The National Alliance of State and Territorial AIDS Directors (NASTAD) announced this month that state AIDS Drug Assistance Programs (ADAPs) are facing “a perfect storm” of financial stresses due to the economic recession.

The result has been budget shortfalls and a series of cutbacks in state ADAP programs around the country.

ADAPs are programs that provide antiretroviral drugs to low-income Americans living with HIV.

Although run by states, the majority of ADAP funding usually comes from the federal government through the Ryan White Program. State contributions typically account for 15 percent to 20 percent of ADAP budgets.

This year, many states are struggling to keep up with increased need for financial assistance from people living with HIV.

“The nation’s current economic situation, increased HIV testing efforts, and more individuals living longer have resulted in a ‘perfect storm’ that has rapidly resulted in swelling ADAP rolls,” wrote NASTAD in a press release.

In a report released May 4, NASTAD noted that ADAP budgets for 2009 increased 4 percent over the 2008 financial year with 63 percent of ADAPs experiencing a growth in budget. However, in many cases this was offset by increases in the number of people relying on ADAPs for their medications.

Furthermore, federal and state contributions to ADAP budgets are at or near all-time lows as a percent of the total budget. Rebate payments from pharmaceutical companies made up 31 percent of ADAP budgets in 2009.

“Increased funds from federal and state governments in addition to price freezes and increased discounts and rebates from companies are all necessary to sustain ADAPs until health reform is fully implemented in 2014,” wrote NASTAD.

During 2009, ADAPs added an average of nearly 1,300 people to its programs per month, an 80 percent increase over 2008. Seventy-five percent of individuals using ADAPs make less than 200 percent of the federal poverty level, or $22,000 per year.

ADAPs with reduced budgets are seeking to control costs by limiting the list of prescription drugs covered, instituting enrollment caps on particular medications, and restricting the number of prescriptions provided per month.

In addition, NASTAD reported last week that ten states had waiting lists, with over 1,000 people nationwide waiting for ADAP assistance.

ADAPs have been working with drug company patient assistance programs to help make medications as accessible as possible for those on the waiting lists.

In response to the crisis and lobbying efforts by NASTAD, the AIDS Healthcare Foundation (AHF), and other AIDS groups, several pharmaceutical companies have agreed to implement price freezes and other measures on drugs purchased through ADAPs.

Merck announced that it would extend price freezes on Isentress (raltegravir) and Crixivan (indinavir) through 2013 for ADAPs, increase discounts, and process rebate payments more quickly.

NASTAD also announced agreements with Abbott Laboratories and Tibotec Therapeutics to extend existing financial agreements. Abbott is the maker of Kaletra (lopinavir/ritonavir) and Norvir (ritonavir); Tibotec makes Prezista (darunavir) and Intelence (etravirine).

Nonetheless, state ADAP programs are pressing for additional federal funding to cover budget gaps.

“Many [ADAPs] are currently advocating for an emergency supplemental appropriation of $126 million to help sustain current services and eliminate waiting lists and other cost containment measures,” wrote NASTAD in a March “Crisis Strategy” briefing.

“Abbott, Merck, and Tibotec’s willingness to help with this crisis demonstrates that they are fully carrying their share of the burden, strengthening the case for further assistance from the federal and state governments at this critical time of unprecedented need for ADAPS,” added Jennifer Brown, spokesperson for the ADAP Crisis Task Force in a press release.

For more information, including the 2010 National ADAP Monitoring Project Annual Report (pdf), please see the NASTAD website.