The Role of Ryan White HIV/AIDS Program (RWHAP) Part B in the Changing Health Care Landscape
RWHAP Part B and ADAP are designed to be safety net options for people living with HIV (PLWH) that have no other method to afford HIV care and treatment. In other words, RWHAP Part B and ADAP are “payers of last resort” when PLWH are under- or uninsured via private insurance, Medicaid, and/or Medicare. Even still, RWHAP Part B serves an important role within the health care landscape for PLWH. In fact, according to the National RHWAP Part B and ADAP Monitoring Project (NPBAMP) Annual Report, in 2016, one-fourth of all PLWH in the United States were served by the RWHAP Part B program and/or ADAP. Furthermore, 81% of ADAP clients were virally suppressed—a proportion which is noticeably greater than the national average of 49%. As a result, it is important to consider why these programs are models for effective public health and health care systems for chronic diseases and what they need to continue to be sustainable and impactful.
The above statistics illustrate the importance of RWHAP Part B programs and ADAPs in helping vulnerable, low-income PLWH achieve optimal health outcomes. These successes have been possible with the expansion of eligible service categories and maximizing the use of available RWHAP Part B program and ADAP funding. Currently, RWHAP Part B funding can cover 13 core medical services and 17 support services, which range from medical case management to health education to housing services. These services can be used to provide vital health care to individuals and to address important socioeconomic inequalities that act as barriers to HIV care and treatment.
Additionally, in recent years ADAPs have been able to expand their drug formularies to cover medications for a wide variety of comorbidities (e.g., mental health treatment, hepatitis C (HCV) treatment medications) which negatively impact health outcomes for PLWH, including viral load suppression. Ten ADAPs maintain open formularies which cover all FDA-approved medications prescribed to their clients. Overall, the collection of diverse services offered by RWHAP Part B and ADAP contribute towards efforts to end the HIV epidemic—a model which could be applied to public health efforts aimed at addressing other chronic diseases.
In addition to providing a wide variety of necessary services and medications to PLWH, another strength of RWHAP Part B/ADAP is its ability to adapt to changes within the broader health care landscape. RWHAP Part B programs and ADAPs are model programs that are built in such a way as to be flexible in meeting the needs of their clients for the long term. Examples of this flexibility include the programs’ ability to seamlessly integrate with the Affordable Care Act (ACA) as well as ongoing efforts to adapt to the current opioid crisis and how it impacts PLWH (e.g., RWHAP funds can be used to support syringe access services). The successes of RWHAP Part B programs and ADAPs are significant both for the positive impact on PLWH, but also for the lessons learned that can be applied to other public health programs. It is imperative that RWHAP Part B programs and ADAPs are supported and maintained through policy and funding.