Transcript The Cost of Resistance - Adap Advocacy Association

AIDS Drug Assistance Programs (ADAPs)
Adequate versus Ideal models
Joey Wynn,
Chairman, South Florida AIDS Network (SFAN)
aaa+ conference, Washington D.C.
July 21st, 2009
Ideal versus Adequate ADAPs
Initial Dialogue about the concepts of
ideal ADAP models versus
adequate programs
(The good, bad & the ugly!)
Ideal versus Adequate ADAPs
Our goals for today’s discussion:
 Identify and create awareness of the importance of appropriate
characteristics for ADAP Programs nationwide
 Identify & Understand the barriers and challenges associated with
evaluating ADAP Programs throughout the country (widen the
net to see the real picture!)
 Begin to identify primary questions, & needed data to answer
them
 Hold an interactive dialogue resulting in a clearer understanding
and expectation of what ADAPs should be doing for their clients
based on their local environments
 Evaluate the need for further investigation into this topic and the
usefulness of such data for the community
Ideal versus Adequate ADAPs

Key elements (core or medical model) of a local
HIV primary care system
Number of Patients accessing services
 Primary care visits (System-wide capacity)
 Laboratory diagnostics (availability and capacity)
 Specialty Labs (Genotype, Pheno, Virtual Pheno, etc..)
 Medications (Formulary Management, PBM, etc…)
 Financial resources to maintain system

Ideal versus Adequate ADAPs

Other elements to consider
 Payor Sources – Funding stream Matrix
 Financial Limitations (Rationing Care)
• Level of Sufficiency of resources versus
demand /need
 Patient’s “Quality of Life” index
 Loss of productive time for Patient
 Loss of productivity levels – Staff
 Patient mortality
Ideal versus Adequate ADAPs

Who Pays for these Medications?????
 ADAP
 General Revenue (State Tax Dollars)
 State Medicaid
 Federal Medicare Programs (A,B,C,D)
 Ryan White A – F (formerly I, II, III, IV)
 Private Insurance Plans
 Local Indigent Plans – Hospital DSH programs
 Patient Assistance Progams – PAPs…..
www.PPARx.org
The Cost of Care! Check please!
(Pharmaceuticals)
State of FLA Medicaid
Reimbursement Broward
Medipass = 824
Broward County
Ryan White Title One
(Part A) = 2,340
Florida ADAP 7/2006
Broward County
2,504 active clients
Reyataz $759.63
Reyataz $1,067.93
Avg cost per client:
$865
Truvada $738.55
Truvada $998.16
Avg $ per prescription:
$301.66
Norvir 100mg $276.19
Norvir 100 mg
$372.85
Avg daily = $82,532
Monthly = $1,403,044
JUNE 2006
BREAKDOWN OF COUNTY HEALTH
DEPARTMENTS BY PHARMACY CATEGORY
ESCAMBIA SANTA ROSA
OKALOOSA
WALTON
HOLMES
JACKSON
WASHINGTON
NASSAU
GADSDEN
CALHOUN
JEFFERSON
LEON
BAY
LIBERTY
GULF
WAKULLA
FRANKLIN
HAMILTON
MADISON
SUWANNEE
TAYLOR
DUVAL
BAKER
COLUMBIA
UNION
LAFAYETTE
CLAY
BRADFORD
ST JOHNS
ALACHUA
DIXIE
GILCHRIST
PUTNAM
FLAGLER
LEVY
MARION
VOLUSIA
LAKE
CITRUS
SEMINOLE
SUMTER
HERNANDO
ORANGE
BREVARD
PASCO
OSCEOLA
HILLSBOROUGH
POLK
PINELLAS
CATEGORY I – County Allocation W/Staff Pharmacist
INDIAN RIVER
MANATEE
SARASOTA
OKEECHOBEE
ST LUCIE
HIGHLANDS
CATEGORY II – County Allocation W/O Staff Pharmacist
DESOTO
MARTIN
HARDEE
CATEGORY III – All Other Counties Share Communal Funding Allocation
CHARLOTTE
LEE
GLADES
HENDRY
PALM BEACH
BROWARD
COLLIER
MONROE
DADE
13
JUNE 2006
FLORIDA AIDS DRUG ASSISTANCE PROGRAM
DRUG EXPENDITURE BY COST
NUCLEOSIDEs / TIDEs
$3,348,699.44
FUSION INHIBITOR
$
75,529.24
PROTEASE INHIBITOR
$1,979,395.14
WASTING
$
13,790.31
NON-NUCLEOSIDE
$ 618,676.69
NEUROPATHY
$
3,916.59
OPPORT. INFECTION
$
87,000.05
OTHERS
$
9,555.64
ANEMIA/NEUTROPENIA
$
89,117.35
HEPATITIS (PILOT)
$
4,542.34
HYPERLIPIDEMIA
$
45,561.45
HYPERGLYCEMIA
$
333.14
JUNE TOTAL $ 6,276,117.38
APRIL EXPENDITURE
5,614,365.67
MAY EXPENDITURE
5,943,824.77
9
JUNE 2006
FLORIDA AIDS DRUG ASSISTANCE PROGRAM
TOP TEN DRUG EXPENDITURES
$1,400,000.00
$1,200,000.00
3004
Total Amount $5,214,228.88
$1,346,767.44
1
CLIENT USAGE
$1,000,000.00
$800,000.00
1621
1408
1770
1162
$199,429.47
LEXIVA
VIRAMUNE $149,525.72
$284,877.59
471
**EPZICOM
$312,971.63
609
VIREAD
***TRIZIVIR
SUSTIVA
REYATAZ
KALETRA
**TRUVADA
$-
**COMBIVIR
$200,000.00
$412,905.45
545
$468,000.59
$400,000.00
$624,137.32
$600,000.00
$692,363.54
$723,250.13
1482
799
11
JUNE 2006
FLORIDA AIDS DRUG ASSISTANCE PROGRAM
ADAP FORMULARY- TOTAL 69 MEDICATIONS
ABACAVIR (ZIAGEN)
EFAVIRENZ (SUSTIVA)
MEGESTROL (MEGACE ES &
MEG. SUSPENSION)
SULFADIAZINE
ABACAVIR/LAMIVUDINE (EPZICOM)
EMTRICITABINE (EMTRIVA)
METFORMIN (GLUCOPHAGE)
TENOFOVIR (VIREAD)
ABACAVIR/LAMIVUDINE/ZIDOVUDIN
E (TRIVIZIR)
ENFUVIRTIDE (FUZEON) *
MICONAZOLE (MONISTAT)
TENOFOVIR/EMTRICITABINE
(TRUVADA)
ACYCLOVIR (ZOVIRAX)
ERYTHROPOIETIN (EPOGEN, PROCRIT)
NANDROLONE (DECADURABOLIN)
TERCONAZOLE (TERAZOL)
AMANTADINE (SYMMETREL) #
ETHAMBUTOL (MYAMBUTOL)
NELFINAVIR (VIRACEPT)
TESTOSTERONE (GEL, PATCH,
INJECTABLE)
AMITRIPTYLINE (ELAVIL)
FILGRASTIM (NEUPOGEN)
NEVIRAPINE (VIRAMUNE)
TIPRANIVIR (APTIVUS)*
AMPRENAVIR (AGENERASE)
FLUCONAZOLE (DIFLUCAN)
NORTRIPTYLINE (PAMELOR)
TMP/SMZ (BACTRIM, SEPTRA)
ATAZANAVIR (REYATAZ)
FOSAMPRENAVIR CALCIUM (LEXIVA)
OSELTAMIVIR (TAMIFLU)#
VACCINES
ATORVASTATIN (LIPITOR)
GABAPENTIN (NEURONTIN)
OXANDROLONE (OXANDRIN)
HEPATITIS A & B
ATOVAQUONE (MEPRON)
GEMFIBROZIL (LOPID)
PRAVASTATIN (PRAVACHOL)
INFLUENZA #
AZITHROMYCIN (ZITHROMAX)
GLIPIZIDE (GLUCOTROL)
PROCHLORPERAZINE
(COMPAZINE)
PNEUMOCOCCAL
CLARITHROMYCIN (BIAXIN)
GLYBURIDE (MICRONASE, GLYNASE,
DIABETA)
PYRIMETHAMINE (DARAPRIM)
ZALCITABINE (HIVID)
DAPSONE (DDS)
HYDROXYUREA (HYDREA)
RIMANTADINE (FLUMADINE)*
ZANAMIVIR (RELENZA)#
DARUNAVIR (Prezista) (NEW)
INDINAVIR (CRIXIVAN)
RIFABUTIN (MYCOBUTIN)
ZIDOVUDINE (AZT,RETROVIR)
DELAVIRDINE (RESCRIPTOR)
LAMIVUDINE (EPIVIR)
RITONAVIR (NORVIR)
ZIDOVUDINE/LAMIVUDINE
(COMBIVIR)
DIDANOSINE (VIDEX,VIDEX EC)
LAMOTRIGINE (LAMICTAL)
ROSUVASTATIN CALCIUM
(CRESTOR)
DIPHENOXYLATE (LOMOTIL)
LEUCOVORIN (FOLINIC ACID)
SAQUINAVIR (FORTOVASE,
INVIRASE)
DRONABINOL (MARINOL
LOPINAVIR (KALETRA
*By prior authorization only
#Seasonal availability only
STAVUDINE (ZERIT)
Pediatric formulations may be available by special arrangement with Central Pharmacy
14
Medicare Part D Standard
Drug Plan Benefit in 2006
Total Spending
$250
$2250
$5100
75% Plan Pays
Deductible
Coverage
Gap
80% Reinsurance
≈ 95%
Total
25% Coinsurance
Beneficiary
Out-Of-Pocket
$250
$750
$3600 TrOOP
Beneficiary Liability
Direct Subsidy/
Beneficiary Premium
15% Plan Pays
5% Coinsurance
Medicare Pays Reinsurance
$+
Distribution of
ARVs by Costs
in the Florida
Medipass system
Q3 2005 Dade & Broward reporting
TradeName
TRUVADA
REYATAZ
KALETRA
VIREAD
COMBIVIR
SUSTIVA
TRIZIVIR
FUZEON
NORVIR SOFT GELATIN
LEXIVA
EPZICOM
VIRAMUNE
ZERIT
ZIAGEN
EPIVIR
RETROVIR
CRIXIVAN
APTIVUS
VIDEX EC
INVIRASE
VIRACEPT
FORTOVASE
NORVIR
RESCRIPTOR
HIVID
AGENERASE
VIDEX BUFFERED
VIDEX
Totals
$1,931,337.54
$1,628,575.85
$1,587,139.06
$1,513,516.01
$1,258,036.14
$929,065.62
$848,423.24
$723,897.08
$715,887.48
$690,589.92
$602,971.44
$558,106.88
$430,191.84
$386,187.23
$295,225.04
$107,235.15
$101,507.05
$80,112.42
$77,317.70
$74,391.51
$59,336.62
$19,027.19
$10,653.78
$10,297.76
$3,954.38
$1,035.16
$661.54
$387.94
$14,645,068.57
Ideal versus Adequate ADAPs

The Ideal ADAP would have:
 Culturally appropriate staff with evening & weekend hours
 Ample staffing resources and counseling options available for adherence
services, drug reaction management, utilization review & Pain
management services
 A variety of geographic locations
 Negotiated the lowest prices possible
 Delivery options available for certain cases
 The broadest, robust formulary possible
 Web-based options for eligibility that used existing data from local service
delivery system & ease of use for clients & case managers
 Experienced staff for drug to drug interactions
 A widely known process to use in the medical community
 Frequent reporting about the program available easily with the community
 Established outcomes & performance indicators
 Annual Report on outcomes & expenditures
 An evaluation component for Insurance purchasing and Premiums
assistance
 A co Pay assistance program
 A P.A.P. service model on site
Ideal versus Adequate ADAPs

Reality Check!!!!! Typical Barriers to care:
 Inadequate funding
 Lack of staffing resources
 Complex infrastructure – (band-aid effect)
 Indigent Population vulnerabilities
 Geographic accessibility
 Hours of operation
 State Gov’t Bureau
Ideal versus Adequate ADAPs

Questions and Answers:
 Where do we go from here?
 Is this topic useful?
 Which stakeholders would benefit from
this type of information?
Ideal versus Adequate ADAPs
Thank you for your time and your
thoughts