Section 4. Programmatic Challenges and Opportunities

Many ADAPs grappled with a number of program-level challenges in CY2023, including pharmacy network issues, health department staff turnover (34 respondents reported this as somewhat or very challenging), ensuring maintenance of client eligibility, timely rebate payments from manufacturers (24 respondents reported this as somewhat or very challenging, an 11% decrease compared with CY2022 and a 26% decrease compared with CY2021), and coordination with other 340B covered entities regarding 340B and program income right-of-way determinations to avoid duplicate discounting. Approximately 42% of all respondents (an 8% decrease compared with CY2022 data) also reported challenges implementing long-acting injectables and other provider-administered drugs as part of their full-pay medication programs and ADAP-funded insurance programs, which has been an important area of NASTAD technical assistance to state and territorial programs.  

To help meet the dynamic challenges and complexities associated with pharmacy- and provider-based prescription drug access and insurance service delivery, contractual services provided by pharmacy benefit managers (PBMs), medical benefit managers (MBMs), and insurance benefit administrators (IBAs) have become increasingly important to ADAPs nationally. Of 49 programs providing data, 40 utilize PBM services, 9 utilize MBM services, and 21 utilize IBA services.