WASHINGTOn—Enrollment in state and territorial AIDS Drug Assistance Programs (ADAPs) which provide drugs to HIV/AIDS patients with limited or no prescription drug coverage continues to grow, according to a report released last month by the Kaiser Family Foundation and the National Alliance of State and Territorial AIDS Directors (NASTAD).

For FY 2007, ADAPS had more than 183,000 people enrolled and reached over a third of all people with HIV receiving care in the U.S.—including 36,000 newly enrolled clients—according to the 2009 National ADAP Monitoring Project Annual Report.

The Department of Health and Human Services’ Health Resources and Services Administration oversees the ADAPs, which were designed serve as a payer of last resort. The programs receive funding from both the federal and state governments and operate in every state, the District of Columbia and U.S. territories and jurisdictions.

Taking into account all funding streams, the overall national ADAP budget reached $1.5 billion in FY 2008. This is an increase of more than $100 million over FY 2007. However, since individual APAP programs receive funding from various sources, including their own states, the overall funding levels of these programs vary from state to state. The report found that 21 ADAPs had decreased budgets overall.

Three states—Indiana, Montana and Nebraska—had to institute a waiting list because of inadequate funding, meaning that some patients must wait to receive their medication until resources become available. According to the report, 62 people were on waiting lists around the country as of March 2009.

Jen Kates, a Kaiser vice president and director of HIV policy and a co-author of the report, said that this is an issue that “comes up each year,” but also said that state ADAP programs may become more strained as a result of the recession and the state fiscal environment. “We see the return of waiting lists and cost-containment measures anticipated by several ADAPS. We also know there is a recession and the state fiscal environment is not very healthy right now,” Kates said during a webcast presentation in which the report was released.

During the webcasts, officials said that directors of state ADAP programs are closely watching how the push for expanded HIVtesting that CDC has advocated in recent years will impact state ADAPs. Concerns have arisen that the increased testing will result in more people seeking HIV care through the ADAP, which would mean that ADAPs will need more funding to keep up with demand.

However, Heather Hauck, director of the AIDS Administration in the Maryland Department of Health and Mental Hygiene, said that even with expanded testing not everyone who finds out they are HIV positive will need to access ADAP. Many individuals may have their own private health insurance. “So, I think the thing to keep in mind is that not all of those individuals are ADAP eligible. There are people who are being tested in their routine medical settings who have private insurance, they have another insurance benefit.”

A question discussed during the webcast was how national healthcare reform would impact ADAPs. Doug Morgan, director of the Division of Service Systems in the HRSA HIV/AIDS Bureau, said that HRSA officials will be monitoring how health care reform will impact the entire Ryan White HIV/AIDS Program, of which ADAP is included.

“We at HRSA are looking at a broader question of what will the impact of health reform have on the Ryan White program and how we will continue to play a role in providing care to people with HIV and AIDS,” he said. “I think that is the much broader issue. It is not just ADAP here; it is the entire program and its role as payer as last resort. So we will have to see how it all plays out.”