change

2014 Part A Contribution

Directed to ADAP

2015 Part A Contribution


Alabama $3,638,484 $0 -100% $0 $0 0%Alaska $686,786 $643,552 -6% $0 $0 0%American Samoa $0 $0 0% — — —Arizona $792,146 $0 -100% $0 $0 0%Arkansas $0 $0 0% $0 $0 0%California $11,000,000 $6,441,447 -41% $0 $0 0%Colorado $0 $0 0% $0 $0 0%Connecticut $0 $0 0% $0 $0 0%Delaware $0 $0 0% $0 $0 0%District of Columbia $0 $0 0% $0 $0 0%Federated States of Micronesia $0 $0 0% — $0 —Florida $11,000,000 $8,954,757 -19% $378,903 $0 -100%Georgia $2,541,600 $10,262,288 304% $2,027,000 $0 -100%Guam $0 $0 0% — — —Hawaii $0 $0 0% $0 $0 0%Idaho $770,295 $486,702 -37% $0 $0 0%Illinois $5,411,162 $4,664,839 -14% $0 $0 0%Indiana $0 $0 0% $195,000 $176,400 -10%Iowa $923,948 $134,158 -85% $0 $0 0%Kansas $0 $0 0% $0 $0 0%Kentucky $0 $0 0% — — —Louisiana $3,034,961 $6,625,015 118% $5,500 $864,485 15618%Maine $0 $0 0% $0 $0 0%Marshall Islands $0 $0 0% — — —Maryland $0 $0 0% $0 $0 0%Massachusetts $0 $0 0% $250,000 $170,635 -32%Michigan $0 $0 0% $0 $0 0%Minnesota $0 $0 0% $0 $0 0%Mississippi $0 $0 0% — $0 —Missouri $0 $0 0% $0 $0 0%Montana $232,287 $54,410 -77% $0 $0 0%Nebraska $0 $0 0% $0 $0 0%Nevada $0 $0 0% $0 — —New Hampshire $0 $0 0% $0 $0 0%New Jersey $5,758,130 $5,260,107 -9% $0 $0 0%New Mexico $0 $0 0% $0 $0 0%New York $0 $0 0% $8,796,739 $8,915,740 1%North Carolina $3,000,000 $2,691,965 -10% $0 $0 0%North Dakota $0 $0 0% $0 $0 0%Northern Mariana Islands $0 $0 0% — — —Ohio $0 $0 0% $0 $0 0%Oklahoma $0 $0 0% $0 $0 0%Oregon $0 $0 0% — $0 —Pennsylvania $0 $0 0% $0 $0 0%Puerto Rico $3,596,177 $9,558,425 166% $0 $0 0%Republic of Palau $0 $0 0% — — —Rhode Island $0 $357,275 100% — $0 —South Carolina $0 $0 0% $0 $0 0%South Dakota $0 $0 0% $0 $0 0%Tennessee $7,485,930 $7,423,368 -1% $747,794 $702,134 -6%Texas $0 $0 0% $152,221 $153,221 1%Utah $1,327,143 $838,539 -37% $0 $0 0%Vermont $0 $0 0% — $0 —Virgin Islands (U.S.) $0 $447,714 100% — $0 —Virginia $11,000,000 $10,155,439 -8% $116,644 $0 -100%Washington $0 $0 0% $0 $0 0%West Virginia $0 $0 0% $0 $0 0%Wisconsin $412,461 $0 -100% $0 $0 0%Wyoming $0 $0 0% $0 $0 0%

Total $72,611,510 $75,000,000 3% $12,669,801 $10,982,615 -13%


35


State/Territory

2014 State

Contribution2015 State

Contribution % Change2014 Estimated

Drug Rebates2015 Estimated

Drug Rebates % Change

Alabama $4,306,645 $4,800,000 11% $1,000,000 $10,000,000 900%Alaska $0 $0 0% $20,150 $20,150 0%American Samoa — — — — — —Arizona $1,000,000 $1,000,000 0% $15,547,202 $9,070,000 -42%Arkansas $82,816 $298,469 260% $995,000 $1,900,500 91%California $5,183,000 $18,191,000 251% $277,771,089 $263,083,887 -5%Colorado $4,513,224 $3,214,455 -29% $4,200,000 $10,000,000 138%Connecticut $0 $0 0% $18,117,112 $16,750,000 -8%Delaware $0 $0 0% $1,500,000 $4,900,000 227%District of Columbia $0 $0 0% $0 $0 0%Federated States of Micronesia — $0 — — $0 —Florida $10,500,000 $10,500,000 0% $15,000,000 $60,000,000 300%Georgia $11,587,504 $11,555,118 -0.3% $1,257,439 $0 -100%Guam — — — — — —Hawaii $440,535 $440,535 0% $1,700,000 $2,300,000 35%Idaho $701,800 $681,800 -3% $3,110,139 $1,990,000 -36%Illinois $14,850,000 $11,000,000 -26% $1,987,000 $4,000,000 101%Indiana $0 $0 0% $35,000,000 $26,483,404 -24%Iowa $547,982 $547,982 0% $1,500,000 $2,828,423 89%Kansas $10,829,714 $10,000 -99.9% $9,483,459 $0 -100%Kentucky — — — — — —Louisiana $0 $0 0% $13,690,044 $25,000,000 83%Maine $50,000 $50,000 0% $1,447,158 $1,500,000 4%Marshall Islands — — — — — —Maryland $0 $0 0% $42,930,000 $49,374,355 15%Massachusetts $1,893,375 $1,893,375 0% $7,500,000 $7,500,000 0%Michigan $0 $0 0% $29,000,000 $30,000,000 3%Minnesota $0 $1,063,678 100% $4,000,000 $1,742,749 -56%Mississippi — $1,750,000 — — $0 —Missouri $3,290,796 $3,566,808 8% $25,692,980 $29,858,110 16%Montana $200,000 $137,090 -31% $400,000 $634,000 59%Nebraska $900,000 $900,000 0% $900,000 $1,500,000 67%Nevada $625,278 — — $3,108,250 — —New Hampshire $0 $0 0% $3,200,000 $2,148,229 -33%New Jersey $0 $0 0% $54,000,000 $55,000,000 2%New Mexico $0 $900,000 100% $0 $0 0%New York $28,750,000 $28,000,000 -3% $195,910,268 $187,252,751 -4%North Carolina $14,797,144 $14,336,118 -3% $10,000,000 $11,866,577 19%North Dakota $0 $0 0% $1,200,000 $800,000 -33%Northern Mariana Islands — — — — — —Ohio $650,000 $2,500,000 285% $8,000,000 $7,000,000 -13%Oklahoma $786,000 $786,000 0% $6,000,000 $6,000,000 0%Oregon $123,724 $0 -100% $4,667,629 $6,058,280 30%Pennsylvania $6,000,000 $10,267,000 71% $60,500,000 $62,315,563 3%Puerto Rico $1,365,388 $1,654,127 21% $1,876,990 $3,985,438 112%Republic of Palau — — — — — —Rhode Island — $0 — — $4,602,008 —South Carolina $5,658,856 $5,658,856 0% $14,000,000 $16,000,000 14%South Dakota $0 $0 0% $1,180,000 $1,715,000 45%Tennessee $7,200,000 $7,000,000 -3% $11,500,000 $15,000,000 30%Texas $32,010,159 $35,102,333 10% $22,800,000 $24,500,000 7%Utah $0 $0 0% $1,500,000 $2,800,000 87%Vermont — $0 — — $750,000 —Virgin Islands (U.S.) — $180,000 — — $320,000 —Virginia $5,681,266 $2,800,000 -51% $10,020,375 $15,000,000 50%Washington $4,905,231 $6,611,092 35% $16,148,254 $17,036,917 6%West Virginia $0 $0 0% $5,200,000 $5,800,000 12%Wisconsin $6,345,520 $1,306,220 -79% $15,620,685 $9,175,000 -41%Wyoming $367,500 $367,500 0% $549,427 $746,400 36%

Total $186,143,457 $189,069,556 2% $960,730,650 $1,016,307,741 6%


36

table 4 Cost rECovEry anD othEr Cost-savIng mEChanIsms (ExCluDIng Drug rEbatEs), Fy2014

State/Territory Private Insurance Medicaid Other Total

Alabama $151,860 $0 $0 $151,860

Alaska $1,276,729 $0 $0 $1,276,729American Samoa — — — —Arizona $13,526 $7,263 $0 $20,789Arkansas $0 $2,500 $0 $2,500California $0 $1,260,051 $0 $1,260,051Colorado $12,500 $0 $0 $12,500Connecticut $3,770,460 $0 $0 $3,770,460Delaware $0 $0 $0 $0District of Columbia $0 $0 $0 $0Federated States of Micronesia $0 $0 $0 $0Florida $65,000 $0 $0 $65,000Georgia $0 $0 $0 $0Guam — — — —Hawaii $0 $0 $0 $0Idaho $0 $0 $0 $0Illinois $4,000,000 $100,000 $0 $4,100,000Indiana $0 $0 $0 $0Iowa $69,528 $122,895 $68,605 $261,028Kansas $0 $0 $0 $0Kentucky — — — —Louisiana $0 $0 $0 $0Maine $0 $5,000 $0 $5,000Marshall Islands — — — —Maryland $102,000 $0 $0 $102,000Massachusetts $0 $0 $0 $0Michigan $13,000 $400,000 $0 $413,000Minnesota $0 $0 $0 $0Mississippi $0 $0 $2,000,000 $5,000,000Missouri $1,500,000 $750,000 $750,000 $3,000,000Montana $14,730 $0 $0 $14,730Nebraska $80,000 $20,000 $0 $100,000Nevada — — — —New Hampshire $0 $0 $0 $0New Jersey $0 $0 $0 $0New Mexico $0 $0 $0 $0New York $14,500,000 $2,000,000 $0 $16,500,000North Carolina — — — —North Dakota $0 $0 $0 $0Northern Mariana Islands — — — —Ohio $0 $0 $0 $0Oklahoma $88,000 $70,000 $0 $158,000Oregon $30,568,000 $0 $0 $30,568,000Pennsylvania $8,074,109 $0 $0 $8,074,109Puerto Rico $0 $20,000,000 $3,804,981 $23,804,981Republic of Palau — — — —Rhode Island $0 $1,018,917 $0 $1,018,917South Carolina $14,182,444 $0 $4,431,418 $18,613,862South Dakota $0 $0 $0 $0Tennessee $0 $0 $0 $0Texas $0 $0 $0 $0Utah $0 $0 $0 $0Vermont $0 $0 $0 $0Virgin Islands (U.S.) $0 $0 $0 $0Virginia $20,925 $44,064 $0 $64,989Washington $100,594 $0 $4,606 $105,200West Virginia $18,000 $12,250 $0 $30,250Wisconsin $50,157 $1,317,369 $0 $1,367,526Wyoming $0 $0 $0 $0

Totals $78,671,562 $27,130,309 $11,059,610 $119,861,481

Total # of ADAPs 22 16 6 28

Note: 51 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, North Carolina, Northern Mariana Islands and Republic of Palau did not respond. A zero ($0) indicates the ADAP responded zero ($0) to the question.

37

table 5 total ClIEnts EnrollED/sErvED anD program ExpEnDIturEs, Fy2014

State/Territory

FY2014 Clients

Enrolled2

FY2014 New

Clients Enrolled

FY2014 Clients Served3 FY2014 ADAP Expenditures

Full-Pay Medications

Only

ADAP- Funded

Insurance Program Only4

Full-Pay Medications and

ADAP-Funded Insurance Program5 Prescription Drugs

Prescription Dispensing

CostsInsurance Premiums

Alabama 1,893 823 1,803 90 0 $16,912,845 $283,669 $0Alaska 143 34 37 81 20 $950,604 $81,441 $490,495American Samoa — — — — — — — —Arizona 2,385 508 924 1,392 13 $1,890,737 $237,653 848,619Arkansas 586 35 319 122 0 $3,755,885 $77,673 $0California 37,011 3,825 15,183 17,894 0 $338,806,065 $1,477,137 $17,107,880Colorado 4,654 664 840 3,192 165 $3,427,426 $574,428 $8,693,402Connecticut 2,432 253 2,216 216 0 $22,634,915 $68,509 $835,277Delaware 108 21 62 46 0 $775,497 $23,545 $132,185District of Columbia 1,399 302 878 339 0 $10,303,701 $180,651 $1,187,275Federated States of Micronesia 10 10 10 0 0 $0 $0 $0Florida 22,988 3,704 16,629 2,762 2,187 $109,720,335 $0 $8,077,816Georgia 9,563 1,820 8,835 499 16 $50,793,483 $1,930,995 $2,019,735Guam — — — — — — — —Hawaii 432 86 156 137 81 $350,760 $31,590 $183,344Idaho 248 42 239 0 0 $5,007,517 $0 $0Illinois 11,988 1,595 3,849 4,814 1,468 $30,376,119 $1,084,432 $4,954,236Indiana 3,117 497 1,244 350 1,523 $12,379,108 $99,404 $14,635,126Iowa 469 71 94 278 97 $213,426 $228,177 $526,507Kansas 1,582 106 148 874 214 $3,068,623 $9,285 $1,214,275Kentucky — — — — — — — —Louisiana 7,507 4,093 — — — $991,848 $88,273 $1,302,890Maine 958 93 23 606 72 $762,142 $1,965 503,711Marshall Islands — — — — — — — —Maryland 7,691 1,097 1,818 2,530 2,113 $38,613,916 $542,378 $0Massachusetts 8,273 698 238 6,107 4 $5,438,152 $2,992 $6,500,122Michigan 5,087 165 1,610 2,541 0 $9,764,523 $95,000 $1,665,763Minnesota 1,656 260 206 1,450 0 $4,026,500 $0 $2,282,987Mississippi 2,207 517 2,038 0 0 $8,241,183 $0 $0Missouri 4,625 580 642 961 2,143 $20,711,123 $60,231 $6,658,772Montana 302 60 59 210 0 $69,471 $537 $0Nebraska 731 115 229 197 124 $2,335,363 $9,047 $649,784Nevada — — — — — — — —New Hampshire 615 41 111 97 279 $2,291,498 $8,911 $488,294New Jersey 7,614 2,100 3,147 1,480 0 $85,470,544 $692,619 $5,333,562New Mexico 592 41 48 507 21 $743,222 $0 $1,664,496New York 26,036 2,589 0 0 23,674 $323,994,739 $2,468,088 $33,218,791North Carolina 8,723 1,518 6,596 1,219 284 $43,348,487 $2,488,074 $0North Dakota 177 55 23 37 102 $698,908 $12,832 $15,607Northern Mariana Islands — — — — — — — —Ohio 6,729 911 1,462 2,395 1,143 $8,253,774 $304,720 $3,877,713Oklahoma 1,830 312 146 1,231 369 $1,156,992 $234,407 $3,524,428Oregon 3,731 327 5 3,563 163 $12,386,177 $2,205,361 $3,068,825Pennsylvania 8,830 2,957 4,355 1,467 2,314 $98,420,112 $580,712 $255,389Puerto Rico 8,412 1,020 7,777 635 0 $56,656,941 $35,007 $0Republic of Palau — — — — — — — —Rhode Island 904 85 225 546 22 $3,161,918 $18,251 $86,657South Carolina 6,013 900 2,825 1,648 1,083 $22,365,424 $853,383 $1,493,382South Dakota 204 46 204 0 0 $1,245,374 $0 $401,694Tennessee 7,294 2,682 3,314 3,980 0 $15,138,786 $459,708 $12,895,039Texas 21,050 3,250 17,343 2,155 226 $104,025,674 $0 $488,986Utah 773 161 338 190 214 $3,887,508 $137,459 $765,460Vermont 349 38 4 345 0 — — —Virgin Islands (U.S.) 181 21 120 51 2 $1,329,432 $41,184 $0Virginia 6,492 1,111 1,713 1,900 2,338 $4,167,534 $318,504 $5,855,770Washington 3,905 356 231 710 2,964 $7,689,976 $294,053 $8,020,305West Virginia 498 74 99 249 141 $3,102,589 $62,428 $128,234Wisconsin 1,459 183 638 821 0 $11,013,411 $0 $1,924,715Wyoming 149 14 0 126 0 $1,587,962 $13,675 $79,066

Total 262,605 42,866 111,053 73,040 45,579 $1,514,458,249 $18,418,388 $164,056,614

1 This table represents ADAP program expenditures in FY2014 (April 1, 2014–March 31, 2015). Only expenditure categories requested in the National ADAP Monitoring Survey are represented in this table.2 For some states, enrolled clients reported may be a snapshot in time rather than a cumulative unduplicated client count. In this instance, some ADAPs may report a higher number of clients served throughout the fiscal year compared to the number of clients enrolled in the program at the end of the fiscal year.3 For the purposes of this report, ADAP clients are considered to be enrolled in either the full-pay medication program or the insurance program. Full-pay medication program clients are defined as those individuals who receive medications paid in full by ADAP with no coordination of insurance or benefits. Insurance program clients are defined as those who have additional coverage (i.e., insurance, Medicare) that ADAP is assisting through paying premiums, deductibles, or co-payments/co-insurance.4 Individuals who had an insurance (i.e., Medicare Part D, Medicaid, private insurance) payment (premium, co-payment/co-insurance, and/or deductible) paid on their behalf using ADAP funds, either fully or in part.5 This includes clients who enrolled in an insurance plan mid-year and those who were enrolled in an insurance plan that did not cover one or more medically necessary medications such that the ADAP’s full-pay prescription program did instead.

Note: 52 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond, but their federal ADAP earmark and ADAP supplemental awards were known and incorporated. A dash (—) indicates the ADAP did not report data.

38

table 5 total ClIEnts EnrollED/sErvED anD program ExpEnDIturEs, Fy2014 (ContInuED)

State/Territory

FY2014 ADAP Expenditures (continued)

Insurance Co-payments and

DeductiblesClient

OutreachAdherence and

Monitoring6

Quality Management

Program Administration Other7

Total Expenditures

Alabama $420,328 $68,661 $68,661 $311,816 $962,783 $0 $19,028,763Alaska $216,637 $0 $54,411 $7,609 $73,312 $0 $1,874,509American Samoa — — — — — — —Arizona $3,026,371 $0 $73,799 $47,186 $623,405 $0 $6,747,770Arkansas $390,445 $0 $0 $0 $131,514 $0 $4,355,517California $33,695,780 $0 $0 $0 $4,127,339 $5,780,108 $400,994,309Colorado $4,582,260 $0 $171,987 $0 $1,415,063 $431,915 $19,296,481Connecticut $1,246,652 $0 $473,283 $285,430 $197,331 $0 $25,741,397Delaware $0 $0 $0 $90,331 $338,675 $0 $1,360,233District of Columbia $362,249 $179,936 $144,461 $0 $2,825,945 $0 $15,184,218Federated States of Micronesia $0 $0 $0 $0 $0 $0 $0Florida $8,808,141 $0 $750,000 $0 $3,783,189 $0 $131,139,481Georgia $1,972,672 $0 $0 $0 $914,110 $0 $57,630,995Guam — — — — — — —Hawaii $498,953 $0 $0 $0 $59,193 $0 $1,123,840Idaho $0 $0 $0 $0 $0 $0 $5,007,517Illinois $3,760,740 $0 $2,950,000 $96,445 $1,435,929 $148,613 $44,806,514Indiana $2,909,996 $0 $0 $100 $1,017,292 $0 $31,041,026Iowa $0 $0 $0 $0 $184,761 $0 $1,152,871Kansas $4,831,746 $0 $0 $0 $0 $0 $9,123,929Kentucky — — — — — — —Louisiana $693,663 $0 $0 $0 $307,667 $0 $3,384,341Maine $552,736 $0 $0 $31,707 $180,992 $8,262 $2,041,515Marshall Islands — — — — — — —Maryland $8,244,421 $378,331 $1,151,178 $773,852 $2,408,862 $0 $52,112,938Massachusetts $0 $0 $489,577 $345,695 $243,748 $0 $13,020,286Michigan $2,459,140 $0 $50,000 $32,291 $680,830 $0 $14,747,547Minnesota $0 $0 $34,058 $224,078 $251,009 $0 $6,818,632Mississippi $0 $0 $0 $0 $0 $0 $8,241,183Missouri $9,834,573 $0 $0 $0 $0 $0 $37,264,699Montana $28,772 $0 $0 $1,875 $6,412 $0 $107,067Nebraska $1,147,399 $0 $0 $0 $131,180 $0 $4,272,773Nevada — — — — — — —New Hampshire $558,454 $0 $0 $59,908 $85,721 $97,754 $3,590,540New Jersey $6,843,079 $0 $0 $0 $975,263 $0 $99,315,067New Mexico $0 $0 $0 $135,912 $138,062 $0 $2,681,692New York $0 $520,000 $1,144,131 $680,000 $2,800,000 $0 $364,825,749North Carolina $3,340,372 $0 $0 $0 $416,188 $0 $49,593,121North Dakota $173,831 $0 $0 $33,273 $101,248 $0 $1,035,699Northern Mariana Islands — — — — — — —Ohio $3,146,328 $0 $0 $0 $792,030 $0 $16,374,565Oklahoma $1,918,590 $0 $145,076 $114,645 $341,558 $140,196 $7,575,892Oregon $2,292,263 $214,678 $0 $46,750 $2,137,894 $1,253,647 $23,605,595Pennsylvania $7,041,818 $0 $0 $0 $1,424,972 $0 $107,723,003Puerto Rico $2,552,168 $0 $344,256 $110,065 $893,709 $0 $60,592,146Republic of Palau — — — — — — —Rhode Island $2,889,158 $0 $0 $0 $176,080 $0 $6,332,064South Carolina $5,068,788 $0 $0 $0 $147,830 $0 $29,928,807South Dakota $1,706,696 $0 $0 $0 $0 $0 $3,353,764Tennessee $6,055,734 $0 $0 $0 $144,160 $0 $34,693,427Texas $7,994,497 $0 $0 $0 $1,046,687 $0 $113,555,844Utah $1,277,940 $0 $0 $69,679 $423,392 $0 $6,561,438Vermont — — — — — — —Virgin Islands (U.S.) $0 $0 $0 $0 $0 $0 $1,370,616Virginia $12,830,356 $0 $0 $43,343 $1,308,073 $0 $24,523,580Washington $394,131 $0 $0 $130,700 $1,767,477 $0 $18,296,642West Virginia $661,779 $0 $0 $6,000 $0 $0 $3,961,030Wisconsin $0 $48,018 $0 $44,076 $162,147 $0 $13,192,367Wyoming $0 $0 $0 $0 $0 $0 $1,680,703

Total $156,429,656 $1,409,624 $8,044,878 $3,722,766 $37,583,032 $7,860,495 $1,911,983,702

6 This category may include HIV disease monitoring laboratory assays paid with ADAP funds as authorized under the HRSA flexibility policy.7 “Other” includes, but is not limited to, contract services to dispense medications, determine eligibility, and manage enrollment; pharmacy charges, dispensing and shipping fees, central pharmacy fees; as well as medical, dental, lab, and nutritional services. Federal ADAP funds may not be used to pay for medical, dental, lab, and nutritional services.

Note: 52 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond, but their federal ADAP earmark and ADAP supplemental awards were known and incorporated. A dash (—) indicates the ADAP did not report data.

39

table 6 total ClIEnts EnrollED anD sErvED, junE 2014 anD junE 2015

State/Territory

June 2014 Clients

Enrolled

June 2015 Clients

Enrolled%

Change

June 2014 Clients Served

June 2015 Clients Served1

% Change

Full-Pay Medications

Only

ADAP-Funded Insurance

Only2

Full-Pay Med-ications and

ADAP-Funded Insurance3

Total Clients Served

Alabama 1,893 1,893 0% 1,893 1,803 90 0 1,893 0%Alaska 100 117 17% 95 22 64 20 106 12%American Samoa — — — — — — — — —Arizona 1,592 1,354 -15% 1,244 459 883 12 1,354 9%Arkansas 783 625 -20% 783 349 128 0 477 -39%California 31,164 25,945 -17% 20,392 8,289 8,768 0 17,057 -16%Colorado 2,976 3,288 10% 1,763 223 1,588 2 1,813 3%Connecticut 1,939 1,879 -3% 1,433 — — — — —Delaware 141 150 6% 119 62 64 0 126 6%District of Columbia 1,622 1,436 -11% 944 574 230 804 -15%Federated States of Micronesia — 0 — — 0 0 0 0 —Florida 17,308 16,147 -7% 13,187 10,479 3,255 5 13,739 4%Georgia 7,879 7,482 -5% 5,902 5,180 106 8 5,294 -10%Guam — — — — — — — — —Hawaii 302 310 3% 226 61 180 2 243 8%Idaho 212 165 -22% 137 165 0 0 165 20%Illinois 6,959 7,803 12% 5,003 2,324 2,365 37 4,726 -6%Indiana 2,566 3,031 18% 2,566 421 2,270 340 3,031 18%Iowa 293 305 4% 253 53 215 1 269 6%Kansas 1,279 1,306 2% 689 89 713 2 804 17%Kentucky — — — — — — — — —Louisiana 5,555 5,731 3% 2,811 1,093 3,370 56 4,519 61%Maine 807 875 8% 386 24 336 6 366 -5%Marshall Islands — — — — — — — — —Maryland 6,045 5,795 -4% 3,374 783 2,719 402 3,904 16%Massachusetts 6,232 6,296 1% 3,703 99 3,145 1 3,245 -12%Michigan 4,626 2,814 -39% 2,419 289 1,509 0 1,798 -26%Minnesota 998 1,074 8% 533 55 582 0 637 20%Mississippi — 1,605 — — 1,386 0 0 1,386 —Missouri 3,255 3,747 15% 2,497 549 2,143 169 2,861 15%Montana1 240 273 14% 119 17 87 0 104 -13%Nebraska 621 672 8% 387 135 343 0 478 24%Nevada 1,150 — — 671 — — — — —New Hampshire 467 349 -25% 285 114 88 56 258 -9%New Jersey 5,858 5,421 -7% 3,749 — — — — —New Mexico 406 390 -4% 406 6 303 1 310 -24%New York 21,151 20,489 -3% 17,114 6,671 9,976 0 16,647 -3%North Carolina 6,910 7,035 2% 5,033 4,184 839 1 5,024 -0.2%North Dakota 153 169 10% 82 22 68 8 98 20%Northern Mariana Islands — — — — — — — — —Ohio 5,159 4,576 -11% 1,928 481 1,363 62 1,906 -1%Oklahoma 1,373 1,543 12% 1,143 142 1,087 38 1,267 11%Oregon 3,034 3,117 3% 2,785 21 1,713 24 1,758 -37%Pennsylvania 6,464 6,212 -4% 5,085 1,488 2,426 831 4,745 -7%Puerto Rico 6,947 5,668 -18% 6,947 5,444 224 0 5,668 -18%Republic of Palau — — — — — — — — —Rhode Island — 615 — — 91 275 3 369 —South Carolina 4,854 4,902 1% 3,488 1,599 2,264 50 3,913 12%South Dakota 231 220 -5% 165 204 0 0 204 24%Tennessee 4,917 4,235 -14% 4,917 1,009 3,226 0 4,235 -14%Texas 18,069 17,997 -0.4% 12,213 10,086 1,928 2 12,016 -2%Utah 550 684 24% 458 209 383 0 592 29%Vermont — 360 — — 4 338 0 342 —Virgin Islands (U.S.) — 149 — — 39 21 0 60 —Virginia 5,192 5,801 12% 4,115 984 3,792 198 4,974 21%Washington 3,111 3,248 4% 3,114 134 1,751 1,363 3,248 4%West Virginia 408 499 22% 274 59 222 11 292 7%Wisconsin 1,001 1,164 16% 669 284 412 0 696 4%Wyoming 157 156 -1% — 0 119 0 119 —

Total 204,949 197,117 147,499 68,258 67,971 3,711 139,940

Comparison Total1 200,244 191,949 -4% 144,468 136,823 -5%

1 For the purposes of this report, ADAP clients are considered to be enrolled in either the full-pay medication program or the insurance program. Full-pay medication program clients are defined as those individuals who receive medications paid in full by ADAP with no coordination of insurance or benefits. Insurance program clients are defined as those who have additional coverage (i.e., insurance, Medicare) that ADAP is assisting through paying premiums, deductibles, or co-payments/co-insurance.2 Individuals who had an insurance (i.e., Medicare Part D, Medicaid, private insurance) payment (premium, co-payment/co-insurance, and/or deductible) paid on their behalf using ADAP funds, either fully or in part.3 This includes clients who enrolled in an insurance plan mid-year and those who were enrolled in an insurance plan that did not cover one or more medically necessary medications such that the ADAP’s full-pay prescription program did instead.

Note: 51 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, New Jersey, Northern Mariana Islands and Republic of Palau did not respond.

40

table 7 aDap ClIEnts sErvED by othEr payErs, junE 2015

State/TerritoryJune 2015

Clients Served Medicaid

Medicaid and

Medicare

Medicare Part D Full Subsidy1

Medicare Part D Partial

Subsidy

Medicare Part D

Standard Benefit


No Form of Insurance Unknown

Alabama 1,893 0 0 0 0 90 0 1,803 0Alaska 106 0 0 0 11 1 72 22 0American Samoa — — — — — — — — —Arizona 1,354 21 2 39 66 287 480 457 2Arkansas 477 0 0 0 128 0 0 349 0California 17,057 186 1,401 1,193 53 1,204 4,731 8,289 0Colorado 1,813 578 0 5 34 385 588 223 0Connecticut — — — — — — — — —Delaware 126 0 0 0 0 0 64 62 0District of Columbia 804 0 6 0 0 0 224 574 0Federated States of Micronesia 0 0 0 0 0 0 0 0Florida 13,739 11 0 97 180 1,062 1,910 10,479 0Georgia 5,294 32 0 0 0 66 265 4,911 20Guam — — — — — — — — —Hawaii 243 0 0 6 3 52 121 61 0Idaho 165 0 0 0 0 0 0 165 0Illinois 4,726 176 0 47 66 377 1,851 2,209 0Indiana 3,031 0 0 0 0 0 2,610 421 0Iowa 269 1 24 0 2 36 153 53 0Kansas 804 57 12 0 0 95 551 89 0Kentucky — — — — — — — — —Louisiana 4,519 16 5 304 70 204 2,861 1,059 0Maine 366 192 15 0 0 20 115 24 0Marshall Islands — — — — — — — — —Maryland 3,904 0 36 383 70 1,665 967 783 0Massachusetts 3,245 1,489 645 152 36 188 636 99 0Michigan 1,798 0 0 233 97 430 749 289 0Minnesota 637 0 0 0 0 19 563 55 0Mississippi 1,386 0 0 0 0 0 0 0 1,386Missouri 2,861 139 543 63 14 76 1,477 549 0Montana 104 0 8 21 9 14 35 17 0Nebraska 478 2 0 7 4 36 294 135 0Nevada — — — — — — — — —New Hampshire 258 7 35 0 31 30 125 30 0New Jersey — — — — — — — — —New Mexico 310 0 0 16 18 70 123 6 77New York 16,647 373 225 1,481 394 1,975 5,528 6,671 0North Carolina 5,024 0 0 182 152 455 51 4,184 0North Dakota 98 11 4 1 0 8 52 22 0Northern Mariana Islands — — — — — — — — —Ohio 1,906 145 0 180 80 350 788 363 0Oklahoma 1,267 0 20 33 91 59 943 121 0Oregon 1,758 197 0 361 86 280 797 5 32Pennsylvania 4,745 165 56 0 1,153 0 1,883 1,488 0Puerto Rico 5,668 5,147 0 31 0 0 422 68 0Republic of Palau — — — — — — — — —Rhode Island 369 0 17 67 7 34 153 91 0South Carolina 3,913 0 0 27 34 198 2,055 1,599 0South Dakota 204 — — — — — — — —Tennessee 4,235 0 0 0 0 0 0 0 4,235Texas 12,016 0 0 0 228 1,563 139 10,086 0Utah 592 0 0 0 1 13 369 209 0Vermont 342 119 60 26 10 16 107 4 0Virgin Islands (U.S.) 60 0 0 0 0 7 14 39 0Virginia 4,974 66 0 0 198 268 3,556 886 0Washington 3,248 32 321 162 25 208 2,366 134 0West Virginia 292 0 0 21 28 68 103 59 13Wisconsin 696 16 12 36 7 81 260 284 0Wyoming 119 27 12 29 10 0 41 0 0

Total 139,940 9,205 3,459 5,203 3,396 11,990 41,192 59,526 5,765

1 Asset limits for full- vs. partial-subsidy under Medicare Part D may be found here.

Note: 49 ADAPs reported data. American Samoa, Connecticut, Guam, Kentucky, Marshall Islands, Nevada, New Jersey, Northern Mariana Islands, Republic of Palau and South Dakota did not respond. A dash (—) indicates the ADAP did not report data.

http://www.medicarerights.org/fliers/Help-With-Drug-Costs/Extra-Help-Chart.pdf%3Fnrd%3D1

41

table 8 aDap ClIEnts sErvED, by raCE/EthnICIty, junE 2015

State/Territory


Non- Hispanic

Black/African

American

Non- Hispanic

White Hispanic Asian

Native Hawaiian/

Pacific Islander

American Indian/ Alaskan Native

Multi- Racial Other Unknown

Alabama 1,893 66% 27% 3% 1% 4% 0.1% 0.1% 0.1% 0%Alaska 106 21% 54% 13% 6% 0% 7% 0% 0% 0%American Samoa — — — — — — — — — —Arizona 1,354 8% 39% 46% 2% 0.1% 1% 4% 0% 0.1%Arkansas 477 37% 52% 2% 1% 0.4% 0.4% 3% 0.4% 4%California 17,057 8% 34% 50% 4% 0.3% 0.2% 1% 0% 3%Colorado 1,813 21% 55% 18% 2% 1% 3% 0% 0% 0%Connecticut — — — — — — — — — —Delaware 126 54% 25% 21% 0% 0% 0% 1% 0% 0%District of Columbia 804 0% 0% 0% 0% 0% 0% 0% 0% 100%Federated States of Micronesia 0 0% 0% 0% 0% 0% 0% 0% 0% 0%Florida 13,739 45% 28% 25% 1% 0.1% 0.2% 0.2% 1% 0%Georgia 5,294 66% 21% 11% 1% 0.02% 0.1% 1% 0.1% 0.3%Guam — — — — — — — — — —Hawaii 243 5% 53% 6% 18% 7% 1% 10% 0% 0%Idaho 165 — — — — — — — — —Illinois 4,726 33% 32% 31% 2% 0.1% 0.1% 1% 1% 0.1%Indiana 3,031 35% 52% 8% 2% 0.03% 0.2% 1% 2% 0%Iowa 269 18% 63% 16% 3% 0% 0.4% 0.4% 0% 0%Kansas 804 26% 51% 20% 2% 0.2% 1% 0% 0% 0%Kentucky — — — — — — — — — —Louisiana 4,519 65% 29% 4% 0.3% 0.2% 0.3% 0.5% 0% 0.2%Maine 366 25% 66% 5% 1% 0% 0.3% 3% 0% 0%Marshall Islands — — — — — — — — — —Maryland 3,904 68% 18% 7% 1% 0.1% 0.2% 0.1% 6% 0.4%Massachusetts 3,245 25% 44% 26% 2% 0.1% 0.4% 1% 0% 3%Michigan 1,798 41% 49% 5% 2% 0.1% 1% 0% 0.4% 2%Minnesota 637 23% 50% 15% 2% 0% 0.5% 0.5% 8% 0%Mississippi 1,386 76% 19% 2% 0.4% 0.2% 0.1% 2% 0.1% 0%Missouri 2,861 50% 43% 6% 0.5% 0.1% 0.4% 0% 0% 0%Montana 104 3% 85% 4% 0% 1% 6% 0% 0% 2%Nebraska 478 29% 43% 23% 3% 0.4% 1% 0.4% 0% 0%Nevada — — — — — — — — — —New Hampshire 258 17% 61% 13% 2% 0% 1% 6% 0% 0%New Jersey — — — — — — — — — —New Mexico 310 3% 35% 57% 0.3% 0.3% 2% 1% 0.3% 1%New York 16,647 34% 26% 32% 2% 0.2% 0.4% 0% 0% 5%North Carolina 5,024 60% 27% 9% 1% 0.1% 1% 0.3% 2% 0%North Dakota 98 41% 53% 0% 0% 0% 2% 4% 0% 0%Northern Mariana Islands — — — — — — — — — —Ohio 1,906 35% 56% 7% 1% 0% 0.2% 1% 0% 0%Oklahoma 1,267 21% 57% 6% 1% 0.1% 4% 11% 0% 0%Oregon 1,758 5% 78% 4% 2% 0.4% 1% 5% 5% 0.2%Pennsylvania 4,745 45% 40% 13% 1% 0.1% 0.1% 0% 1% 0%Puerto Rico 5,668 0% 0% 100% 0% 0% 0% 0% 0% 0%Republic of Palau — — — — — — — — — —Rhode Island 369 16% 50% 29% 2% 0% 0.3% 2% 1% 0.3%South Carolina 3,913 68% 26% 5% 0.3% 0% 0.1% 1% 0.2% 0%South Dakota 204 27% 56% 6% 0.5% 0% 10% 0% 0% 0%Tennessee 4,235 55% 40% 4% 0.4% 0.05% 0.3% 0.02% 0.1% 0%Texas 12,016 31% 24% 41% 1% 0.02% 0.2% 0% 1% 1%Utah 592 9% 57% 29% 4% 1% 1% 0% 0% 0.2%Vermont 342 0% 0% 0% 0% 0% 0% 0% 0% 100%Virgin Islands (U.S.) 60 80% 5% 15% 0% 0% 0% 0% 0% 0%Virginia 4,974 60% 27% 11% 1% 0.1% 1% 0% 0% 1%Washington 3,248 13% 62% 19% 2% 1% 1% 3% 0% 0%West Virginia 292 29% 63% 7% 0% 0% 0% 1% 0% 0%Wisconsin 696 28% 45% 22% 2% 0.3% 1% 0% 0% 1%Wyoming 119 9% 74% 4% 1% 0% 3% 8% 0% 0%

Total 139,940 36% 32% 26% 2% 0.2% 0.4% 1% 1% 2%

Note: 50 ADAPs reported data. American Samoa, Connecticut, Guam, Kentucky, Marshall Islands, Nevada, New Jersey, Northern Mariana Islands and Republic of Palau did not respond. A dash (—) indicates the ADAP did not report data. A zero (0%) indicates the ADAP responded zero (0%) to the question.

42

table 9 aDap ClIEnts sErvED, by gEnDEr, junE 2015


Clients Served Male Female Transgender Unknown

Alabama 1,893 72% 28% 0% 0%Alaska 106 76% 24% 0% 0%American Samoa — — — — —Arizona 1,354 82% 16% 1% 0%Arkansas 477 67% 32% 0.4% 0%California 17,057 90% 10% 1% 0%Colorado 1,813 85% 14% 1% 0%Connecticut — — — — —Delaware 126 72% 27% 1% 0%District of Columbia 804 77% 22% 0.1% 0%Federated States of Micronesia 0 0% 0% 0% 0%Florida 13,739 76% 23% 1% 0%Georgia 5,294 75% 25% 0.2% 0%Guam — — — — —Hawaii 243 89% 10% 0.4% 0%Idaho 165 — — — —Illinois 4,726 83% 16% 1% 0%Indiana 3,031 80% 19% 1% 0%Iowa 269 81% 19% 0% 0%Kansas 804 77% 22% 1% 0%Kentucky — — — — —Louisiana 4,519 73% 26% 1% 0%Maine 366 77% 23% 1% 0%Marshall Islands — — — — —Maryland 3,904 65% 35% 0.1% 0%Massachusetts 3,245 70% 29% 1% 0.1%Michigan 1,798 84% 16% 0% 0%Minnesota 637 76% 24% 0% 0%Mississippi 1,386 75% 24% 0.4% 0%Missouri 2,861 81% 17% 1% 0%Montana 104 86% 14% 0% 0%Nebraska 478 78% 22% 0.4% 0%Nevada — — — — —New Hampshire 258 73% 26% 2% 0%New Jersey — — — — —New Mexico 310 90% 9% 0.3% 0%New York 16,647 78% 22% 0.3% 0%North Carolina 5,024 73% 26% 1% 0%North Dakota 98 65% 35% 0% 0%Northern Mariana Islands — — — — —Ohio 1,906 84% 15% 0.3% 0.2%Oklahoma 1,267 83% 17% 0% 0%Oregon 1,758 89% 11% 1% 0%Pennsylvania 4,745 78% 22% 0.4% 0%Puerto Rico 5,668 34% 66% 0% 0%Republic of Palau — — — — —Rhode Island 369 77% 22% 1% 0%South Carolina 3,913 73% 27% 1% 0%South Dakota 204 67% 33% 0% 0%Tennessee 4,235 72% 27% 0.4% 0%Texas 12,016 79% 21% 1% 0%Utah 592 85% 14% 0.3% 0%Vermont 342 0% 0% 0% 100%Virgin Islands (U.S.) 60 48% 52% 0% 0%Virginia 4,974 72% 27% 1% 0%Washington 3,248 85% 14% 1% 0.2%West Virginia 292 76% 24% 0% 0%Wisconsin 696 83% 15% 2% 0%Wyoming 119 80% 20% 0% 0%

Total 139,940 76% 23% 1% 0.3%


43

table 10 aDap ClIEnts sErvED, by agE, junE 2015

State/Territory

June 2015 Clients Served ≤ 12 Years 13–24 Years 25–44 Years 45–64 Years > 64 Years Unknown

Alabama 1,893 0% 5% 57% 36% 1% 0%Alaska 106 0% 3% 38% 57% 3% 0%American Samoa — — — — — — —Arizona 1,354 0.1% 2% 37% 54% 6% 0%Arkansas 477 0% 11% 51% 38% 1% 0%California 17,057 0% 1% 36% 53% 11% 0%Colorado 1,813 0.3% 2% 39% 53% 5% 0%Connecticut — — — — — — —Delaware 126 1% 2% 43% 50% 5% 0%District of Columbia 804 0% 2% 38% 52% 8% 0%Federated States of Micronesia 0 0% 0% 0% 0% 0% 0%Florida 13,739 0.01% 5% 38% 54% 4% 0%Georgia 5,294 0.02% 4% 45% 48% 3% 0%Guam — — — — — — —Hawaii 243 0% 1% 23% 57% 20% 0%Idaho 165 — — — — — —Illinois 4,726 0.02% 3% 43% 48% 6% 0%Indiana 3,031 0.1% 5% 46% 45% 3% 0%Iowa 269 0% 2% 46% 46% 6% 0%Kansas 804 1% 2% 45% 48% 4% 0%Kentucky — — — — — — —Louisiana 4,519 0% 5% 48% 43% 3% 0%Maine 366 0% 2% 32% 61% 5% 0%Marshall Islands — — — — — — —Maryland 3,904 0.1% 1% 33% 56% 10% 0%Massachusetts 3,245 0.03% 1% 21% 69% 9% 0%Michigan 1,798 0.4% 2% 33% 56% 8% 0%Minnesota 637 0.5% 3% 40% 48% 8% 0%Mississippi 1,386 0% 11% 51% 36% 2% 0%Missouri 2,861 0.4% 7% 52% 40% 1% 0%Montana 104 0% 1% 38% 56% 5% 0%Nebraska 478 1% 3% 45% 46% 5% 0%Nevada — — — — — — —New Hampshire 258 0% 3% 22% 67% 8% 0%New Jersey — — — — — — —New Mexico 310 0.3% 2% 29% 66% 2% 0%New York 16,647 0.04% 2% 36% 54% 8% 0%North Carolina 5,024 0.02% 5% 42% 48% 5% 0%North Dakota 98 1% 2% 45% 51% 1% 0%Northern Mariana Islands — — — — — — —Ohio 1,906 0% 4% 35% 54% 7% 0%Oklahoma 1,267 0% 3% 42% 52% 3% 0%Oregon 1,758 0% 1% 29% 61% 9% 0%Pennsylvania 4,745 0.1% 3% 33% 56% 8% 0%Puerto Rico 5,668 0.1% 4% 30% 62% 4% 0%Republic of Palau — — — — — — —Rhode Island 369 0.3% 0.3% 28% 61% 10% 0%South Carolina 3,913 0.2% 6% 42% 49% 4% 0%South Dakota 204 1% 2% 45% 48% 4% 0%Tennessee 4,235 0.1% 10% 47% 43% 0% 0%Texas 12,016 0.02% 5% 47% 44% 4% 0%Utah 592 0.3% 3% 54% 41% 2% 0%Vermont 342 0% 0% 0% 0% 0% 100%Virgin Islands (U.S.) 60 0% 0% 27% 63% 10% 0%Virginia 4,974 0.02% 10% 45% 43% 2% 0%Washington 3,248 0% 1% 30% 60% 8% 0%West Virginia 292 0% 3% 25% 65% 7% 0%Wisconsin 696 1% 6% 43% 44% 6% 0%Wyoming 119 2% 3% 56% 35% 3% 0%

Total 139,940 0.1% 4% 39% 51% 6% 0.2%


44

table 11 ADAP Clients serveD, by inCome level, June 2015

State/Territory

Financial Eligibility June 2015

Clients Served

≤ 100% FPL

101–138%1

FPL

139–200%

FPL

201–300%

FPL

301–400%

FPL> 401%

FPL Unknown

Full-Pay Medications (Uninsured)

ADAP-Funded Insurance Program

Alabama 250% FPL 250% FPL 1,893 90% 4% 4% 2% 0.1% 0% 0%Alaska 400% FPL 400% FPL 106 40% 14% 21% 25% 0% 0% 0%American Samoa — — — — — — — — — —Arizona 400% FPL 400% FPL 1,354 26% 10% 32% 27% 5% 0.2% 0%Arkansas 400% FPL 400% FPL 477 53% 23% 19% 3% 1% 0% 0%California 500% FPL 500% FPL 17,057 60% 5% 14% 14% 7% 1% 0.1%Colorado 500% FPL 400% FPL 1,813 37% 10% 20% 20% 10% 2% 0%Connecticut 400% FPL 400% FPL — — — — — — — —Delaware 500% FPL 500% FPL 126 26% 18% 24% 20% 10% 2% 0%District of Columbia 500% FPL 500% FPL 804 55% 6% 19% 12% 7% 2% 0%Federated States of Micronesia — — 0 0% 0% 0% 0% 0% 0% 0%Florida 400% FPL 400% FPL 13,739 52% 11% 18% 14% 4% 0% 0%Georgia 300% FPL 300% FPL 5,294 53% 15% 21% 11% 0% 0% 0.3%Guam — — — — — — — — — —Hawaii 400% FPL 400% FPL 243 19% 21% 35% 21% 4% 0% 0%Idaho 200% FPL 200% FPL 165 — — — — — — —Illinois 300% FPL 500% FPL 4,726 39% 12% 22% 18% 7% 3% 0%Indiana 300% FPL 300% FPL 3,031 50% 17% 19% 14% 0% 0% 0.4%Iowa 200% FPL 400% FPL 269 14% 6% 30% 42% 8% 0% 0%Kansas 300% FPL 300% FPL 804 47% 11% 19% 23% 0% 0% 0.4%Kentucky — — — — — — — — — —Louisiana 300% FPL 300% FPL 4,519 51% 16% 18% 14% 0% 0% 1%Maine 500% FPL 500% FPL 366 45% 10% 15% 19% 5% 5% 0%Marshall Islands — — — — — — — — — —Maryland 500% FPL 500% FPL 3,904 14% 10% 23% 27% 16% 10% 0%Massachusetts 500% FPL2 500% FPL2 3,245 42% 9% 15% 17% 10% 7% 0%Michigan 450% FPL 450% FPL 1,798 14% 10% 28% 29% 15% 4% 1%Minnesota 400% FPL 400% FPL 637 18% 6% 24% 31% 21% 0% 0%Mississippi 300% FPL 300% FPL 1,386 60% 13% 19% 8% 0% 0% 1%Missouri 300% FPL 300% FPL3 2,861 50% 10% 18% 19% 3% 0% 0%Montana 430% FPL 430% FPL 104 28% 16% 26% 13% 4% 0% 13%Nebraska 300% FPL 300% FPL 478 44% 18% 26% 13% 0% 0% 0%Nevada — — — — — — — — — —New Hampshire 400% FPL 400% FPL 258 28% 11% 25% 27% 9% 0% 0%New Jersey 500% FPL 500% FPL — — — — — — — —New Mexico 400% FPL 400% FPL 310 20% 13% 33% 27% 8% 0% 0%New York 435% FPL 435% FPL 16,647 31% 13% 20% 21% 13% 2% 0%North Carolina 300% FPL 300% FPL 5,024 54% 15% 21% 10% 0% 0% 0%North Dakota 400% FPL 400% FPL 98 30% 10% 21% 21% 17% 0% 0%Northern Mariana Islands — — — — — — — — — —Ohio 300% FPL 300% FPL 1,906 23% 13% 31% 33% 0% 0% 0%Oklahoma 200% FPL 400% FPL 1,267 42% 13% 20% 18% 6% 0% 0%Oregon 500% FPL 500% FPL 1,758 30% 20% 24% 18% 8% 0% 0%Pennsylvania 500% FPL3 500% FPL3 4,745 22% 10% 18% 24% 15% 11% 0%Puerto Rico 200% FPL 200% FPL 5,668 99.75% 0.2% 0.04% 0% 0% 0% 0%Republic of Palau — — — — — — — — — —Rhode Island 400% FPL 400% FPL 369 33% 26% 22% 17% 2% 0% 0%South Carolina 300% FPL 550% FPL 3,913 48% 10% 17% 16% 6% 3% 0%South Dakota 300% FPL 300% FPL 204 42% 15% 21% 22% 0% 0% 0%Tennessee 300% FPL 300% FPL 4,235 47% 11% 18% 24% 0% 0% 0%Texas 200% FPL 200% FPL 12,016 90% 3% 7% 0% 0.01% 0% 0%Utah 250% FPL 250% FPL 592 54% 12% 19% 15% 0% 0% 0.2%Vermont 500% FPL 500% FPL 342 0% 0% 0% 0% 0% 0% 100%Virgin Islands (U.S.) 300% FPL 300% FPL 60 53% 12% 15% 17% 3% 0% 0%Virginia 400% FPL 400% FPL 4,974 57% 12% 16% 11% 4% 0% 0.1%Washington 400% FPL 400% FPL 3,248 25% 17% 22% 24% 12% 0% 0%West Virginia 400% FPL 400% FPL 292 0% 15% 41% 34% 11% 0% 0%Wisconsin 300% FPL 300% FPL 696 30% 37% 0% 31% 0% 0% 1%Wyoming 350% FPL 350% FPL 119 37% 18% 17% 23% 6% 0% 0%

Total 139,940 50% 10% 17% 15% 6% 1% 0.3%

1 In 2014, the ACA expanded Medicaid eligibility to most people with income up to 133% of the federal poverty level (FPL). However, in addition to new income counting rules for most Medicaid populations (called “Modified Adjusted Gross Income”), there is an additional 5% disregard of income, effectively bumping the Medicaid income eligibility threshold to 138% FPL.2 In Massachusetts, the 500% FPL income eligibilty requirement also includes a $5,060 allowance for each dependent.3 In Pennsylvania, clients at >500% FPL who have dependents have an allowance for those dependents that account for income over the determined limit.

Note: 50 ADAPs reported data. American Samoa, Connecticut, Guam, Kentucky, Marshall Islands, Nevada, New Jersey, Northern Mariana Islands and Republic of Palau did not respond. A dash (—) indicates the ADAP did not report data. A zero (0%) indicates the ADAP responded zero (0%) to the question. The 2015 Federal Poverty Level (FPL) was $11,770 (slightly higher in Alaska and Hawaii) for a household of one.

45

table 12 aDap ClIEnts sErvED, by hIv/aIDs status, junE 2015

State/Territory


All Clients Served

Subset of June 2015

Clients Served by Full-Pay

Medications Only

Full-Pay Medications Only

HIV positive,

not- Stage 3

HIV infection

(AIDS)

HIV positive,

AIDS status

unknown

CDC- defined Stage 3

HIV infection

(AIDS)3 Unknown

HIV positive,

not- Stage 3

HIV infection

(AIDS)

HIV positive,

AIDS status

unknown


HIV infection

(AIDS)3 Unknown

Alabama 1,893 0% 100% 0% 0% — — — — —Alaska 106 31% 29% 11% 28% — — — — —American Samoa — — — — — — — — — —Arizona 1,354 30% 9% 59% 2% 459 31% 11% 54% 3%Arkansas 477 79% 4% 16% 0.2% — — — — —California 17,057 68% 7% 23% 2% 8,289 71% 7% 20% 2%Colorado 1,813 59% 0% 41% 0.1% 223 45% 0% 24% 0%Connecticut — — — — — — — — — —Delaware 126 52% 0% 48% 0% 62 55% 0% 45% 0%District of Columbia 804 0% 100% 0% 0% — — — — —Federated States of Micronesia 0 0% 0% 0% 0% — — — — —Florida 13,739 61% 31% 9% 0% 10,479 61% 29% 10% 0%Georgia 5,294 60% 12% 28% 1% 5,180 59% 12% 28% 1%Guam — — — — — — — — — —Hawaii 243 48% 12% 40% 0% — — — — —Idaho 165 — — — — — — — — —Illinois 4,726 54% 0.1% 46% 0% 2,324 54% 0% 46% 0%Indiana 3,031 56% 0% 44% 0% — — — — —Iowa 269 12% 37% 10% 0% 53 38% 11% 51% 0%Kansas 804 46% 10% 44% 0% 89 72% 7% 21% 0%Kentucky — — — — — — — — — —Louisiana 4,519 41% 6% 52% 0% — — — — —Maine 366 58% 8% 34% 0% 24 88% 4% 8% 0%Marshall Islands — — — — — — — — — —Maryland 3,904 68% 12% 20% 0% 783 66% 19% 16% 0%Massachusetts 3,245 44% 2% 54% 0% 99 41% 2% 57% 0%Michigan 1,798 0% 0% 0% 100% — — — — —Minnesota 637 0% 100% 0% 0% — — — — —Mississippi 1,386 60% 6% 33% 0.4% 1,386 60% 6% 33% 0%Missouri 2,861 47% 26% 26% 1% 549 40% 31% 28% 1%Montana 104 63% 1% 36% 1% — — — — —Nebraska 478 60% 0% 40% 0% 135 67% 0% 33% 0%Nevada — — — — — — — — — —New Hampshire 258 52% 5% 42% 0% 114 53% 7% 39% 1%New Jersey — — — — — — — — — —New Mexico 310 36% 1% 62% 1% — — — — —New York 16,647 0% 64% 36% 0% — — — — —North Carolina 5,024 87% 0% 12% 1% 4,184 87% 0% 12% 1%North Dakota 98 53% 0% 47% 0% 22 68% 0% 32% 0%Northern Mariana Islands — — — — — — — — — —Ohio 1,906 60% 11% 30% 0% 481 64% 12% 24% 0%Oklahoma 1,267 62% 0% 38% 0% — — — — —Oregon 1,758 31% 69% 0% 0% 21 48% 52% 0% 0%Pennsylvania 4,745 57% 8% 33% 2% — — — — —Puerto Rico 5,668 73% 0.3% 26% 1% 5,444 72% 0% 27% 1%Republic of Palau — — — — — — — — — —Rhode Island 369 44% 2% 55% 0% 91 49% 2% 48% 0%South Carolina 3,913 53% 5% 39% 3% 1,599 52% 7% 39% 2%South Dakota 204 85% 2% 13% 0% — — — — —Tennessee 4,235 62% 9% 29% 0% — — — — —Texas 12,016 0% 100% 0% 0% 10,086 0% 100% 0% 0%Utah 592 70% 0% 28% 2% 209 63% 0% 32% 5%Vermont 342 0% 0% 0% 100% — — — — —Virgin Islands (U.S.) 60 85% 0% 15% 0% 39 87% 0% 13% 0%Virginia 4,974 55% 12% 34% 0% 984 52% 16% 33% 0%Washington 3,248 0% 50% 50% 0% — — — — —West Virginia 292 62% 1% 38% 0% — — — — —Wisconsin 696 43% 0.1% 57% 0% — — — — —Wyoming 119 0% 0% 0% 100% 0 0% 0% 0% 0%

Total 139,940 44% 28% 26% 2% 53,408 53% 29% 18% 1%

1 Individuals who had an insurance (i.e., Medicare Part D, Medicaid, private insurance) payment (premium, co-payment/co-insurance, and/or deductible) paid on their behalf using ADAP funds, either fully or in part.2 This includes clients who enrolled in an insurance plan mid-year and those who were enrolled in an insurance plan that did not cover one or more medically necessary medications such that the ADAP’s full-pay prescription program did instead.3 The AIDS case definition used as part of this Report may be found here and is consistent with the most recent ADR submission. Please note, however, that an updated case definition was released by CDC in April 2014 (located here). Neither definition should be considered fixed; that is, an individual who meets the AIDS case definition at one particular time should not necessarily be assumed to be an AIDS case in the future. Report using the most recent HIV/AIDS status recorded for each client as of June 30, 2015 among those served by the ADAP program in June 2015 (including those clients on ARVs and those clients not on ARVs). If a client did not receive an HIV/AIDS status during June 2015, reported based on the last HIV/AIDS status recorded for that individual prior to June 30, 2015.

Note: 50 ADAPs reported data. American Samoa, Connecticut, Guam, Kentucky, Marshall Islands, Nevada, New Jersey, Northern Mariana Islands and Republic of Palau did not respond. A dash (--) indicates the ADAP did not report data. Data reflect clients enrolled in ADAPs over the past 12 months or the most recent 12 months for which data are available. A dash (--) indicates the ADAP did not report data. A zero (0%) indicates the ADAP responded zero (0%) to the question. In some cases, an ADAP was able to report data though was unable to distinguish between clients served by the full-pay medications program only, the ADAP-funded insurance program only, and the full-pay medications and ADAP-funded insurance programs.Note: Many ADAPs were unable to report HIV/AIDS Status separately for: clients served by a full-pay prescription program only; clients served by an ADAP-funded insurance program only; and clients served by a fully-pay prescription program and ADAP-funded insurance program. As such, the percentage of clients that fall into each HIV/AIDS Status category are reported under “All Clients Served” for each state for which this is the case.


http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6303a1.htm%3Fs_cid%3Drr6303a1_e


46

table 12 aDap ClIEnts sErvED, by hIv/aIDs status, junE 2015 (ContInuED)

State/Territory

Subset of June 2015

Clients Served by

ADAP- Funded

Insurance Only1

ADAP-Funded Insurance Only1

Subset of June 2015


Medications and ADAP-

Funded Insurance2

Full-Pay Medications and ADAP-Funded Insurance2

HIV positive,

not- Stage 3

HIV infection

(AIDS)

HIV positive,

AIDS status

unknown


HIV infection

(AIDS)3 Unknown

HIV positive,

not- Stage 3

HIV infection

(AIDS)

HIV positive,

AIDS status

unknown


HIV infection

(AIDS)3 Unknown

Alabama — — — — — — — — — —Alaska — — — — — — — — — —American Samoa — — — — — — — — — —Arizona 883 29% 8% 61% 1% 12 42% 0% 50% 8%Arkansas — — — — — — — — — —California 8,768 64% 7% 26% 2% 0 0% 0% 0% 0%Colorado 1,588 61% 0% 44% 0% 2 0% 0% 0% 0%Connecticut — — — — — — — — — —Delaware 64 48% 0% 52% 0% 0 0% 0% 0% 0%District of Columbia — — — — — — — — — —Federated States of Micronesia — — — — — — — — — —Florida 3,255 60% 36% 4% 0% 5 60% 40% 0% 0%Georgia 106 96% 0% 0% 4% 8 63% 0% 38% 0%Guam — — — — — — — — — —Hawaii — — — — — — — — — —Idaho — — — — — — — — — —Illinois 2,365 54% 0% 46% 0% 37 38% 0% 62% 0%Indiana — — — — — — — — — —Iowa 215 5% 44% 0% 0% 1 0% 0% 100% 0%Kansas 713 43% 10% 47% 0% 2 100% 0% 0% 0%Kentucky — — — — — — — — — —Louisiana — — — — — — — — — —Maine 336 55% 8% 36% 0% 6 100% 0% 0% 0%Marshall Islands — — — — — — — — — —Maryland 2,719 69% 10% 21% 0% 402 67% 10% 24% 0%Massachusetts 3,145 44% 2% 54% 0% 1 0% 0% 100% 0%Michigan — — — — — — — — — —Minnesota — — — — — — — — — —Mississippi 0 0% 0% 0% 0% 0 0% 0% 0% 0%Missouri 2,143 48% 25% 26% 1% 169 52% 22% 26% 0%Montana — — — — — — — — — —Nebraska 343 57% 0% 43% 0% 0 0% 0% 0% 0%Nevada — — — — — — — — — —New Hampshire 88 49% 6% 45% 0% 56 55% 2% 43% 0%New Jersey — — — — — — — — — —New Mexico — — — — — — — — — —New York — — — — — — — — — —North Carolina 839 88% 0% 11% 1% 1 100% 0% 0% 0%North Dakota 68 53% 0% 47% 0% 8 13% 0% 88% 0%Northern Mariana Islands — — — — — — — — — —Ohio 1,363 58% 10% 31% 0% 62 56% 11% 32% 0%Oklahoma — — — — — — — — — —Oregon 1,713 31% 69% 0% 0% 24 33% 67% 0% 0%Pennsylvania — — — — — — — — — —Puerto Rico 224 83% 0% 17% 0% 0 0% 0% 0% 0%Republic of Palau — — — — — — — — — —Rhode Island 275 42% 1% 56% 0% 3 0% 0% 100% 0%South Carolina 2,264 54% 4% 39% 3% 50 44% 6% 46% 4%South Dakota — — — — — — — — — —Tennessee — — — — — — — — — —Texas 1,928 0% 100% 0% 0% 2 0% 100% 0% 0%Utah 383 75% 0% 25% 0% 0 0% 0% 0% 0%Vermont — — — — — — — — — —Virgin Islands (U.S.) 21 81% 0% 19% 0% 0 0% 0% 0% 0%Virginia 3,792 56% 10% 34% 0% 198 58% 16% 26% 0%Washington — — — — — — — — — —West Virginia — — — — — — — — — —Wisconsin — — — — — — — — — —Wyoming 119 0% 0% 0% 100% 0 0% 0% 0% 0%

Total 39,720 54% 17% 28% 1% 1,049 57% 13% 29% 0.3%

1 Individuals who had an insurance (i.e., Medicare Part D, Medicaid, private insurance) payment (premium, co-payment/co-insurance, and/or deductible) paid on their behalf using ADAP funds, either fully or in part.2 This includes clients who enrolled in an insurance plan mid-year and those who were enrolled in an insurance plan that did not cover one or more medically necessary medications such that the ADAP’s full-pay prescription program did instead.3 The AIDS case definition used as part of this Report may be found here and is consistent with the most recent ADR submission. Please note, however, that an updated case definition was released by CDC in April 2014 (located here). Neither definition should be considered fixed; that is, an individual who meets the AIDS case definition at one particular time should not necessarily be assumed to be an AIDS case in the future. Report using the most recent HIV/AIDS status recorded for each client as of June 30, 2015 among those served by the ADAP program in June 2015 (including those clients on ARVs and those clients not on ARVs). If a client did not receive an HIV/AIDS status during June 2015, reported based on the last HIV/AIDS status recorded for that individual prior to June 30, 2015.

Note: 50 ADAPs reported data. American Samoa, Connecticut, Guam, Kentucky, Marshall Islands, Nevada, New Jersey, Northern Mariana Islands and Republic of Palau did not respond. A dash (--) indicates the ADAP did not report data. Data reflect clients enrolled in ADAPs over the past 12 months or the most recent 12 months for which data are available. A dash (--) indicates the ADAP did not report data. A zero (0%) indicates the ADAP responded zero (0%) to the question. In some cases, an ADAP was able to report data though was unable to distinguish between clients served by the full-pay medications program only, the ADAP-funded insurance program only, and the full-pay medications and ADAP-funded insurance programs.Note: Many ADAPs were unable to report HIV/AIDS Status separately for: clients served by a full-pay prescription program only; clients served by an ADAP-funded insurance program only; and clients served by a fully-pay prescription program and ADAP-funded insurance program. As such, the percentage of clients that fall into each HIV/AIDS Status category are reported under “All Clients Served” for each state for which this is the case.


http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6303a1.htm%3Fs_cid%3Drr6303a1_e


47

table 13 aDap ClIEnts by vIral loaD1, EnrollED DurIng 12-month pErIoD, junE 2015

State/Territory


All Clients Served

Subset of June 2015 Clients

Served by Full-Pay

Medications Only

Full-Pay Medications Only

Viral Load ≤200

Viral Load >200 Unknown

Viral Load ≤200


Alabama 1,893 83% 16% 2% — — — —Alaska 106 61% 9% 29% — — — —American Samoa — — — — — — — —Arizona 1,354 87% 9% 4% 459 85% 13% 2%Arkansas 477 37% 63% 0.2% — — — —California 17,057 87% 10% 3% 8,289 83% 14% 3%Colorado 1,813 93% 7% 0.1% 223 60% 9% 0%Connecticut — — — — — — — —Delaware 126 88% 12% 0% 62 89% 11% 0%District of Columbia 804 0% 0% 100% — — — —Federated States of Micronesia 0 0% 0% 0% — — — —Florida 13,739 85% 15% 0% 10,479 82% 18% 0%Georgia 5,294 44% 30% 27% 5,180 43% 30% 27%Guam — — — — — — — —Hawaii 243 88% 8% 4% — — — —Idaho 165 — — — — — — —Illinois 4,726 91% 9% 0% 2,324 87% 13% 0%Indiana 3,031 36% 15% 49% — — — —Iowa 269 94% 4% 2% 53 91% 8% 2%Kansas 804 81% 18% 0.5% 89 81% 19% 0%Kentucky — — — — — — — —Louisiana 4,519 0% 0% 100% — — — —Maine 366 60% 8% 32% 24 54% 17% 29%Marshall Islands — — — — — — — —Maryland 3,904 89% 11% 0% 783 80% 20% 0%Massachusetts 3,245 93% 7% 0% 99 82% 18% 0%Michigan 1,798 0% 0% 100% — — — —Minnesota 637 89% 11% 0% — — — —Mississippi 1,386 55% 22% 23% 1,386 55% 22% 23%Missouri 2,861 85% 13% 2% 549 71% 23% 5%Montana 104 91% 9% 0% — — — —Nebraska 478 79% 9% 12% 135 64% 14% 21%Nevada — — — — — — — —New Hampshire 258 76% 7% 17% 114 70% 11% 19%New Jersey — — — — — — — —New Mexico 310 91% 8% 1% — — — —New York 16,647 88% 9% 3% — — — —North Carolina 5,024 83% 17% 0.04% 4,184 81% 19% 0.05%North Dakota 98 90% 7% 3% 22 77% 18% 5%Northern Mariana Islands — — — — — — — —Ohio 1,906 89% 10% 1% 481 80% 18% 2%Oklahoma 1,267 66% 33% 1% — — — —Oregon 1,758 79% 6% 14% 21 52% 19% 29%Pennsylvania 4,745 69% 9% 22% — — — —Puerto Rico 5,668 73% 10% 17% 5,444 73% 10% 17%Republic of Palau — — — — — — — —Rhode Island 369 91% 8% 2% 91 84% 14% 2%South Carolina 3,913 85% 13% 2% 1,599 78% 20% 2%South Dakota 204 86% 14% 0% — — — —Tennessee 4,235 74% 15% 12% — — — —Texas 12,016 54% 46% 0.01% 10,086 53% 47% 0.01%Utah 592 59% 17% 25% 209 42% 21% 37%Vermont 342 0% 0% 100% — — — —Virgin Islands (U.S.) 60 85% 15% 0% 39 87% 13% 0%Virginia 4,974 74% 20% 6% 984 66% 29% 5%Washington 3,248 0% 0% 100% — — — —West Virginia 292 78% 22% 0% — — — —Wisconsin 696 92% 8% 0.1% — — — —Wyoming 119 0% 0% 100% 0 0% 0% 0%

Total 139,940 72% 15% 13% 53,408 71% 23% 6%

1 Reported using the most recent viral load recorded for each client as of June 30, 2015 among those served by the ADAP program in June 2015 (including those clients on ARVs and those clients not on ARVs). If a client did not receive a viral load during June 2015, reported based on the last viral load recorded for that individual prior to June 30, 2015.2 Individuals who had an insurance (i.e., Medicare Part D, Medicaid, private insurance) payment (premium, co-payment/co-insurance, and/or deductible) paid on their behalf using ADAP funds, either fully or in part.3 This includes clients who enrolled in an insurance plan mid-year and those who were enrolled in an insurance plan that did not cover one or more medically necessary medications such that the ADAP’s full-pay prescription program did instead.

Note: 50 ADAPs reported data. American Samoa, Connecticut, Guam, Kentucky, Marshall Islands, Nevada, New Jersey, Northern Mariana Islands and Republic of Palau did not respond. A dash (--) indicates the ADAP did not report data. Data reflect clients enrolled in ADAPs over the past 12 months or the most recent 12 months for which data are available. A dash (--) indicates the ADAP did not report data. A zero (0%) indicates the ADAP responded zero (0%) to the question. In some cases, an ADAP was able to report data though was unable to distinguish between clients served by the full-pay medications program only, the ADAP-funded insurance program only, and the full-pay medications and ADAP-funded insurance programs.

Note: Many ADAPs were unable to report Viral Load separately for: clients served by a full-pay prescription program only; clients served by an ADAP-funded insurance program only; and clients served by a fully-pay prescription program and ADAP-funded insurance program. As such, the percentage of clients that fall into each Viral Load category are reported under “All Clients Served” for each state for which this is the case.

48

table 13 aDap ClIEnts by vIral loaD1, EnrollED DurIng 12-month pErIoD, junE 2015 (ContInuED)

State/Territory

Subset of June 2015

Clients Served by

ADAP-Funded Insurance

Only2

ADAP-Funded Insurance Only2

Subset of June 2015


Medications and ADAP-Funded

Insurance3

Full-Pay Medications and ADAP-Funded Insurance3

Viral Load ≤200


Viral Load ≤200


Alabama — — — — — — — —Alaska — — — — — — — —American Samoa — — — — — — — —Arizona 883 88% 7% 4% 12 83% 17% 0%Arkansas — — — — — — — —California 8,768 90% 7% 3% 0 0% 0% 0%Colorado 1,588 97% 7% 0.1% 2 100% 0% 0%Connecticut — — — — — — — —Delaware 64 88% 13% 0% 0 0% 0% 0%District of Columbia — — — — — — — —Federated States of Micronesia — — — — — — — —Florida 3,255 95% 5% 0% 5 100% 0% 0%Georgia 106 85% 6% 9% 8 75% 25% 0%Guam — — — — — — — —Hawaii — — — — — — — —Idaho — — — — — — — —Illinois 2,365 94% 6% 0% 37 92% 8% 0%Indiana — — — — — — — —Iowa 215 95% 3% 2% 1 100% 0% 0%Kansas 713 81% 18% 1% 2 100% 0% 0%Kentucky — — — — — — — —Louisiana — — — — — — — —Maine 336 61% 7% 32% 6 67% 0% 33%Marshall Islands — — — — — — — —Maryland 2,719 91% 9% 0% 402 94% 6% 0%Massachusetts 3,145 93% 7% 0% 1 100% 0% 0%Michigan — — — — — — — —Minnesota — — — — — — — —Mississippi 0 0% 0% 0% 0 0% 0% 0%Missouri 2,143 88% 10% 1% 169 81% 16% 3%Montana — — — — — — — —Nebraska 343 85% 7% 8% 0 0% 0% 0%Nevada — — — — — — — —New Hampshire 88 80% 2% 18% 56 80% 7% 13%New Jersey — — — — — — — —New Mexico — — — — — — — —New York — — — — — — — —North Carolina 839 93% 7% 0% 1 100% 0% 0%North Dakota 68 93% 4% 3% 8 100% 0% 0%Northern Mariana Islands — — — — — — — —Ohio 1,363 93% 7% 0.3% 62 82% 15% 3%Oklahoma — — — — — — — —Oregon 1,713 80% 6% 14% 24 58% 21% 21%Pennsylvania — — — — — — — —Puerto Rico 224 71% 11% 18% 0 0% 0% 0%Republic of Palau — — — — — — — —Rhode Island 275 93% 5% 1% 3 100% 0% 0%South Carolina 2,264 90% 9% 2% 50 92% 8% 0%South Dakota — — — — — — — —Tennessee — — — — — — — —Texas 1,928 59% 41% 0% 2 100% 0% 0%Utah 383 68% 15% 18% 0 0% 0% 0%Vermont — — — — — — — —Virgin Islands (U.S.) 21 81% 19% 0% 0 0% 0% 0%Virginia 3,792 76% 18% 6% 198 74% 22% 4%Washington — — — — — — — —West Virginia — — — — — — — —Wisconsin — — — — — — — —Wyoming 119 0% 0% 100% 0 0% 0% 0%

Total 39,720 87% 10% 3% 1,049 85% 12% 3%

1 Reported using the most recent viral load recorded for each client as of June 30, 2015 among those served by the ADAP program in June 2015 (including those clients on ARVs and those clients not on ARVs). If a client did not receive a viral load during June 2015, reported based on the last viral load recorded for that individual prior to June 30, 2015.2 Individuals who had an insurance (i.e., Medicare Part D, Medicaid, private insurance) payment (premium, co-payment/co-insurance, and/or deductible) paid on their behalf using ADAP funds, either fully or in part.3 This includes clients who enrolled in an insurance plan mid-year and those who were enrolled in an insurance plan that did not cover one or more medically necessary medications such that the ADAP’s full-pay prescription program did instead.

Note: 50 ADAPs reported data. American Samoa, Connecticut, Guam, Kentucky, Marshall Islands, Nevada, New Jersey, Northern Mariana Islands and Republic of Palau did not respond. A dash (--) indicates the ADAP did not report data. Data reflect clients enrolled in ADAPs over the past 12 months or the most recent 12 months for which data are available. A dash (--) indicates the ADAP did not report data. A zero (0%) indicates the ADAP responded zero (0%) to the question. In some cases, an ADAP was able to report data though was unable to distinguish between clients served by the full-pay medications program only, the ADAP-funded insurance program only, and the full-pay medications and ADAP-funded insurance programs.Note: Many ADAPs were unable to report Viral Load separately for: clients served by a full-pay prescription program only; clients served by an ADAP-funded insurance program only; and clients served by a fully-pay prescription program and ADAP-funded insurance program. As such, the percentage of clients that fall into each Viral Load category are reported under “All Clients Served” for each state for which this is the case.

49

table 14 aDap ClIEnt EnrollmEnt proCEssEs, as oF junE 30, 2015

State/Territory

Intake at Local ASOs, CBOs, and

Local Health Department1

(ADAP Funds Not Used)

Intake at Local ASOs, CBOs, and

Local Health Department (ADAP Funds Used All or

In Part)

Intake at ADAP

Office

Intake at Private Clinical Settings

Online Appli-cation

Appli-cation

Over the Phone

Faxed Appli-cation

Mailed Appli-cation

Other State

Programs

Other Enrollment Processes

Alabama No Yes No Yes No No No No No NoAlaska No No Yes No No Yes Yes Yes No YesAmerican Samoa — — — — — — — — — —Arizona Yes No Yes No No Yes Yes Yes No YesArkansas No No No Yes No No No No No NoCalifornia Yes Yes No Yes No No Yes Yes No NoColorado No Yes Yes Yes No No Yes Yes No NoConnecticut No No No No No No Yes Yes No NoDelaware Yes No No Yes No No No No No NoDistrict of Columbia No Yes Yes No No No Yes Yes No NoFederated States of Micronesia — — — — — — — — — —Florida No No Yes No No No No No No NoGeorgia Yes No No No Yes No No Yes No NoGuam — — — — — — — — — —Hawaii Yes No No Yes No No No No No NoIdaho Yes No No Yes No No No No No NoIllinois Yes No Yes Yes Yes Yes Yes Yes No NoIndiana Yes No No No No No No No No NoIowa No Yes No No No No No No No NoKansas No Yes No No No No No No No NoKentucky — — — — — — — — — —Louisiana Yes Yes No Yes No No Yes Yes No NoMaine Yes No No Yes No No Yes Yes No NoMarshall Islands — — — — — — — — — —Maryland Yes No Yes Yes No No Yes Yes No NoMassachusetts Yes No Yes Yes No No Yes Yes No NoMichigan No Yes No Yes No No Yes Yes No NoMinnesota Yes Yes No Yes Yes No Yes Yes No NoMississippi No No No Yes No No No No No NoMissouri Yes Yes No No No No No No No NoMontana Yes Yes No Yes Yes No Yes Yes No NoNebraska Yes No Yes Yes No No Yes Yes Yes NoNevada — — — — — — — — — —New Hampshire No Yes No Yes No No Yes Yes No NoNew Jersey Yes No No Yes No No Yes Yes No NoNew Mexico Yes No No No No No No No No NoNew York Yes No No No No No Yes Yes No NoNorth Carolina Yes No No Yes No No No Yes No NoNorth Dakota Yes No No No No No No No No NoNorthern Mariana Islands — — — — — — — — — —Ohio No No Yes No Yes Yes Yes Yes No NoOklahoma No No No Yes Yes No No No Yes NoOregon No No Yes No No No Yes Yes No YesPennsylvania No No No No No No Yes Yes No YesPuerto Rico Yes No No No No No Yes Yes No YesRepublic of Palau — — — — — — — — — —Rhode Island No Yes Yes Yes No No Yes Yes No NoSouth Carolina Yes No No Yes No No Yes Yes Yes NoSouth Dakota Yes No No Yes No No No Yes No YesTennessee No Yes No No Yes No No No No NoTexas No No No No No No Yes Yes No NoUtah No Yes No Yes No No Yes Yes No NoVermont No No No No No No Yes Yes No NoVirgin Islands (U.S.) No Yes Yes No No No No No No NoVirginia No No Yes No No Yes Yes Yes No NoWashington No No No No No No Yes Yes No NoWest Virginia Yes No Yes Yes No No No Yes No NoWisconsin Yes No Yes Yes No No Yes Yes No NoWyoming No Yes No No No No No No No No

Total 26 16 16 27 7 5 30 34 3 6

1 ASOs=AIDS Service Organizations; CBOs=Community-Based Organizations.

Note: 52 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond. A dash (—) indicates the ADAP did not report data.

50

table 15 aDap ClIEnt FInanCIal ElIgIbIlIty rEquIrEmEnts, as oF junE 30, 2015

State/Territory

Financial Eligibility1 Calculation Basis


ADAP-Funded Insurance Program Gross Income

Modified Adjusted

Gross Income (MAGI) Net Income

Individual Income

Household Income

Family Income

Alabama 250% FPL 250% FPL Yes No No Yes No YesAlaska 400% FPL 400% FPL Yes No No No No YesAmerican Samoa — — — — — — — —Arizona 400% FPL 400% FPL No Yes No No No NoArkansas 400% FPL 400% FPL Yes No No Yes Yes YesCalifornia 500% FPL 500% FPL No Yes No No Yes NoColorado 500% FPL 400% FPL No Yes No No Yes NoConnecticut 400% FPL 400% FPL No No Yes Yes Yes NoDelaware 500% FPL 500% FPL No Yes No No No NoDistrict of Columbia 500% FPL 500% FPL Yes No No Yes No NoFederated States of Micronesia — — No No No No Yes YesFlorida 400% FPL 400% FPL Yes No No No Yes NoGeorgia 300% FPL 300% FPL Yes Yes No No No NoGuam — — — — — — — —Hawaii 400% FPL 400% FPL Yes No No No No YesIdaho 200% FPL 200% FPL No No No No No NoIllinois 300% FPL 500% FPL No Yes No No Yes NoIndiana 300% FPL 300% FPL No Yes No No No NoIowa 200% FPL2 400% FPL Yes Yes No No No NoKansas 300% FPL 300% FPL Yes No No No No NoKentucky — — — — — — — —Louisiana 300% FPL 300% FPL Yes No No No Yes NoMaine 500% FPL 500% FPL Yes No No No Yes NoMarshall Islands — — — — — — — —Maryland 500% FPL 500% FPL Yes No No No Yes NoMassachusetts 500% FPL 500% FPL Yes No No Yes No NoMichigan 450% FPL 450% FPL Yes Yes No No Yes NoMinnesota 400% FPL 400% FPL Yes No No No Yes NoMississippi 300% FPL 300% FPL Yes Yes No No No NoMissouri 300% FPL 300% FPL3 Yes No No No Yes NoMontana 430% FPL 430% FPL Yes Yes No Yes Yes NoNebraska 300% FPL 300% FPL Yes Yes No No Yes NoNevada — — — — — — — —New Hampshire 400% FPL 400% FPL Yes No No No Yes NoNew Jersey 500% FPL 500% FPL Yes No No No Yes NoNew Mexico 400% FPL 400% FPL Yes No No Yes Yes NoNew York 435% FPL 435% FPL Yes No No No Yes NoNorth Carolina 300% FPL 300% FPL Yes No No No No YesNorth Dakota 400% FPL 400% FPL Yes No No No No NoNorthern Mariana Islands — — — — — — — —Ohio 300% FPL 300% FPL Yes No No No No NoOklahoma 200% FPL 400% FPL Yes Yes No Yes Yes YesOregon 500% FPL 500% FPL Yes No Yes Yes No YesPennsylvania 500% FPL 500% FPL Yes No No No No NoPuerto Rico 200% FPL 200% FPL No No Yes No No NoRepublic of Palau — — — — — — — —Rhode Island 400% FPL 400% FPL Yes Yes No No No NoSouth Carolina 300% FPL 550% FPL Yes No No No No NoSouth Dakota 300% FPL 300% FPL Yes No No No No NoTennessee 300% FPL 300% FPL Yes Yes No Yes Yes YesTexas 200% FPL 200% FPL No Yes No No No NoUtah 250% FPL 250% FPL Yes No No No Yes NoVermont 500% FPL 500% FPL No No Yes Yes Yes NoVirgin Islands (U.S.) 300% FPL 300% FPL Yes No No Yes No NoVirginia 400% FPL 400% FPL Yes No No No No NoWashington 400% FPL 400% FPL Yes Yes Yes No No YesWest Virginia 400% FPL 400% FPL No Yes No No No NoWisconsin 300% FPL 300% FPL Yes No No No No NoWyoming 350% FPL 350% FPL Yes No No Yes No No

1 In 2014, the ACA expanded Medicaid eligibility to most people with income up to 133% of the federal poverty level (FPL). However, in addition to new income counting rules for most Medicaid populations (called “Modified Adjusted Gross Income”), there is an additional 5% disregard of income, effectively bumping the Medicaid income eligibility threshold to 138% FPL.2 In Iowa, the 200% FPL income eligibilty requirement for the full-pay prescription program also includes a “work deduction” for those clients receiving greater than $500 per month in support.3 In Missouri, ADAP support premium, deductible and co-payment/co-insurance payments for clients at 301–400% FPL who meet additional eligibility criteria.

Note: 51 ADAPs reported data. American Samoa, Federated States of Micronesia, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond. A dash (—) indicates the ADAP did not report data. The 2015 Federal Poverty Level (FPL) was $11,770 (slightly higher in Alaska and Hawaii) for a household of one.

51

table 16 aDap ClIEnt mEDICal ElIgIbIlIty rEquIrEmEnts, as oF junE 30, 2015

State/Territory

Medical Eligibility1

Proof of HIV Status CD4 Count Viral Load Prescription for ARV Other











Alabama Yes Yes No No No No Yes Yes No NoAlaska Yes Yes No No No No Yes Yes No NoAmerican Samoa — — — — — — — — — —Arizona Yes Yes No No Most recent laboratory

tests obtained during enrollment or recertification

Most recent laboratory tests obtained during enrollment or recertification

Yes Yes No No

Arkansas Yes Yes No No No No No No No NoCalifornia Yes Yes Current within 12 months

of enrollmentCurrent within 12 months of enrollment

Current within 12 months of enrollment


No No No No

Colorado Yes Yes No No No No No No No NoConnecticut Yes Yes Current within 12 months




No No No No

Delaware Yes Yes No No No No No No No NoDistrict of Columbia Yes Yes Current within 6 months




No No No No

Federated States of Micronesia Yes No No No No No Yes No No NoFlorida Yes Yes Current within 6 months




Yes Yes No No

Georgia Yes Yes No No No No No No No NoGuam — — — — — — — — — —Hawaii Yes Yes No No No No No No No NoIdaho Yes Yes No No No No No No No NoIllinois No No Most recent laboratory





No No No No

Indiana Yes Yes No No No No No No No NoIowa Yes Yes No No No No Yes Yes No NoKansas Yes Yes No No No No No No No NoKentucky — — — — — — — — — —Louisiana Yes Yes No No No No No No No NoMaine Yes Yes Current within 12 months




No No No No

Marshall Islands — — — — — — — — — —Maryland Yes Yes Current within 6 months


Detectable viral load Detectable viral load No No Yes Yes

Massachusetts Yes Yes Current within 12 months of enrollment




No No No No

Michigan Yes Yes Most recent laboratory tests obtained during enrollment or recertification




No No No No

Minnesota Yes Yes Yes Yes Yes Yes No No No NoMississippi Yes Yes No No No No No No No NoMissouri Yes Yes No No No No No No No No

52

State/Territory

Medical Eligibility1

Proof of HIV Status CD4 Count Viral Load Prescription for ARV Other











Montana Yes Yes No No No No No No No NoNebraska Yes Yes No No No No No No No NoNevada — — — — — — — — — —New Hampshire Yes Yes No No No No No No No NoNew Jersey Yes Yes No No No No No No No NoNew Mexico Yes Yes No No No No Yes No No NoNew York Yes Yes No No No No No No No NoNorth Carolina No No No No No No Yes Yes No NoNorth Dakota Yes Yes No No No No No No No NoNorthern Mariana Islands — — — — — — — — — NoOhio Yes Yes No No No No No No No NoOklahoma Yes Yes No No No No No No No NoOregon Yes Yes No No No No No No No NoPennsylvania Yes Yes Most recent laboratory


No Most recent laboratory tests obtained during enrollment or recertification

No No No No No

Puerto Rico Yes Yes No No No No No No No NoRepublic of Palau — — — — — — — — — —Rhode Island Yes Yes No No No No No No No NoSouth Carolina Yes Yes No No No No Yes Yes No YesSouth Dakota Yes No Most recent laboratory


No Most recent laboratory tests obtained during enrollment or recertification

No No No No No

Tennessee Yes Yes No No No No No No No YesTexas Yes Yes Most recent laboratory





Yes Yes No No

Utah Yes Yes No No No No Yes Yes No NoVermont Yes Yes No No No No No No No NoVirgin Islands (U.S.) Yes Yes Most recent laboratory



Detectable viral load Detectable viral load No No No No

Virginia Yes Yes No No No No No No No NoWashington Yes Yes No No No No No No No NoWest Virginia Yes Yes No No No No No No No NoWisconsin Yes Yes No No No No No No No NoWyoming Yes Yes No No No No No No No No

1 CD4 = CD4 cell count; VL = Viral load.


53

table 17 aDap ClIEnt ElIgIbIlIty rEquIrEmEnts, as oF junE 30, 2015

State/Territory

Asset Limits State Residency Requirement



Full-Pay Medications (Uninsured) ADAP-Funded Insurance Program

Alabama No No Proof of state residency required Proof of state residency requiredAlaska Yes Yes Must be a resident for at least 30

days with proof and intent to stayMust be a resident for at least 30 days with proof and intent to stay

American Samoa — — — —Arizona No No Proof of state residency required Proof of state residency requiredArkansas No No Proof of state residency required Proof of state residency requiredCalifornia No No Proof of state residency required Proof of state residency requiredColorado No No Proof of state residency required Proof of state residency requiredConnecticut No No Self-attestation required Self-attestation requiredDelaware No No Proof of state residency required Proof of state residency requiredDistrict of Columbia $25,000 $25,000 Proof of state residency required Proof of state residency requiredFederated States of Micronesia No No Self-attestation required Self-attestation requiredFlorida No No Self-attestation required Self-attestation requiredGeorgia $10,000 $10,000 Proof of state residency required Proof of state residency requiredGuam — — — —Hawaii No No Proof of state residency required2 Proof of state residency required2

Idaho No No Proof of state residency required Proof of state residency requiredIllinois No No Proof of state residency required Proof of state residency requiredIndiana No No Proof of state residency required Proof of state residency requiredIowa No No Proof of state residency required Proof of state residency requiredKansas No No Proof of state residency required Proof of state residency requiredKentucky — — — —Louisiana No No Proof of state residency required Proof of state residency requiredMaine No No Proof of state residency required Proof of state residency requiredMarshall Islands — — — —Maryland No No Proof of state residency required Proof of state residency requiredMassachusetts No No Proof of state residency required Proof of state residency requiredMichigan No No Proof of state residency required Proof of state residency requiredMinnesota No No Self-attestation required Self-attestation requiredMississippi No No Proof of state residency required Proof of state residency requiredMissouri No No Proof of state residency required Proof of state residency requiredMontana No No Proof of state residency required Proof of state residency requiredNebraska No No Self-attestation required Self-attestation requiredNevada — — — —New Hampshire No No Proof of state residency required Proof of state residency requiredNew Jersey No No Proof of state residency required Proof of state residency requiredNew Mexico $10,000 $10,000 Proof of state residency required Proof of state residency requiredNew York 250003 250003 Proof of state residency required Proof of state residency requiredNorth Carolina No No Proof of state residency required Proof of state residency requiredNorth Dakota No No Must be a resident for at least 60

days with proof and intent to stayMust be a resident for at least 60 days with proof and intent to stay

Northern Mariana Islands — — — —Ohio No No Proof of state residency required Proof of state residency requiredOklahoma No No Proof of state residency required Proof of state residency requiredOregon No No Proof of state residency required Proof of state residency requiredPennsylvania $58,250 No Proof of state residency required Proof of state residency requiredPuerto Rico No No Must be a resident for at least 60

days with proofMust be a resident for at least 60 days with proof

Republic of Palau — — — —Rhode Island No No Proof of state residency required Proof of state residency requiredSouth Carolina No No Self-attestation required Self-attestation requiredSouth Dakota No No Proof of state residency required Proof of state residency requiredTennessee No No Proof of state residency required Proof of state residency requiredTexas No No Proof of state residency required Proof of state residency requiredUtah $5,0004 $5,0004 Proof of state residency required Proof of state residency requiredVermont No No Proof of state residency required Proof of state residency requiredVirgin Islands (U.S.) No No Self-attestation required Self-attestation requiredVirginia No No Proof of state residency required Proof of state residency requiredWashington No No Proof of state residency required Proof of state residency requiredWest Virginia No No Proof of state residency required Proof of state residency requiredWisconsin No No Proof of state residency required Proof of state residency requiredWyoming No No Proof of state residency required Proof of state residency required

Total 7 6 52 52

1 In Alaska, clients must not own more than one home or registered vehicle.2 With provisions for individuals who are physically present and live in the state but lack any documentation to that effect, such as homeless persons.3 In New York, the $25,000 asset limit for ADAP eligibility does not include federally-recognized retirement accounts.4 In Utah, in addition to the $5,000 asset limit for ADAP eligibility, clients must not own more than one home or registered vehicle.


54

table 17 aDap ClIEnt ElIgIbIlIty rEquIrEmEnts, as oF junE 30, 2015 (ContInuED)

State/Territory

Case Management Requirement

Other Requirement



Alabama Ongoing Ongoing NoAlaska Ongoing Ongoing No

American Samoa — — —Arizona As needed As needed NoArkansas Ongoing Ongoing NoCalifornia No No Must be 18 years of age and must not be eligible for full-scope of MedicaidColorado As needed As needed NoConnecticut No No NoDelaware Ongoing Ongoing NoDistrict of Columbia No No NoFederated States of Micronesia As needed No NoFlorida As needed As needed NoGeorgia Ongoing Ongoing NoGuam — — —Hawaii Ongoing Ongoing NoIdaho Ongoing Ongoing NoIllinois No No NoIndiana Ongoing Ongoing NoIowa Ongoing Ongoing NoKansas Ongoing Ongoing NoKentucky — — —Louisiana No No NoMaine No No NoMarshall Islands — — —Maryland No No Must not be eligible for MedicaidMassachusetts No No NoMichigan No No NoMinnesota No No NoMississippi As needed As needed NoMissouri Ongoing Ongoing NoMontana As needed As needed NoNebraska No No NoNevada — — —New Hampshire Ongoing Ongoing NoNew Jersey No No NoNew Mexico Initial Ongoing NoNew York No No NoNorth Carolina No No NoNorth Dakota Ongoing Ongoing No

Northern Mariana Islands — — —Ohio As needed As needed NoOklahoma As needed As needed NoOregon Ongoing No NoPennsylvania As needed No NoPuerto Rico Ongoing Ongoing Yes

Republic of Palau — — —Rhode Island Ongoing Ongoing YesSouth Carolina No As needed NoSouth Dakota Ongoing No NoTennessee Ongoing Ongoing NoTexas No No YesUtah As needed As needed NoVermont No No NoVirgin Islands (U.S.) Ongoing Ongoing NoVirginia No No NoWashington No No NoWest Virginia Ongoing Ongoing NoWisconsin No No NoWyoming No Ongoing No

Total 52 52 52


55

table 18 aDap Drug purChasIng, junE 2015

State/Territory Purchasing Mechanism

Participates in 340B Drug

Discount Program

Participates in HRSA Prime

Vendor Program

Average Dispensing Fee

Per Prescription1

Alabama Dual Yes Yes $10Alaska Direct purchase Yes Yes $25American Samoa — — — —Arizona Direct purchase Yes Yes $10Arkansas Dual Yes Yes $6California Rebate Yes No $2Colorado Dual Yes Yes $6Connecticut Rebate Yes No $0Delaware Hybrid Yes Yes $6District of Columbia Direct purchase No No $11Federated States of Micronesia Direct purchase No No $0Florida Dual Yes Yes $0Georgia Dual Yes Yes $12Guam — — — —Hawaii Dual Yes Yes $14Idaho Rebate Yes No —Illinois Dual Yes Yes $13Indiana Rebate Yes No $2Iowa Dual Yes Yes $20Kansas Rebate Yes No $3Kentucky — — — —Louisiana Dual Yes Yes $14Maine Rebate Yes No $3Marshall Islands — — — —Maryland Rebate Yes Yes $3Massachusetts Rebate Yes No $0.45Michigan Rebate Yes No $5Minnesota Rebate Yes No $4Mississippi Direct purchase Yes Yes $0Missouri Rebate Yes No $0Montana Dual Yes Yes $5Nebraska Dual Yes No $2Nevada — — — —New Hampshire Rebate No No $2New Jersey Direct purchase Yes No $0New Mexico Direct purchase Yes Yes $0New York Rebate Yes No $3North Carolina Dual Yes Yes $14North Dakota Rebate Yes No $6Northern Mariana Islands — — — —Ohio Hybrid Yes Yes $13Oklahoma Dual Yes Yes $6Oregon Dual Yes Yes $26Pennsylvania Rebate Yes Yes $4Puerto Rico Dual Yes Yes $3Republic of Palau — — — —Rhode Island Rebate Yes No $3South Carolina Dual Yes Yes $14South Dakota Rebate Yes No $5Tennessee Direct purchase Yes Yes $14Texas Hybrid Yes No $0Utah Dual Yes No $20Vermont Rebate Yes No $0Virgin Islands (U.S.) Dual Yes No $15Virginia Dual Yes Yes $0Washington Rebate Yes No $5West Virginia Rebate No No $3Wisconsin Rebate Yes No $4Wyoming Rebate Yes Yes $0

Total 48 26

Direct Purchase states – ADAPs using this model centrally purchase and dispense medications through their own pharmacy or a single contract pharmacy service provider.

Rebate states – These are ADAPs who pay retail pharmacies a pre-determined amount at the point of sale for drugs dispensed to ADAP clients. ADAP then bills drug manufacturers for the 340B Unit Rebate amount for the number of units dispensed.

Hybrid states – A direct purchase state that utilizes an existing entity (e.g., University Hospital) to purchase and distribute ADAP drugs. The entity maintains a single drug inventory purchased at 340B prices. To secure the additional supplemental discounts negotiated by the ADAP Crisis Task Force, these ADAPs must submit rebate claims for the supplemental discount amount.

Dual Purchaser – ADAPs that purchase and dispense medications through their own pharmacy or a single contract pharmacy service provider AND pay retail pharmacies for some clients and file rebate claims including partial pay claims.

340B Drug Pricing Program – requires drug manufacturers to provide outpatient drugs to eligible health care organizations for eligible patients at significantly reduced prices. The 340B program is designed to provide a pricing benefit to safety-net providers. The 340B program is administered by the Office of Pharmacy Affairs.

HRSA Prime Vendor Program – Participants in the 340B Program may also participate in the 340B Prime Vendor Program. A “prime vendor” is an entity that negotiates with manufacturers on behalf of a group of drug purchasers, in order to obtain reduced drug prices. HRSA has chosen a prime vendor to negotiate additional discounts (i.e., lower than the 340B ceiling price or sub-340B ceiling price) for participants, including ADAPs.

1 Note: States may pay a different dispensing fee for generic vs. brand name medications.


56

table 19 aDap Drug ExpEnDIturEs (InCluDIng purChasEs anD Co-paymEnts), junE 2015


Drug Purchases

Drug Purchases % of Total

Expenditures

June 2015 Co-Payment

Expenditures

Co-Payment % of Total

Expenditures

June 2015 Total Drug Expenditures

(Including Purchases and Co-payments)

Alabama $401,102 100% $0 0% $401,102Alaska $89,228 86% $14,198 14% $103,426American Samoa — — — — —Arizona $962,032 68% $449,491 32% $1,411,523Arkansas $464,575 95% $24,969 5% $489,544California $21,933,577 92% $1,868,059 8% $23,801,636Colorado $527,098 61% $334,772 39% $861,870Connecticut $2,246,771 94% $150,373 6% $2,397,144Delaware $212,032 100% $0 0% $212,032District of Columbia $1,030,432 97% $36,419 3% $1,066,851Federated States of Micronesia $0 0% $0 0% $0Florida $14,115,922 96% $542,178 4% $14,658,100Georgia $4,240,166 100% $0 0% $4,240,166Guam — — — — —Hawaii $69,612 70% $29,903 30% $99,515Idaho — — — — —Illinois $2,277,223 87% $347,333 13% $2,624,556Indiana $1,239,212 100% $0 0% $1,239,212Iowa $82,173 73% $30,506 27% $112,679Kansas — — — — —Kentucky — — — — —Louisiana $1,029,529 68% $483,735 32% $1,513,264Maine $74,427 61% $48,384 39% $122,811Marshall Islands — — — — —Maryland $2,122,146 76% $670,863 24% $2,793,009Massachusetts $290,146 70% $123,548 30% $413,694Michigan $1,502,733 100% $0 0% $1,502,733Minnesota $257,966 90% $27,194 10% $285,160Mississippi $1,008,383 100% $0 0% $1,008,383Missouri $2,156,060 89% $273,935 11% $2,429,995Montana $69,471 100% $0 0% $69,471Nebraska $162,245 72% $63,553 28% $225,798Nevada — — — — —New Hampshire $103,154 79% $27,543 21% $130,697New Jersey $5,835,507 93% $439,338 7% $6,274,845New Mexico $51,908 100% $0 0% $51,908New York $26,912,199 100% $0 0% $26,912,199North Carolina $3,756,748 95% $217,654 5% $3,974,402North Dakota $64,755 86% $10,642 14% $75,397Northern Mariana Islands — — — — —Ohio $385,013 58% $276,149 42% $661,162Oklahoma $119,881 53% $107,018 47% $226,899Oregon $1,193,459 100% $0 0% $1,193,459Pennsylvania $7,481,264 94% $458,476 6% $7,939,740Puerto Rico $2,861,971 96% $103,812 4% $2,965,783Republic of Palau — — — — —Rhode Island $209,350 54% $174,910 46% $384,260South Carolina $1,288,171 70% $562,926 30% $1,851,097South Dakota $64,214 100% $0 0% $64,214Tennessee $318,983 37% $548,636 63% $867,619Texas $8,424,600 95% $450,580 5% $8,875,180Utah $289,588 88% $40,971 12% $330,559Vermont $0 0% $32,830 100% $32,830Virgin Islands (U.S.) $19,436 100% $0 0% $19,436Virginia $1,111,999 59% $788,582 41% $1,900,581Washington $235,073 41% $336,633 59% $571,706West Virginia $312,427 91% $31,024 9% $343,451Wisconsin $1,190,622 100% $0 0% $1,190,622Wyoming — — — — —

Total $120,794,583 92% $10,127,137 8% $130,921,720

Note: 49 ADAPs reported data. American Samoa, Guam, Idaho, Kansas, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands, Republic of Palau and Wyoming did not respond. A zero ($0) indicates the ADAP responded zero ($0) to the question.

57

table 20 aDap Drug Expenditures (Including purchases and Co-payments), by Drug Category, june 2015

State/TerritoryJune 2015 Total

Expenditures

June 2015 ARV Total

Expenditures1

ARV % of Total Expen-ditures1

June 2015 “A1” OI

Total Expen-ditures2

“A1” OI % of Total

Expen-ditures2

June 2015 HCV Total

Expen-ditures3

HCV % of Total Expen-

ditures3

June 2015 All Other Total Expenditures

All Other % of Total

Expen-ditures

Alabama $401,102 $401,102 100% $0 0% $0 0% $0 0.0%Alaska $103,426 $101,691 98% $58 0% $0 0% $1,677 2%American Samoa — — — — — — — — —Arizona $1,411,523 $1,241,793 88% $30,247 2% $17,363 1% $122,120 9%Arkansas $489,544 $275,067 56% $6,275 1% $206,202 42% $2,000 0.4%California $23,801,636 $22,925,656 96% $181,077 1% $49,029 0.2% $645,874 3%Colorado $861,870 $502,304 58% $12,744 1% $333,636 39% $13,186 2%Connecticut $2,397,144 $1,187,008 50% $11,563 0.5% $0 0% $1,198,573 50%Delaware $212,032 $198,249 93% $957 0.5% $4 0.002% $12,822 6%District of Columbia $1,066,851 $1,039,727 97% $22,756 2% $2,316 0.2% $2,052 0.2%Federated States of Micronesia $0 $0 0% $0 0% $0 0% $0 0%Florida $14,658,100 $14,622,624 100% $35,476 0.2% $0 0% $0 0%Georgia $4,240,166 $4,209,673 99% $30,493 1% $0 0% $0 0.00%Guam — — — — — — — — —Hawaii $99,515 $93,228 94% $253 0% $0 0% $6,034 6%Idaho — — — — — — — — —Illinois $2,624,556 $2,357,223 90% $51,783 2% $0 0% $215,550 8%Indiana $1,239,212 $678,905 55% $4,462 0.4% $0 0% $555,845 45%Iowa $112,679 $83,045 74% $153 0.1% $29,048 26% $433 0.4%Kansas — — — — — — — — —Kentucky — — — — — — — — —Louisiana $1,513,264 $1,402,553 93% $32,926 2% $2,511 0.2% $75,274 5%Maine $122,811 $119,354 97% $731 1% $0 0% $2,726 2%Marshall Islands — — — — — — — — —Maryland $2,793,009 $2,728,239 98% $23,406 1% $1,626 0.1% $39,738 1%Massachusetts $413,694 $289,462 70% $741 0.2% $48 0.01% $123,443 30%Michigan $1,502,733 $1,452,722 97% $9,938 1% $0 0% $40,073 3%Minnesota $285,160 $280,483 98% $1,098 0.4% $0 0% $3,579 1%Mississippi $1,008,383 $977,764 97% $22,739 2% $0 0% $7,880 1%Missouri $2,429,995 $1,362,507 56% $10,478 0.4% $0 0% $1,057,010 43%Montana $69,471 $68,432 99% $187 0.3% $0 0% $852 1%Nebraska $225,798 $222,114 98% $1,604 1% $0 0% $2,080 1%Nevada — — — — — — — — —New Hampshire $130,697 $108,163 83% $1,205 1% $0 0% $21,329 16%New Jersey $6,274,845 $5,548,102 88% $288,942 5% $167,662 3% $270,139 4%New Mexico $51,908 $51,154 99% $218 0% $0 0.0% $536 1%New York $26,912,199 $24,942,496 93% $500,000 2% $13,135 0.05% $1,456,568 5%North Carolina $3,974,402 $3,807,104 96% $36,249 1% $0 0% $131,049 3%North Dakota $75,397 $70,453 93% $3,576 5% $0 0% $1,368 2%Northern Mariana Islands — — — — — — — — —Ohio $661,162 $649,996 98% $3,365 1% $0 0% $7,801 1%Oklahoma $226,899 $205,921 91% $3,571 2% $1,588 1% $15,819 7%Oregon $1,193,459 $829,990 70% $25,567 2% $6,635 1% $331,267 28%Pennsylvania $7,939,740 $6,554,696 83% $52,553 1% $1,590 0.02% $1,330,901 17%Puerto Rico $2,965,783 $2,916,593 98% $49,190 2% $0 0% $0 0%Republic of Palau — — — — — — — — —Rhode Island $384,260 $375,167 98% $1,482 0.4% $0 0% $7,611 2%South Carolina $1,851,097 $1,833,695 99% $8,006 0.4% $0 0% $9,396 1%South Dakota $64,214 $42,810 67% $2,481 4% $0 0% $18,923 29%Tennessee $867,619 $867,619 100% $0 0% $0 0% $0 0%Texas $8,875,180 $8,743,615 99% $59,477 0.67% $3,168 0% $68,920 1%Utah $330,559 $325,557 98% $5,002 2% $0 0% $0 0%Vermont $32,830 $32,830 100% $0 0% $0 0% $0 0%Virgin Islands (U.S.) $19,436 $15,514 80% $28 0.1% $0 0% $3,894 20%Virginia $1,900,581 $1,809,835 95% $16,052 1% $62,947 3% $11,747 1%Washington $571,706 $420,004 73% $123,305 22% $878 0.2% $27,519 5%West Virginia $343,451 $329,097 96% $6,398 2% $0 0% $7,956 2%Wisconsin $1,190,622 $1,174,190 99% $13,712 1% $0 0% $2,720 0.2%Wyoming — — — — — — — — —

Total $130,921,720 $120,475,526 92% $1,692,523 1% $899,386 1% $7,854,284 6%

1 ARV = Antiretrovirals.2 “A1” OI = Drugs recommended (“A1”) for the prevention and treatment of opportunistic infections (OIs).3 HCV = Drugs recommended for the treatment of hepatitis C (HCV).

Note: 49 ADAPs reported data. American Samoa, Guam, Idaho, Kansas, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands, Republic of Palau and Wyoming did not respond. A dash (—) indicates the ADAP did not report data. A zero ($0) indicates the ADAP responded zero ($0) to the question.

58

table 21 aDap prEsCrIptIons FIllED (InCluDIng purChasEs anD Co-paymEnts), junE 2015

State/TerritoryJune 2015 Drug

Purchases Rx1

Drug Purchases Rx % of Total Rx

June 2015 Co-Payment Rx

Co-Payment Rx % of Total Rx June 2014 Total Rx

Alabama 2,974 100% 0 0% 2,974Alaska 355 100% 0 0% 355American Samoa — — — — —Arizona 4,145 44% 5,300 56% 9,445Arkansas 2,302 77% 697 23% 2,999California 25,168 45% 31,111 55% 56,279Colorado 637 10% 5,575 90% 6,212Connecticut 3,144 76% 1,010 24% 4,154Delaware 2,282 100% 0 0% 2,282District of Columbia 1,392 79% 375 21% 1,767Federated States of Micronesia 0 0% 0 0% 0Florida 19,995 77% 5,851 23% 25,846Georgia 10,861 100% 0 0% 10,861Guam — — — — —Hawaii 183 27% 489 73% 672Idaho — — — — —Illinois 4,991 58% 3,592 42% 8,583Indiana 5,127 100% 0 0% 5,127Iowa 126 20% 500 80% 626Kansas — — — — —Kentucky — — — — —Louisiana 2,025 18% 9,024 82% 11,049Maine 70 8% 836 92% 906Marshall Islands — — — — —Maryland 2,938 32% 6,117 68% 9,055Massachusetts 568 5% 11,764 95% 12,332Michigan 5,778 100% 0 0% 5,778Minnesota 526 46% 626 54% 1,152Mississippi 2,831 100% 0 0% 2,831Missouri 2,726 34% 5,324 66% 8,050Montana 301 100% 0 0% 301Nebraska 435 49% 457 51% 892Nevada — — — — —New Hampshire 198 25% 592 75% 790New Jersey 7,878 57% 5,941 43% 13,819New Mexico 313 100% 0 0% 313New York 56,229 100% 0 0% 56,229North Carolina 12,684 79% 3,452 21% 16,136North Dakota 99 39% 155 61% 254Northern Mariana Islands — — — — —Ohio 1,199 33% 2,391 67% 3,590Oklahoma 485 8% 5,299 92% 5,784Oregon 10,720 100% 0 0% 10,720Pennsylvania 10,424 52% 9,596 48% 20,020Puerto Rico 14,305 97% 457 3% 14,762Republic of Palau — — — — —Rhode Island 181 23% 592 77% 773South Carolina 3,929 51% 3,749 49% 7,678South Dakota 467 100% 0 0% 467Tennessee 1,768 32% 3,741 68% 5,509Texas 20,400 91% 2,060 9% 22,460Utah 256 73% 95 27% 351Vermont 0 0% 349 100% 349Virgin Islands (U.S.) 303 0% 0 0% 303Virginia 2,953 32% 6,378 68% 9,331Washington 325 22% 1,125 78% 1,450West Virginia 560 57% 414 43% 974Wisconsin 1,727 100% 0 0% 1,727Wyoming 0 0% 0 0% 0

Total 249,283 65% 135,034 35% 384,317

1 Rx = Prescription.

Note: 50 ADAPs reported data. American Samoa, Guam, Idaho, Kansas, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond. A dash (—) indicates the ADAP did not report data. A dash (—) indicates the ADAP did not report data. A zero (0) indicates the ADAP responded zero (0) to the question.

59

table 22 aDap prescriptions Filled (Including purchases and Co-payments), by Drug Category, june 2015

State/TerritoryJune 2015 Total Rx1

June 2015 ARV Total

Rx2

ARV % of Total Rx2

June 2015 “A1” OI

Total Rx3

“A1” OI % of Total Rx3

June 2015 HCV Total

Rx4

HCV % of Total Rx4

June 2015 All Other Total Rx

All Other Rx % of Total Rx

Alabama 2,974 2,974 100% 0 0% 0 0% 0 0%Alaska 355 278 78% 37 10% 0 0% 40 11%American Samoa — — — — — — — — —Arizona 9,445 4,660 49% 1,146 12% 3 0.03% 3,636 38%Arkansas 2,999 2,280 76% 700 23% 19 1% 0 0%California 56,279 34,746 62% 4,142 7% 12 0.02% 17,379 31%Colorado 6,212 3,396 55% 1,235 20% 2 0.03% 1,579 25%Connecticut 4,154 1,815 44% 262 6% 0 0% 2,077 50%Delaware 2,282 1,031 45% 81 4% 1 0.04% 1,169 51%District of Columbia 1,767 1,561 88% 57 3% 7 0.4% 142 8%Federated States of Micronesia 0 0 0% 0 0% 0 0% 0 0%Florida 25,846 23,543 91% 2,303 9% 0 0% 0 0%Georgia 10,861 9,386 86% 1,475 14% 0 0% 0 0%Guam — — — — — — — — —Hawaii 672 464 69% 47 7% 0 0% 161 24%Idaho — — — — — — — — —Illinois 8,583 6,688 78% 716 8% 0 0% 1,179 14%Indiana 5,127 1,237 24% 166 3% 0 0% 3,724 73%Iowa 626 489 78% 27 4% 5 1% 105 17%Kansas — — — — — — — — —Kentucky — — — — — — — — —Louisiana 11,049 3,864 35% 841 8% 12 0% 6,332 57%Maine 906 510 56% 49 5% 0 0% 347 38%Marshall Islands — — — — — — — — —Maryland 9,055 5,935 66% 311 3% 13 0.1% 2,796 31%Massachusetts 12,332 3,148 26% 128 1% 10 0.1% 9,046 73%Michigan 5,778 3,332 58% 238 4% 0 0% 2,208 38%Minnesota 1,152 536 47% 99 9% 0 0% 517 45%Mississippi 2,831 2,045 72% 429 15% 0 0% 357 13%Missouri 8,050 2,720 34% 238 3% 0 0% 5,092 63%Montana 301 236 78% 14 5% 0 0% 51 17%Nebraska 892 642 72% 41 5% 0 0% 209 23%Nevada — — — — — — — — —New Hampshire 790 314 40% 12 2% 0 0% 464 59%New Jersey 13,819 6,268 45% 962 7% 15 0.1% 6,574 48%New Mexico 313 250 80% 21 7% 0 0% 42 13%New York 56,229 28,459 51% 2,747 5% 23 0.04% 25,000 44%North Carolina 16,136 9,637 60% 1,346 8% 0 0% 5,153 32%North Dakota 254 162 64% 46 18% 0 0% 46 18%Northern Mariana Islands — — — — — — — — —Ohio 3,590 2,768 77% 199 6% 0 0% 623 17%Oklahoma 5,784 2,654 46% 289 5% 7 0.12% 2,834 49%Oregon 10,720 3,040 28% 647 6% 28 0.3% 7,005 65%Pennsylvania 20,020 7,193 36% 873 4% 4 0.02% 11,950 60%Puerto Rico 14,762 12,018 81% 2,744 19% 0 0% 0 0%Republic of Palau — — — — — — — — —Rhode Island 773 635 82% 26 3% 0 0% 112 14%South Carolina 7,678 6,019 78% 540 7% 0 0% 1,119 15%South Dakota 467 222 48% 52 11% 0 0% 193 41%Tennessee 5,509 5,509 100% 0 0% 0 0% 0 0%Texas 22,460 19,519 87% 1,095 5% 1 0.004% 1,845 8%Utah 351 294 84% 57 16% 0 0% 0 0%Vermont 349 349 100% 0 0% 0 0% 0 0%Virgin Islands (U.S.) 303 209 69% 14 5% 0 0% 80 26%Virginia 9,331 5,675 61% 569 6% 5 0.1% 3,082 33%Washington 1,450 727 50% 222 15% 7 0.5% 494 34%West Virginia 974 714 73% 74 8% 0 0% 186 19%Wisconsin 1,727 1,433 83% 162 9% 0 0% 132 8%Wyoming 0 0 0% 0 0% 0 0% 0 0%

Total 384,317 231,584 60% 27,479 7% 174 0.05% 125,080 33%

1 Rx = Prescription.2 ARV = Antiretrovirals.3 “A1” OI = Drugs recommended (“A1”) for the prevention and treatment of opportunistic infections (OIs).

Note: 50 ADAPs reported data. American Samoa, Guam, Idaho, Kansas, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond. A dash (—) indicates the ADAP did not report data. A dash (—) indicates the ADAP did not report data. A zero (0) indicates the ADAP responded zero (0) to the question.

60

table 23 aDap prEsCrIptIon DIstrIbutIon, junE 2015

State/Territory

Mail Order Delivered to Client’s Home

Mail Order Delivered to Client’s Clinic Central Pharmacy Pick-up

Central Pharmacy Distribution

Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance

Alabama No Yes Yes No No No No NoAlaska Yes Yes Yes Yes No No No NoAmerican Samoa — — — — — — — —Arizona Yes Yes Yes Yes Yes Yes Yes YesArkansas Yes Yes No No Yes Yes Yes YesCalifornia Yes Yes No No No No No NoColorado Yes Yes Yes Yes Yes Yes Yes YesConnecticut No Yes No No No No No NoDelaware No Yes No No No No Yes NoDistrict of Columbia Yes Yes No No Yes Yes No NoFederated States of Micronesia No No No No No No No NoFlorida Yes Yes Yes Yes No No Yes NoGeorgia Yes No No No No No No NoGuam — — — — — — — —Hawaii Yes Yes Yes Yes Yes Yes Yes YesIdaho No No Yes No No No No NoIllinois Yes Yes Yes Yes Yes Yes No NoIndiana No Yes No No No No No YesIowa Yes Yes Yes Yes Yes Yes Yes YesKansas No Yes No No No No No NoKentucky — — — — — — — —Louisiana No No No No No No No NoMaine No Yes No No No No No NoMarshall Islands — — — — — — — —Maryland No Yes No Yes No No No NoMassachusetts No No No No No No No NoMichigan Yes Yes Yes Yes No No No NoMinnesota Yes Yes No No No No No NoMississippi Yes Yes Yes Yes No No Yes YesMissouri No Yes No No No No No NoMontana Yes Yes Yes Yes Yes Yes Yes YesNebraska Yes Yes No No Yes No Yes NoNevada — — — — — — — —New Hampshire Yes Yes No No No No No NoNew Jersey No No No No No No No NoNew Mexico Yes Yes Yes Yes Yes No Yes NoNew York Yes Yes Yes Yes No No No NoNorth Carolina Yes Yes Yes Yes Yes Yes Yes YesNorth Dakota No No No No No No No NoNorthern Mariana Islands — — — — — — — —Ohio Yes Yes Yes Yes No No No NoOklahoma Yes Yes Yes Yes Yes Yes No NoOregon Yes Yes Yes Yes No No No NoPennsylvania No No No No No No No NoPuerto Rico No No No No No No Yes NoRepublic of Palau — — — — — — — —Rhode Island No No No No No No No NoSouth Carolina Yes Yes Yes Yes No Yes No NoSouth Dakota No No No No No No Yes NoTennessee Yes Yes Yes No Yes Yes Yes YesTexas No No No No No No No NoUtah Yes Yes No No No No No NoVermont No No No No No No No NoVirgin Islands (U.S.) No Yes No No No No No NoVirginia No Yes No Yes No No Yes NoWashington No No No No No No No NoWest Virginia Yes Yes No No No No No NoWisconsin Yes Yes Yes Yes No No No NoWyoming No No No No No No No No

Total 28 37 21 20 13 12 16 10


61

table 23 aDap prEsCrIptIon DIstrIbutIon, junE 2015 (ContInuED)

State/Territory

Client Choice of Pharmacy or Mail Order

Designated ADAP Pharmacy(ies) for Pick-up Other

Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance

Alabama No Yes Yes No No NoAlaska Yes Yes Yes Yes No NoAmerican Samoa — — — — — —Arizona Yes Yes Yes No No NoArkansas No No Yes Yes No NoCalifornia Yes Yes Yes Yes No NoColorado Yes Yes Yes Yes Yes YesConnecticut Yes Yes No No No NoDelaware No Yes Yes No No NoDistrict of Columbia No No Yes Yes No NoFederated States of Micronesia No No No No No NoFlorida No No No Yes No NoGeorgia Yes Yes Yes No No NoGuam — — — — — —Hawaii No No No No No NoIdaho No Yes No No No NoIllinois No No No No No NoIndiana Yes Yes No No No NoIowa No No No No No NoKansas Yes Yes No No No NoKentucky — — — — — —Louisiana Yes Yes Yes Yes No NoMaine No No Yes Yes No NoMarshall Islands — — — — — —Maryland Yes Yes Yes Yes No NoMassachusetts Yes Yes Yes Yes No NoMichigan Yes Yes Yes Yes No NoMinnesota Yes Yes No No No NoMississippi No No No No Yes YesMissouri Yes Yes Yes Yes No NoMontana Yes Yes Yes Yes No NoNebraska No Yes Yes Yes No NoNevada — — — — — —New Hampshire Yes Yes No No No NoNew Jersey Yes Yes No No No NoNew Mexico No Yes Yes No No NoNew York Yes Yes Yes Yes No NoNorth Carolina Yes Yes Yes No No NoNorth Dakota No No Yes Yes No NoNorthern Mariana Islands — — — — — —Ohio No No No No No NoOklahoma Yes Yes Yes Yes No NoOregon No No Yes Yes Yes YesPennsylvania No No Yes Yes No NoPuerto Rico No No Yes Yes No NoRepublic of Palau — — — — — —Rhode Island No No Yes Yes No NoSouth Carolina No No No No No NoSouth Dakota No No No Yes No NoTennessee Yes Yes Yes Yes No NoTexas No Yes Yes No No NoUtah No No Yes Yes No NoVermont Yes Yes No No No NoVirgin Islands (U.S.) No Yes Yes Yes No NoVirginia No Yes Yes No No NoWashington No No Yes Yes No NoWest Virginia Yes Yes No No No NoWisconsin Yes Yes No No No NoWyoming Yes Yes No No No No

Total 25 33 32 26 3 3


62

table 24 ClIEnts sErvED through InsuranCE purChasIng anD ContInuatIon, 2015

State/TerritoryJune 2015 Clients Served ADAP-Funded Insurance Premium Only1

Deductible/Co-pay/ Co-insurance Only

Premium and Deductible/ Co-pay/Co-insurance

Alabama 90 0 0 90Alaska 84 6 30 48American Samoa — — — —Arizona 895 130 521 244Arkansas 128 0 0 128California 8,768 885 6,655 1,228Colorado 1,590 — — —Connecticut — — — —Delaware 64 64 0 0District of Columbia 230 59 171 0Federated States of Micronesia 0 0 0 0Florida 3,260 0 990 2,270Georgia 114 114 0 0Guam — — — —Hawaii 182 29 124 29Idaho 0 0 0 0Illinois 2,402 1,256 525 621Indiana 2,610 0 340 2,270Iowa 216 29 97 90Kansas 715 0 713 2Kentucky — — — —Louisiana 3,426 142 763 2,521Maine 342 33 234 75Marshall Islands — — — —Maryland 3,121 869 1,850 402Massachusetts 3,146 626 1,975 545Michigan 1,509 390 1,119 0Minnesota 582 0 0 582Mississippi 0 0 0 0Missouri 2,312 629 573 1,110Montana 87 2 55 30Nebraska 343 122 137 84Nevada — — — —New Hampshire 144 41 78 25New Jersey — — — —New Mexico 304 0 0 304New York 9,976 0 0 9,976North Carolina 840 0 840 0North Dakota 76 14 57 5Northern Mariana Islands — — — —Ohio 1,425 0 719 706Oklahoma 1,125 303 283 539Oregon 1,737 1,042 207 488Pennsylvania 3,257 — — —Puerto Rico 224 0 224 0Republic of Palau — — — —Rhode Island 278 20 215 43South Carolina 2,314 195 1,601 518South Dakota 0 0 0 0Tennessee 3,226 887 1,009 1,330Texas 1,930 0 1,848 82Utah 383 296 68 19Vermont 338 0 235 103Virgin Islands (U.S.) 21 0 21 0Virginia 3,990 1,907 382 1,701Washington 3,114 1,492 811 811West Virginia 233 1 180 52Wisconsin 412 251 0 161Wyoming 119 119 0 0

Total 71,682 11,953 25,650 29,232

1 Clients for whom multiple months’ premiums (e.g. a payment was made in April for premium payments for April, May, and June) were paid should only be counted as one individual.

Note: 49 ADAPs reported data. American Samoa, Colorado, Connecticut, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands, Pennsylvania and Republic of Palau did not respond. A dash (—) indicates the ADAP did not report data. A dash (—) indicates the ADAP did not report data.

63

table 25 aDap FunDs usED anD ClIEnts sErvED through InsuranCE purChasIng anD ContInuatIon, 2015

State/Territory FY2015 Estimated

Expenditures

June 2015 Expenditures

Insurance Premiums Insurance

Deductibles

Insurance Co-payments/ Co-insurance Other

Alabama $300,000 $8,136 $0 $54,707 $0Alaska $217,342 $27,341 $0 $0 $14,197American Samoa — — — — —Arizona $1,141,746 $74,848 $0 $216,323 $0Arkansas $450,000 $0 $0 $23,594 $0California $59,461,918 $946,651 $0 $1,996,866 $0Colorado $14,500,000 $344,176 $76,797 $378,590 $135,000Connecticut $1,057,957 $120,285 $0 $181,969 $0Delaware $132,185 $29,273 $0 $0 $0District of Columbia $250,000 $0 $0 $36,419 $0Federated States of Micronesia $0 $0 $0 $0 $0Florida $21,207,218 $720,009 $0 $482,277 $0Georgia $3,062,400 $229,792 $0 $0 $0Guam — — — — —Hawaii $755,000 $17,625 $0 $29,903 $0Idaho $0 $0 $0 $0 $0Illinois $8,900,000 $411,226 $0 $333,835 $0Indiana $12,076,452 $735,943 $248,602 $403,830 $0Iowa $850,000 $180,141 $0 $30,506 $0Kansas $4,500,000 $127,231 $0 $301,822 $0Kentucky — — — — —Louisiana $17,000,000 $1,302,890 $33,202 $256,263 $0Maine $1,162,092 $52,400 $842 $47,541 $0Marshall Islands — — — — —Maryland $12,000,000 $678,544 $83,987 $670,686 $0Massachusetts $7,000,000 $429,490 $0 $290,145 $0Michigan $3,500,000 $430,399 $40,986 $163,943 $0Minnesota $1,684,949 $207,836 $0 $27,894 $0Mississippi $0 $0 $0 $0 $0Missouri $34,701,589 $676,374 $42,567 $311,039 $0Montana $420,000 $28,772 $0 $45,097 $1,063Nebraska $2,520,000 $81,467 $0 $65,216 $0Nevada — — — — —New Hampshire $1,047,000 $37,153 $0 $27,544 $0New Jersey $16,700,000 $607,124 $0 $0 $0New Mexico $1,530,000 $127,495 $0 $0 $0New York $55,000,000 $2,700,000 $0 $0 $1,300,000North Carolina — $0 $0 $3,340,372 $0North Dakota $50,000 $4,513 $0 $10,642 $0Northern Mariana Islands — — — — —Ohio $8,645,280 $370,877 $0 $276,150 $0Oklahoma $8,085,000 $304,081 $0 $109,129 $50,071Oregon $5,468,310 $226,911 $0 $201,032 $0Pennsylvania $7,100,000 $21,771 $458,476 $0 $0Puerto Rico $2,500,000 $0 $0 $312,984 $3,838Republic of Palau — — — — —Rhode Island $2,283,230 $11,587 $151,241 $23,668 $0South Carolina $9,125,000 $225,955 $209,549 $330,809 $0South Dakota $0 $0 $0 $0 $0Tennessee $14,500,000 $730,708 $268,242 $548,636 $0Texas $8,992,490 $49,617 $0 $466,378 $0Utah $2,463,300 $95,774 $29,150 $11,821 $0Vermont $86,700 $6,397 $0 $32,830 $0Virgin Islands (U.S.) $112,900 $0 $0 $26,717 $0Virginia $29,859,876 $1,224,229 $0 $701,284 $0Washington $9,723,576 $627,042 $0 $0 $337,089West Virginia $725,000 $10,647 $1,680 $39,978 $0Wisconsin $2,203,045 $296,605 $0 $0 $0

Wyoming $325,000 $6,585 $0 $0 $0

Total $395,376,555 $15,545,920 $1,645,321 $12,808,439 $1,841,258


64

table 26 ClIEnts sErvED through InsuranCE purChasIng anD ContInuatIon, by InsuranCE plan EnrollmEnt, 2015

State/Territory

June 2015 Clients Served who have Private Insurance



Enrolled in Other Private Insurance Unknown

Alabama 0 0% 0% 0% 0%Alaska 72 75% 10% 15% 0%American Samoa — — — — —Arizona 480 73% 0% 30% 0%Arkansas 0 0% 0% 0% 0%California 4,731 16% 0% 0% 84%Colorado 588 37% 10% 53% 0%Connecticut — — — — —Delaware 64 100% 0% 0% 0%District of Columbia 224 0% 0% 0% 100%Federated States of Micronesia 0 0% 0% 0% 0%Florida 1,910 57% 8% 35% 0%Georgia 265 30% 3% 67% 0%Guam — — — — —Hawaii 121 16% 2% 83% 0%Idaho 0 0% 0% 0% 0%Illinois 1,851 76% 10% 15% 0%Indiana 2,610 17% 64% 19% 0%Iowa 153 0% 39% 61% 0%Kansas 551 52% 6% 40% 3%Kentucky — — — — —Louisiana 2,861 82% 2% 16% 0%Maine 115 20% 34% 42% 0%Marshall Islands — — — — —Maryland 967 89% 42% 25% 0%Massachusetts 636 25% 61% 15% 0%Michigan 749 46% 0% 54% 0%Minnesota 563 32% 40% 28% 0%Mississippi 0 0% 0% 0% 0%Missouri 1,477 58% 15% 27% 0%Montana 35 74% 0% 26% 0%Nebraska 294 63% 7% 30% 0%Nevada — — — — —New Hampshire 125 56% 0% 44% 0%New Jersey — — — — —New Mexico 123 63% 15% 21% 0%New York 5,528 0% 0% 0% 100%North Carolina 51 100% 0% 0% 0%North Dakota 52 10% 4% 87% 0%Northern Mariana Islands — — — — —Ohio 788 47% 0% 53% 0%Oklahoma 943 78% 0% 22% 0%Oregon 797 39% 34% 24% 3%Pennsylvania 1,883 0% 0% 0% 100%Puerto Rico 422 0% 0% 100% 0%Republic of Palau — — — — —Rhode Island 153 24% 0% 0% 74%South Carolina 2,055 51% 2% 22% 25%South Dakota — — — — —Tennessee 0 0% 0% 0% 0%Texas 139 0% 0% 100% 0%Utah 369 36% 40% 25% 0%Vermont 107 36% 0% 64% 0%Virgin Islands (U.S.) 14 0% 0% 100% 0%Virginia 3,556 93% 0% 7% 0%Washington 2,366 25% 0% 75% 0%West Virginia 103 50% 2% 49% 0%Wisconsin 260 50% 0% 50% 0%Wyoming 41 76% 0% 24% 0%

Total 41,192 40% 10% 21% 31%

1 Clients for whom multiple months’ premiums (e.g. a payment was made in April for premium payments for April, May, and June) were paid should only be counted as one individual.

Note: 49 ADAPs reported data. American Samoa, Connecticut, Guam, Kentucky, Marshall Islands, Nevada, New Jersey, Northern Mariana Islands, Republic of Palau and South Dakota did not respond. A dash (—) indicates the ADAP did not report data.

65

table 27 aDap polICIEs rElatED to InsuranCE purChasIng as oF junE 30, 2015

State/Territory

ADAP Pays Premiums ADAP Pays Deductibles

Below 100%

FPL

100– 138%

FPL

138– 250%

FPL

250– 400%

FPL

400% FPL and

higher

Below 100%

FPL

100– 138%

FPL

138– 250%

FPL

250– 400%

FPL

400% FPL and

higher

Alabama Yes Yes Yes No No Yes Yes Yes No NoAlaska Yes Yes Yes Yes No Yes Yes Yes Yes NoAmerican Samoa — — — — — — — — — —Arizona Yes Yes Yes Yes No Yes Yes Yes Yes NoArkansas No No No No No Yes Yes No No NoCalifornia3 Yes Yes Yes Yes Yes Yes Yes Yes Yes YesColorado Yes Yes Yes Yes No Yes Yes Yes Yes NoConnecticut No No Yes Yes No No No No No NoDelaware No No Yes Yes Yes No No Yes Yes YesDistrict of Columbia No No No No Yes No No No No YesFederated States of Micronesia No No No No No No No No No NoFlorida Yes Yes Yes Yes No Yes Yes Yes Yes NoGeorgia Yes Yes Yes Yes No No No No No NoGuam — — — — — — — — — —Hawaii Yes Yes Yes Yes No Yes Yes Yes Yes NoIdaho No No No No No No No No No NoIllinois Yes Yes Yes Yes Yes Yes Yes Yes Yes YesIndiana4 Yes Yes Yes Yes No Yes Yes Yes Yes NoIowa No No Yes Yes No No No Yes Yes NoKansas Yes Yes Yes Yes No Yes Yes Yes Yes NoKentucky — — — — — — — — — —Louisiana Yes Yes Yes No No Yes Yes Yes No NoMaine Yes Yes Yes Yes Yes Yes Yes Yes Yes YesMarshall Islands — — — — — — — — — —Maryland Yes Yes Yes Yes Yes Yes Yes Yes Yes YesMassachusetts Yes Yes Yes Yes Yes No No No No NoMichigan No No Yes Yes Yes No No Yes Yes YesMinnesota4 Yes Yes Yes Yes No Yes Yes Yes Yes NoMississippi No No No No No No No No No NoMissouri Yes Yes Yes Yes No Yes Yes Yes Yes NoMontana Yes Yes Yes Yes Yes Yes Yes Yes Yes YesNebraska Yes Yes Yes No No Yes Yes Yes No NoNevada — — — — — — — — — —New Hampshire Yes Yes Yes Yes Yes Yes Yes Yes Yes YesNew Jersey4 No No Yes Yes Yes No No Yes Yes YesNew Mexico Yes Yes Yes Yes No Yes Yes Yes Yes NoNew York Yes Yes Yes Yes Yes Yes Yes Yes Yes YesNorth Carolina No No No No No Yes Yes Yes Yes NoNorth Dakota Yes Yes Yes Yes No Yes Yes Yes Yes NoNorthern Mariana Islands — — — — — — — — — —Ohio Yes Yes Yes Yes No Yes Yes Yes Yes NoOklahoma Yes Yes Yes Yes No Yes Yes Yes Yes NoOregon Yes Yes Yes Yes Yes Yes Yes Yes Yes YesPennsylvania Yes Yes Yes Yes Yes Yes Yes Yes Yes YesPuerto Rico No No No No No Yes Yes Yes No NoRepublic of Palau — — — — — — — — — —Rhode Island Yes Yes Yes Yes No Yes Yes Yes Yes NoSouth Carolina Yes Yes Yes Yes Yes Yes Yes Yes Yes YesSouth Dakota No No No No No No No No No NoTennessee Yes Yes Yes No No Yes Yes Yes No NoTexas Yes Yes Yes No No No No No No NoUtah Yes Yes Yes No No Yes Yes Yes No NoVermont Yes Yes Yes Yes Yes Yes Yes Yes Yes YesVirgin Islands (U.S.) No No No No No No No No No NoVirginia Yes Yes Yes Yes No Yes Yes Yes Yes NoWashington Yes Yes Yes Yes No Yes Yes Yes Yes NoWest Virginia No Yes Yes Yes No Yes Yes Yes Yes NoWisconsin Yes Yes Yes Yes No Yes Yes Yes Yes NoWyoming Yes Yes Yes Yes No Yes Yes Yes Yes No

Total 37 38 43 37 16 38 38 41 35 15

1 Federal ADAP funds cannot be used to pay for medical co-payments/co-insurance.2 The Affordable Care Act provides a new tax credit to help individuals afford health coverage purchased through the Marketplace. If a person qualifies, they may choose how much advance credit payments to apply to premiums each month, up to a maximum amount.3 California’s ADAP assists enrolled clients in paying insurance deductibles for prescriptions only.4 ADAP requires a copy of clients’ tax return be submitted as documentation of income.

Note: 52 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond. A dash (—) indicates the ADAP did not report data or responded “no.”

66

table 27 aDap polICIEs rElatED to InsuranCE purChasIng as oF junE 30, 2015 (ContInuED)

State/Territory

ADAP Pays Co-payments/ Co-insurance

(prescription only)

ADAP Pays Co-payments/ Co-insurance

(medical only1)

ADAP Requires Advance Tax

Credit2

ADAP Requires Tax Return Submission

Below 100%

FPL

100-138%

FPL

138-250%

FPL

250–400%

FPL

400% FPL and higher

Below 100%

FPL

100–138%

FPL

138–250%

FPL

250–400%

FPL

400% FPL and higher

100–138%

FPL

138–250%

FPL

100–138%

FPL

138–250%

FPL

Alabama Yes Yes Yes No No Yes Yes Yes No No No No No NoAlaska Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes YesAmerican Samoa — — — — — — — — — — — — — —Arizona Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes YesArkansas Yes Yes No No No No No No No No N/A N/A N/A N/ACalifornia3 Yes Yes Yes Yes Yes No No No No No No Yes No YesColorado Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes YesConnecticut Yes Yes Yes Yes No No No No No No No Yes No NoDelaware Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes No YesDistrict of Columbia No No No No Yes No No No No Yes N/A N/A N/A N/AFederated States of Micronesia No No No No No No No No No No N/A N/A N/A N/AFlorida Yes Yes Yes Yes No No No No No No Yes Yes No NoGeorgia No No No No No No No No No No Yes Yes Yes YesGuam — — — — — — — — — — — — — —Hawaii Yes Yes Yes Yes No No No No No No Yes Yes Yes YesIdaho No No No No No No No No No No No No No NoIllinois Yes Yes Yes Yes Yes No No No No No Yes Yes Yes YesIndiana4 Yes Yes Yes Yes No Yes Yes Yes Yes No No No Yes YesIowa No No Yes Yes No No No No No No No Yes No YesKansas Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes YesKentucky — — — — — — — — — — — — — —Louisiana Yes Yes Yes No No Yes Yes Yes No No No No No NoMaine Yes Yes Yes Yes Yes No No No No No Yes Yes No NoMarshall Islands — — — — — — — — — — — — — —Maryland Yes Yes Yes Yes Yes No No No No No Yes Yes Yes YesMassachusetts Yes Yes Yes Yes Yes No No No No No Yes Yes Yes YesMichigan No No Yes Yes Yes No No Yes Yes Yes No Yes No NoMinnesota4 Yes Yes Yes Yes No No No No No No No Yes Yes YesMississippi No No No No No No No No No No N/A N/A N/A N/AMissouri Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes YesMontana Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesNebraska Yes Yes Yes No No Yes Yes Yes No No Yes Yes Yes YesNevada — — — — — — — — — — — — — —New Hampshire Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No NoNew Jersey4 No No Yes Yes Yes No No Yes Yes Yes No Yes Yes YesNew Mexico Yes Yes Yes Yes No No No No No No Yes Yes Yes YesNew York Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No NoNorth Carolina Yes Yes Yes Yes No No No No No No N/A N/A N/A N/ANorth Dakota Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes YesNorthern Mariana Islands — — — — — — — — — — — — — —Ohio Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes YesOklahoma Yes Yes Yes Yes No No No No No No Yes Yes Yes YesOregon Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes No YesPennsylvania Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No NoPuerto Rico Yes Yes Yes No No No No No No No N/A N/A N/A N/ARepublic of Palau — — — — — — — — — — — — — —Rhode Island Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes YesSouth Carolina Yes Yes Yes Yes Yes No No No No No Yes Yes No NoSouth Dakota No No No No No No No No No No N/A N/A N/A N/ATennessee Yes Yes Yes No No Yes Yes Yes No No No Yes No YesTexas Yes Yes Yes No No No No No No No No No No NoUtah Yes Yes Yes No No No No No No No Yes Yes No NoVermont Yes Yes Yes Yes Yes No No No No No Yes Yes Yes YesVirgin Islands (U.S.) Yes Yes Yes Yes No No Yes Yes Yes No N/A N/A N/A N/AVirginia Yes Yes Yes Yes No No No No No No Yes Yes Yes YesWashington Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes No NoWest Virginia Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes YesWisconsin Yes Yes Yes Yes No No No No No No Yes Yes Yes YesWyoming Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes

Total 43 43 45 38 17 22 23 25 21 9 29 38 25 30

1 Federal ADAP funds cannot be used to pay for medical co-payments/co-insurance.2 The Affordable Care Act provides a new tax credit to help individuals afford health coverage purchased through the Marketplace. If a person qualifies, they may choose how much advance credit payments to apply to premiums each month, up to a maximum amount.3 California’s ADAP assists enrolled clients in paying insurance deductibles for prescriptions only.4 ADAP requires a copy of clients’ tax return be submitted as documentation of income.

Note: 52 ADAPs reported data. American Samoa, Guam, Kentucky, Marshall Islands, Nevada, Northern Mariana Islands and Republic of Palau did not respond. A dash (—) indicates the ADAP did not report data or responded “no.”

67

table 28 aDap polICIEs rElatED to mEDICarE part D, as oF junE 30, 2015

State/Territory

ADAP Pays Premiums

ADAP Pays Deductibles ADAP Pays Co-payments Eligible for ADAP

Provide Medications During the Donut Hole

Partial Subsidy Clients

Stan-dard

Clients


Stan-dard

Clients

Dually Eligible Clients

Full Subsidy Clients


Stan-dard

Clients

Dually Eligible Clients

Full Subsidy Clients


Standard Clients

Alabama No Yes No Yes No No No Yes No No No Yes YesAlaska No No Yes Yes No Yes Yes Yes No Yes Yes Yes YesAmerican Samoa — — — — — — — — — — — — —Arizona No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesArkansas No No Yes No No No Yes No No No Yes No NoCalifornia Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesColorado Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesConnecticut Yes Yes No No No Yes Yes Yes No Yes Yes Yes YesDelaware No No No No Yes Yes Yes Yes Yes Yes Yes Yes YesDistrict of Columbia Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesFederated States of Micronesia No No No No No No No No No No No No NoFlorida No No Yes Yes Yes No Yes Yes Yes No Yes Yes YesGeorgia Yes Yes No No No No No No No No Yes Yes YesGuam — — — — — — — — — — — — —Hawaii Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesIdaho No No No No No No Yes Yes No No No Yes YesIllinois Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesIndiana No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesIowa No No Yes Yes Yes No Yes Yes Yes No Yes Yes YesKansas No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesKentucky — — — — — — — — — — — — —Louisiana Yes Yes Yes Yes No Yes Yes Yes No Yes Yes Yes YesMaine No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesMarshall Islands — — — — — — — — — — — — —Maryland Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesMassachusetts Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes YesMichigan Yes Yes Yes Yes No Yes Yes Yes No Yes Yes Yes YesMinnesota No Yes Yes Yes No No Yes Yes No No Yes Yes YesMississippi No No No No No Yes Yes Yes No No No Yes YesMissouri Yes Yes Yes Yes No Yes Yes Yes No Yes Yes Yes YesMontana No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesNebraska No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesNevada — — — — — — — — — — — — —New Hampshire Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesNew Jersey No Yes No No Yes Yes Yes Yes Yes No Yes Yes YesNew Mexico Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesNew York Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes YesNorth Carolina No No Yes Yes No Yes Yes Yes No Yes Yes Yes YesNorth Dakota Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesNorthern Mariana Islands — — — — — — — — — — — — —Ohio Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesOklahoma Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesOregon Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesPennsylvania Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesPuerto Rico No No Yes Yes No Yes Yes Yes No Yes Yes Yes YesRepublic of Palau — — — — — — — — — — — — —Rhode Island No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesSouth Carolina No No Yes Yes No No Yes Yes No No Yes Yes YesSouth Dakota No No No No No No No No No No No No NoTennessee No Yes No Yes No Yes Yes Yes No Yes Yes Yes YesTexas Yes Yes No No No No Yes Yes No No Yes Yes YesUtah Yes Yes Yes Yes No Yes Yes Yes No Yes Yes Yes YesVermont Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesVirgin Islands (U.S.) No No Yes Yes No Yes Yes Yes No Yes Yes Yes NoVirginia Yes Yes Yes Yes No No Yes Yes No No Yes Yes YesWashington Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesWest Virginia No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesWisconsin Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes YesWyoming Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Total 27 32 40 41 30 40 48 48 31 38 47 49 48


68

table 29 aDap managEmEnt praCtICEs In plaCE, as oF junE 30, 2015

State/Territory

Client Cost-SharingOverall Program Enrollment Cap

Drug Specific Enrollment Cap

Maximum Cost Per Client

Maximum Number of Prescriptions Per

Client Per Month

Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance

Alabama No No No No No No No Yes No NoAlaska No No No No No No No No No NoAmerican Samoa — — — — — — — — — —Arizona No No No No No No No Yes No NoArkansas No No No No No No No No No NoCalifornia Yes Yes No No No No No Yes No NoColorado No No No No No No No No No NoConnecticut No No No No No No No No No NoDelaware No Yes Yes Yes No No No No No NoDistrict of Columbia No No Yes Yes No No Yes Yes No NoFederated States of Micronesia No No No No No No No No No NoFlorida No No No No No No No No No NoGeorgia No No No No Yes No No Yes No NoGuam — — — — — — — — — —Hawaii No No No No Yes Yes No No No NoIdaho No No No No Yes No No No No NoIllinois No No No No Yes No Yes No No NoIndiana No No Yes Yes No No No No No NoIowa No No No No No No No No No NoKansas No No No No No No No No No NoKentucky — — — — — — — — — —Louisiana No No No No No No No No No NoMaine No Yes No No No No No No No NoMarshall Islands — — — — — — — — — —Maryland No No No No No No No No No NoMassachusetts No No No No No No No No No NoMichigan No No No No No No No No No NoMinnesota No No No No No No No No No NoMississippi No No Yes Yes No No No No No NoMissouri No No No No No No No No No NoMontana No No No No No No No No No NoNebraska No No No No No No No No No NoNevada — — — — — — — — — —New Hampshire No No No No No No No No No NoNew Jersey No No No No No No No No No NoNew Mexico No Yes No No No No No No No NoNew York No No No No No No No No No NoNorth Carolina No No No No No No No No No NoNorth Dakota No No No No No No No No No NoNorthern Mariana Islands — — — — — — — — — —Ohio No No No No No No No No No NoOklahoma No No No No No No No No No NoOregon No No No No No No No No No NoPennsylvania No No No No No No Yes Yes No NoPuerto Rico No No No No No No No Yes No NoRepublic of Palau — — — — — — — — — —Rhode Island No No No No No No No No No NoSouth Carolina No No No No No No No No No NoSouth Dakota No No Yes No No No Yes No No NoTennessee Yes Yes No No No No No Yes No NoTexas No No No No No No No No Yes NoUtah No No Yes Yes No No No No No NoVermont No No No No No No No No No NoVirgin Islands (U.S.) No No No No No No No No No NoVirginia No No No No No No No No No NoWashington Yes Yes No No Yes Yes No No No NoWest Virginia No No No No No No No No No NoWisconsin No No No No No No No No No NoWyoming Yes Yes No No No No No No No No

Total 4 7 6 5 5 2 4 8 1 0

1 ADAP practices are defined as those dictated by the ADAP, not inclusive of those required by individual insurance plans through which the ADAP may provide insurance coverage to clients.2 Step therapy – The practice of beginning drug therapy for a medical condition with the most cost-effective and safest drug therapy and progressing to other more costly or risky therapy, only if necessary. The aims are to control costs and minimize risks. Also called step protocol. Step therapy does not apply to antiretrovirals.


69

table 29 aDap managEmEnt praCtICEs In plaCE, as oF junE 30, 2015 (ContInuED)

State/Territory

Drug(s) with Prior Authorization

Drug(s) with Clinical Criteria

Drug(s) with Required Resistance Testing Step Therapy2 Other

Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance

Alabama Yes Yes Yes No Yes No No No No NoAlaska No No Yes Yes No No No No No NoAmerican Samoa — — — — — — — — — —Arizona No Yes Yes Yes Yes Yes No No Yes YesArkansas Yes Yes No No No No No No No NoCalifornia Yes Yes Yes Yes No No Yes Yes No NoColorado Yes Yes Yes Yes No No No No No NoConnecticut Yes Yes No No No No No No No NoDelaware Yes Yes Yes Yes Yes Yes No No No NoDistrict of Columbia Yes Yes Yes Yes No No No No No NoFederated States of Micronesia No No Yes Yes No No No No No NoFlorida Yes No Yes No No No No No No NoGeorgia Yes No Yes Yes Yes No No No No NoGuam — — — — — — — — — —Hawaii No No No No No No No No Yes YesIdaho Yes No Yes No Yes No No No No NoIllinois Yes No Yes No Yes No No No No NoIndiana No Yes No Yes No No No Yes No NoIowa No No No No No No No No No NoKansas Yes No Yes No No No No No No NoKentucky — — — — — — — — — —Louisiana No No No No No No No No No NoMaine No No No No Yes Yes No No No NoMarshall Islands — — — — — — — — — —Maryland Yes Yes Yes Yes No No No No No NoMassachusetts No No No No No No No No No NoMichigan Yes Yes No No Yes Yes Yes Yes No NoMinnesota Yes Yes No No No No No No No NoMississippi No No No No No No No No No NoMissouri No No No No No No No No No NoMontana Yes Yes Yes Yes Yes Yes Yes Yes No NoNebraska Yes Yes No No No No No No No NoNevada — — — — — — — — — —New Hampshire Yes Yes No No No No Yes Yes No NoNew Jersey Yes Yes No No No No No No No NoNew Mexico Yes No No No No No No No No NoNew York Yes Yes Yes Yes No No No No Yes YesNorth Carolina No No No No No No No No No NoNorth Dakota No No No No No No No No No NoNorthern Mariana Islands — — — — — — — — — —Ohio Yes Yes Yes Yes Yes Yes No No No NoOklahoma No No No No No No No No No NoOregon Yes No No No No No No No No NoPennsylvania No No No No No No No No No NoPuerto Rico Yes Yes Yes Yes No No No No No NoRepublic of Palau — — — — — — — — — —Rhode Island Yes Yes No No No No No No No NoSouth Carolina Yes Yes No No No No No No No NoSouth Dakota No No No No No No No No No NoTennessee No No No No No No No No No NoTexas No No Yes No No No No No No NoUtah No No No No No No No No No NoVermont No No No No No No No No No NoVirgin Islands (U.S.) Yes Yes No No No No No No No NoVirginia No Yes Yes No No No No Yes No NoWashington Yes Yes Yes Yes Yes Yes No No No NoWest Virginia Yes Yes No No No No Yes Yes No NoWisconsin No No No No No No No No No NoWyoming Yes Yes No No No No No No No No

Total 30 26 21 15 11 7 5 7 3 3

1 ADAP practices are defined as those dictated by the ADAP, not inclusive of those required by individual insurance plans through which the ADAP may provide insurance coverage to clients.2 Step therapy - The practice of beginning drug therapy for a medical condition with the most cost-effective and safest drug therapy and progressing to other more costly or risky therapy, only if necessary. The aims are to control costs and minimize risks. Also called step protocol. Step therapy does not apply to antiretrovirals.


70

table 30 KEy DatEs In thE hIstory oF aDap

1987 First antiretroviral (AZT, an NRTI) approved by the FDA; Federal government provides grants to states to help them

purchase AZT, marking beginning of federally funded, state-administered “AZT Assistance Programs.”

1990 ADAPs incorporated into Title II of the newly created Ryan White CARE Act.

1995 First protease inhibitor approved by FDA, and the highly active antiretroviral therapy (HAART) era begins.

1996 First reauthorization of CARE Act—federal ADAP earmark created; first non-nucleoside reverse transcriptase inhibitor

(NNRTI) approved by FDA.

2000 Second reauthorization of CARE Act. Changes for ADAPs include: allowance of insurance purchasing and

maintenance; flexibility to provide other limited services (e.g., adherence support and outreach); and creation

of ADAP supplemental grants program.

2003 NASTAD’s ADAP Crisis Task Force formed to negotiate with pharmaceutical companies on pricing of antiretroviral

medications; first fusion inhibitor approved by FDA.

2004 President’s ADAP Initiative (PAI) announced, allocating $20 million in one-time funding outside of the ADAP system

to reduce ADAP waiting lists in 10 states.

2006 Third reauthorization of the CARE Act, now called, “Title XXVI of the PHS Act as amended by the Ryan White HIV/

AIDS Treatment Modernization Act of 2006” or the “Ryan White Program.” Changes for ADAP include: new formula for

determining state awards, which incorporates living HIV and AIDS cases; new minimum formulary requirement; and

an increase in the ADAP Supplemental set-aside and changes in eligibility and matching requirements.

2007 New minimum formulary requirement effective July 1; first CCR5 antagonist and integrase inhibitor approved by FDA.

2009 Fourth reauthorization of the Ryan White Program. The reauthorization was for four years and included several

technical changes.

2010 Patient Protection and Affordable Care Act (PPACA) signed into law. ADAP emergency funding announced by the

Obama Administration, allocating $25 million in funding to address ADAP waiting lists and cost-containment

measures.

2011 ADAP emergency funding continued at $40 million. In December 2011, President Obama announced an additional

$35 million for ADAPs to address ADAP waiting lists and cost containment measures. Awards from this funding will

be available to states based on a competitive application.

2012 ADAP emergency funding awarded at $75 million, including the continuation of FY2011 funding the allocation of an

additional $35 million announced by President Obama in December 2011.

2013 Open enrollment for insurance through the insurance marketplace established under the Affordable Care Act begins

on October 1.

2014 The first open enrollment period for insurance through the insurance marketplace established under the Affordable

Care Act ends on March 31, 2014. The second open enrollment period begins on November 15, 2014.

2015 The second open enrollment period for insurance through the insurance marketplace established under the

Affordable Care Act ends on April 30, 2015. The third open enrollment period begins on November 1, 2015.

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table 31 hIv/aIDs antIrEtrovIral anD opportunIstIC InFECtIon mEDICatIons

FDA-Approved Antiretroviral Medications

Generic Name Brand Name

CYP34A Inhibitors (Pharmocokinetic Boosters)

cobicistat Tybost

Multi-Class Combination Products

efavirenz, emtricitabine, and tenoforvir disoproxil fumarate Atripla

rilpivirine, emtricitabine, and tenoforvir disoproxil fumarate Complera

elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate Stribild

NRTIs

abacavir sulfate, ABC Ziagen

abacavir, zidovudine, and lamivudine Trizivir

abacavir and lamivudine Epzicom

didanosine, dideoxyinosine, ddL Videx

emtricitabine, FTC Emtriva

lamivudine and zidovudine Combivir

lamivudine, 3TC Epivir

stavudine, d4T Zerit

tenofovir, disoproxil fumarate, TDF Viread

tenofovir disoproxil fumarate and emtricitabine Truvada

zidovudine, azidothymidine, AZT, ZDV Retrovir

NNRTIs

delavirdine, DLV Rescriptor

efavirenz, EFV Sustiva

etravirine Intelence

nevirapine, NVP Viramune

rilpivirine Edurant

Protease Inhibitors

amprenavir, APV Agenerase1

atazanavir sulfate, ATV Reyataz

darunavir Prezista

fosamprenavir calcium, FOS-APV Lexiva

indinavir, IDV Crixivan

lopinavir and ritonavir, LPV/RTV Kaletra

nelfinavir mesylate, NFV Viracept

ritonavir, RTV Norvir

saquinavir mesylate, SQV Invirase

tipranavir, TPV Aptivus

Protease Inhibitor and CYP34A Inhibitor (Pharmocokinetic Booster) Combinations

atazanavir, cobicistat Evotaz

darunavir/cobicistat Prezcobix

Fusion Inhibitors

enfuvirtide, T-20 Fuzeon

Entry Inhibitors - CCR5 Co-Receptor Antagonist

maraviroc Selzentry

HIV Integrase Strand Transfer Inhibitors

dolutegravir Tivicay

elvitegravir Vitekta

raltegravir Isentress

HIV Integrase Strand Transfer Inhibitor and NRTI Combinations

abacavir/lamivudine, dolutegravir Triumeq

1 The manufacturer of Agenerase (amprenavir) discontinued the sale and distribution of the drug in capsule form, used for adult dosing, after 2004 and is instead manufacturing fosamprenavir (Lexiva), a “prodrug” of Agenerase (a prodrug is an inactive precursor of a drug, converted into its active form in the body). Agenerase is still availabe in pediatric dosing.

Source: FDA, “Drugs Used in the Treatment of HIV Infection”: http://www.fda.gov/oashi/aids/virals.html. Also see: DHHS, “Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents,” December 16, 2013: http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf.

72

table 31 hIv/aIDs antIrEtrovIral anD opportunIstIC InFECtIon mEDICatIons (ContInuED)

“A1” Medications for the Prevention & Treatment of Opportunistic Infections (Highly Recommended)1

Generic Name Brand Name

acyclovir Zovirax

amphotericin B Fungizone

azithromycin Zithromax

cidofovir Vistide

clarithromycin Biaxin

clindamycin Cleocin

ethambutol —

famciclovir Famvir

fluconazole Diflucan

flucytosine Ancobon

foscarnet Foscavir

ganciclovir Cytovene

isoniazid (INH) Lanizid, Nydrazid

itraconazole Sporonox

leucovorin calcium Wellcovorin

liposomal amphotericin B —

peg-interferon alfa-2a PEG-Intron

peg-interferon alfa-2b —

pentamidine Nebupent

prednisone Deltasone, Liquid Pred, Metocorten, Orasone, Panasol, Prednicen-M, Sterapred

probenecid —

pyrazinamide (PZA) —

pyrimethamine Daraprim, Fansidar

ribavirin Virazole, Rebetol, Copegus

rifabutin Mycobutin

rifampin (RIF) Rifadin, Rimactane

sulfadiazine (oral generic) Microsulfon

trimethoprim- sulfamethoxazole (TMP/SMX) Bactrim, Septra

valacyclovir Valtrex

valganciclovir Valcyte

1 “A” = “should always be offered”; “1” = “evidence from at least one properly randomized, controlled trial”

Sources: CDC, “Guidelines for the Prevention of Opportunistic Infections in Persons Infected with Human Immunodeficiency Virus.” MMWR, 51 (No. RR08),1-46; 2002; CDC, “Treating Opportunistic Infections Among HIV-Infected Adults and Adolescents.” MMWR, 53 (No. RR15), 1–112; 2004. Also see: DHHS, “Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents,” December 16, 2013: http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf.

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NatioNal aDaP MoNitoriNg Project - NASTAD · opyright ree ector aps.com 4 THE fUNDING TO PROVIDE SERVICES u uThe total ADAP budget increased by 1% between FY2014 and FY2015, reaching