RWHAP Part B Program Funding
Section 2
Traditional Federal Grant Awards
Based on a formula and eligibility-based distribution mechanism, RWHAP Part B programs are traditionally eligible to receive the following categories of federal funding: Part B Base, Part B Supplemental (if applicable), Part B ADAP Earmark, Part B ADAP Supplemental (if applicable), and ADAP Emergency Relief Funding (if applicable). In FY 2020, RWHAP Part B programs (n=59) were Congressionally appropriated nearly $1.283 billion, with $900 million (70%) awarded by HRSA to ADAP specifically (i.e., via Part B ADAP Earmark [n=59], Part B ADAP Supplemental [n=7], and ADAP Emergency Relief Funding [n=14]). By comparison, RWHAP Part B programs and ADAPs were awarded $1.317 billion and $898 million in FY 2019, representing a -2.6% and 0.22% change for each, respectively.
RWHAP Part B programs may choose to allocate a portion or all of their Part B Base and/or Part B Supplemental to ADAP. For FY 2020, 33 RWHAP Part B programs reported having allocated some portion of their RWHAP Part B Base and/or Part B Supplemental to ADAP, representing 2.4% of their overall ADAP budgets. As the largest component of the RWHAP Part B program with the greatest number of clients served – 242,997 of 250,781 (97%) RWHAP Part B clients served in CY 2019 were ADAP clients – ADAPs represented 72% of the overall Part B budget in FY 2020. Among survey respondents, the proportion of the RWHAP Part B budget used for ADAP ranged from 3% in Alaska to 92% in California and New York. Yet these Part B budget allocations alone do not meet the needs of ADAPs or their clients. Jurisdictions generally require additional funding streams to both sustain and expand their infrastructure and service delivery, particularly to meet the goals of federal EHE efforts and the fiscal needs of programs, especially with the ongoing COVID-19 pandemic.
EHE Grant Awards
In February 2019, the White House administration announced Ending the HIV Epidemic: A Plan for America (EHE), which is the federal plan to end the HIV epidemic by 2030. In FY 2020, HRSA awarded $117 million in support of EHE activities, including $55 million to 39 Phase 1 priority jurisdictions: metropolitan areas and eight states (seven with largely rural epidemics [Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, and South Carolina] and one [Ohio] on behalf of a heavily impacted jurisdiction [Hamilton County]). EHE awards to RWHAP Part B programs totaled nearly $7.2 million ($6.16 million in EHE funds allocated to RWHAP Part B program and/or ADAP budget funding were reported by 6 states).
CARES Act Grants
The FY 2020 CARES Act provided one-time supplemental funding to help 581 RWHAP Part A, B, C and D programs prevent, prepare for, and respond to the COVID-19-related core medical and support service needs of their clients. HRSA awarded a total of $24.5 million in CARES Act funding to RWHAP Part B programs ($18.44 million in CARES Act funds allocated to RWHAP Part B program and/or ADAP budget funding were reported by 39 jurisdictions).
Additional Funding Sources
RWHAP Part B programs must use at least 75% of federal RWHAP awards (e.g., Part B Base, Part B Supplemental) to fund core medical services, including ADAP (unless a “75/25 waiver” is approved by HRSA HAB). Part B programs may exceed the 75/25 requirement using non-federal funding including rebates or program income. RWHAP Part A programs in eligible metropolitan areas may contribute direct-appropriated funds to their Part B counterparts. Such decisions are made locally and reflect an effort between RWHAP Parts A and B programs to avoid duplicating service delivery and to mutually ensure each other’s success in serving the needs of PLWHA.
Additional sources that may be available to RWHAP Part B programs include other federal funding (e.g., carry-over from prior Part B Base or ADAP Earmark awards), state general revenue funding, private donations, program income, and rebates received as part of medication purchasing.
Rebates (46%), Part B ADAP earmark (24%), and Part B base (9%) make up the greatest proportions of the overall Part B budget for FY 2020. Rebates, payments received by some ADAPs from pharmaceutical manufacturers after paying for medications for clients, are tracked separately from front-end discounts and account for both the repayment to ADAP from a manufacturer for a drug expenditure and any additional savings generated. The total amount of rebates received as well as the proportion of the Part B budget they represented significantly increased between FY 2019 and FY 2020 (i.e., from 41% to 46%).
In FY 2020, $77 and $75.8 million were the amounts of program income used for eight Part B programs and nine ADAPs, respectively, representing 4.6% of the total Part B budget – a 1.5% increase over the proportion of the Part B budget attributed to program income in FY 2019. Separately from rebates, ADAPs may also generate program income that may be used for allowable RWHAP services and activities, including ADAP. For example, an ADAP may bill third-party insurance for the usual and customary cost for medications filled for ADAP clients even if the medications were purchased at 340B pricing.
Between FY 2016 and FY 2020, the RWHAP Part B program and ADAP budgets have increased by 27.9% and 19.3%, respectively.
Total RWHAP Part B Budget, By Source, FY2017-FY2020
Note: Rebates are tracked separately from front-end discounts and account for both repayment to ADAP from a manufacturer for a drug expenditure and any additional savings generated.
Note: 49 programs reported data. Alabama, American Samoa, Federated States of Micronesia, Guam, Indiana, Marshall Islands, Mississippi, Nevada, Northern Mariana Islands, and Republic of Palau did not respond.
Total ADAP Budget, By Source, FY1996-FY2020
