科研之友
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摘要
AIDS Drug Assistance Programs, enacted through the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, are the ※payer of last resort§ for prescription medications for lower income, uninsured, or underinsured people living with HIV/AIDS. ADAPs face declining funding from the federal government. State funding of ADAP is discretionary, but some states increased their contributions to meet the gap in funding. The demand for ADAP support is increasing as people living with HIV are living longer; the antiretroviral therapy (ART) guidelines have been changed to recommend initiation of treatment for all; the United States is increasing HIV testing goals; and the recession continues. In the setting of increased demand and limited funding, ADAPs are employing cost containment measures. Since 2010, emergency federal funds have bailed out ADAP, but these are not sustainable. In the coming years, providers and policy makers associated with HIV care will need to navigate the implementation of the Affordable Care Act (ACA). Lessons learned from the challenges associated with providing sustainable access to ART for vulnerable populations through ADAP should inform upcoming decisions about how to ensure delivery of ART during and after the implementation of the ACA. 1. Introduction AIDS Drug Assistance Programs (ADAPs) were enacted through the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990. These programs, an integral component of HIV care in the United States, are the ※payer of last resort§ for prescription medications for lower income, uninsured, or underinsured people living with HIV (PLWH). The provision of these medications to all provides an important incentive for HIV testing, as testing agencies can assure those tested that treatment will be available regardless of ability to pay. In addition, an uninterrupted supply of subsidized HIV medications provides the best opportunity for enrolled individuals to maintain an undetectable viral load, reducing their risk of transmitting the virus. In 2006, ADAP accounted for 41% of the CARE Act＊s $1.93 billion budget [1]. According to the National Association of State and Territorial AIDS Directors, ADAP provides ART to 1 in 4 PLWH, indicating that the ※safety net§ is holding a substantial population. Unfortunately, ADAPs have not been able to meet the demand for their support, and they recently faced the worst funding crisis since their inception [2]. ADAP funds vary based on annual federal allocations and discretionary state support, making planning difficult. With the Affordable Care Act
