2024 National RWHAP Part B ADAP Monitoring Project Annual Report

NASTAD’s National RWHAP Part B ADAP Monitoring Project Annual Report documents key trends, challenges, and successes faced by state and territorial AIDS Drug Assistance Programs (ADAPs) ensuring equitable access to antiretroviral therapy and other essential medicines for people living with HIV/AIDS (PLWHA) nationally. The 2024 Annual Report includes longitudinal data spanning several domains widely considered vital to the success of ADAPs and, importantly, the identification of opportunities to ensure the best possible health outcomes for low-income PLWHA who would otherwise have limited or no prescription drug coverage.

Following the March 1987 U.S. Food and Drug Administration (FDA) approval of zidovudine (Retrovir; AZT), the first antiretroviral with demonstrated efficacy as a treatment for AIDS, concerns emerged regarding the high cost of the drug – approximately $9,000 a year in 1987; roughly $25,000 in 2024 dollars – and the access challenges faced by PLWHA with limited insurance and financial resources. In response, the Health Resources and Services Administration (HRSA) launched the AZT Drug Reimbursement Program in late 1987, with Congressional funds appropriated to all 50 states to support purchasing of the drug for uninsured and underinsured PLWHA. Grant award amounts were determined using a formula based on the number of people living with AIDS in each state, with New York, California, Texas, Florida, and New Jersey receiving 71 percent of the $30 million funds distributed.

These programs laid the groundwork for AIDS Drug Assistance Programs (ADAPs) authorized by Congress under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990. Since the first reauthorization of the CARE Act in 1996, ADAPs have been funded as a separate line item under Title II of the CARE Act – Ryan White HIV/AIDS Program Part B – and remain charged with ensuring access to lifesaving antiretroviral drugs and biologics, “A1” opportunistic infection medications, and outpatient medications for comorbid conditions that disproportionately impact PLWHA and/or affect the adherence to, or effectiveness of, HIV treatment.

ADAPs are able to support access to prescription drugs through two mechanisms: (1) by paying for any client medications on the program’s formulary, with significant up-front discounting and/or back-end rebating made possible via the 340B Drug Pricing Program; and (2) as authorized by Congress under the second reauthorization of the CARE ACT in 2000, by paying for a portion or all of a client’s premiums and cost sharing (including deductibles, copayments, and coinsurance costs) for private or public insurance that includes prescription drug coverage.

The CARE Act enables ADAPs to cover a broad array of medications with a limited number of requirements (e.g., all medications and ancillary devices must be FDA-approved). ADAPs’ expansive coverage is critical to their success and consistent with overall goals of the RWHAP to meet the comprehensive and evolving pharmaceutical needs of PLWHA, including access to novel antiretroviral medications (including provider-administered drugs and biologics), curative hepatitis C treatments, substance use medications, mental health medications, and sex hormones for gender-affirming therapy.

Unless otherwise noted, findings highlighted in the 2024 Annual Report are based on budgetary data for fiscal year 2022 (FY2022) and programmatic data for calendar year 2022 (CY2022) received from 49 states, the District of Columbia, and one U.S. territory (Puerto Rico). No fiscal or programmatic data were received from West Virginia, the U.S. Virgin Islands, or the Pacific Island Jurisdictions.