VIRGINIA ADAP DATA REPORT JANUARY 2013
Anne Giuranna Rhodes, Services AnalystHIV Care Services, Division of Disease Prevention
Virginia Department of Health
VA ADAP 2010-2012
•Began 11/2010, ended 8/2012
•Highest number was 1,112 in 12/2011
Waitlist
•Significant drop in cost per person in early 2011 due to NASTAD agreements
Direct ADAP
•Began collecting rebates in 2011
•Served 387 persons in 2012
Medicare D
ADAP Waitlist History
Virginia ADAP expanded ADAP enrollment criteria and reduced the wait list throughout 2011 and 2012
November 2011: CD4 count at or below 200 December 2011: CD4 count at or below 350 April 2012: CD4 count at or below 500 July 2012: removal of clinical criteria August 2012: began immediate processing of new
applications (no longer placed any new persons on waitlist)
Eliminated the wait list as of August 30, 2012.
CD4 Count Distribution of VA Waitlist
Data Source: AIDS Drug Assistance Program Waitlist DataDivision of Disease Prevention, Office of Epidemiology, Virginia Department of Health, December 2012
Nov 2011 (n=1,091)
Dec 2011 (n=1,104)
April 2012 (n=946)
Jul-2012 (n=570)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
>500201-500< 200
VA ADAP Wait List Removals
4054440575
4060540640
4066840696
4072540756
4078740817
4084840878
4090940940
4096941000
4103041061
4109141123
411530
200
400
600
800
1000
1200
Nu
mb
er
of
Clien
ts
Virginia AIDS Drug Assistance Program Waitlist2011 to 2012
Data Source: AIDS Drug Assistance Program Waitlist DataDivision of Disease Prevention, Office of Epidemiology, Virginia Department of Health, December 2012
Direct ADAP Summary: 2012
Active Clients December 31, 2012: 3,613 (2,276)
Clients Served Jan-Dec 2012: 4,001 (3,008)
Avg. Persons Served Per Month 2012: 2,118 (1,816)
Avg. Total Cost per Month 2012: $1.86M ($1.65M)
Avg. Cost Per Person Per Month 2012: $881 ($913)
Avg. New Clients Per Month 2012: 101 (14)
*Numbers in parentheses are from 1 year ago (January to December 2011)
Direct ADAP: Persons per MonthJanuary 2010 to December 2012
2010
01
2010
02
2010
03
2010
04
2010
05
2010
06
2010
07
2010
08
2010
09
2010
10
2010
11
2010
12
2011
01
2011
02
2011
03
2011
04
2011
05
2011
06
2011
07
2011
08
2011
09
2011
10
2011
11
2011
12
2012
01
2012
02
2012
03
2012
04
2012
05
2012
06
2012
07
2012
08
2012
09
2012
10
2012
11
2012
121000
1500
2000
2500
3000
3500
4000
Persons with an Rx Active Clients
Num
ber
of
Clients
Ended Waitlist
Began waitlist
Data Source: AIDS Drug Assistance Program DataDivision of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013
Direct ADAP Demographics: 2012
64.811.4
10.3
7.16.4
Clients by Federal Poverty Level:
Total Clients = 4,001< 100%101-138% 139-200% 201 or moreUnknown
Data Source: AIDS Drug Assistance Program DataDivision of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013
Direct ADAP Demographics: 2012
20.9
4.7
36.9
19.5
5.7
2.6 9.9
Clients by Gender/Race:Total Clients = 4,001
White Males White Females Black Males Black Females
Hispanic Males Hispanic Females Other Gender/Race
Data Source: AIDS Drug Assistance Program DataDivision of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013
Direct ADAP Demographics: 2012
14.1
15
17.341.7
11.9
Clients by Current CD4 Count
< 200 201-350 351-500 > 500
Unknown
Clients by Gender/Race
75
15.5
9.5
Clients by Current Viral Load
< 200 200 or above Unknown
Lab results are from 2010 and later, from Ryan White and the Electronic HIV/AIDS Reporting System (eHARS), Division of Disease Prevention, Virginia Department of Health
Total Clients =4,001
Medicare Part D Demographics: 2012
51.4
5.2
21.6
11.6
1.6 0.3 3.4
Clients by Gender/Race
White Males White FemalesBlack Males Black FemalesHispanic Males Hispanic FemalesOther Gender/Race
2.6
22.7
39.5
14.2
20.9
Clients by Age
< 40 40 to 49 50 to 59 60 to 64
65 or older
Data Source: Medicare Part D Assistance Program Data (MPAP)Division of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013
Total Clients = 387
Medicare Part D: Rebate Revenue
Paid by Rx Companies to rebate to 340B
price for any co-pay paid on retail
Rx
VDH able to capture rebates for Medicare Part
D starting in 1/2011
Projections of amount of revenue
generated are often not feasible
VDH sends list of co-pays by drug
to companies and receives one
check from each company
Rebates
Rebates allow Virginia to recoup the cost differential between the price paid for the medication at point-of-sale and the 340B price, when ADAP pays for any part of the drug cost.
Drug Cost$100
$150
$200
340B; $185
Rebate; $15
Dollars
Full Retail Price = $200
Copay$5
Profit$10
Medicare Part D: Rebate Revenue2011-2012
Jan-June 2011
July-Dec 2011
Jan-June 2012
$0
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
$700,000
$800,000
$900,000
$1,000,000
$307,330
$155,538
$339,279
$608,252
$870,934
$519,279
Copays billed Rebates
Dollars
Data Source: AIDS Drug Assistance Program, Financial Tracking DataDivision of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013
VA-ADAP Value of Dispensed Drugs: Direct ADAP Only
RW09
10
RW10
11
RW11
12
RW12
13(p
roje
cted
)0
5
10
15
20
25
30 28 27.6
19.5
24.2
Million
s o
f D
ollars
Value of dispensed drug is the sum of all filled prescriptions for direct ADAP
Does not include any returned medication, increases in drug inventory levels, or revenue generated from ADAP (Medicaid backbilling, Rebates)
Data Source: AIDS Drug Assistance Program DataDivision of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013
Pre-Existing Condition Insurance Program: VA-ADAP 2013
Covers medications and
medical care (through Dec
2013)
Enrollment of 350-450 in 2013
Average Annual Premiums are
$2,748 per client
Can Collect Rebates on Medications
Cap on annual costs of $6,250 (in-network), $10K (out of
network)
ADAP Costs by Program: Projections April 2013 to March 2014
Jul-1
2
Aug-1
2
Sep-
12
Oct-1
2
Nov-1
2
Dec-1
2
Jan-
13
Feb-
13
Mar-1
3
Apr-1
3
May-1
3
Jun-
13
Jul-1
3
Aug-1
3
Sep-
13
Oct-1
3
Nov-1
3
Dec-1
3
Jan-
14
Feb-
14
Mar-1
4$0.0
$500,000.0
$1,000,000.0
$1,500,000.0
$2,000,000.0
$2,500,000.0
$3,000,000.0
$3,500,000.0
$4,000,000.0
$4,500,000.0
$5,000,000.0
Cost for Direct ADAP Total PCIP/Exchanges Cost Total MPAP Cost
Cost
Per
Month
Assumptions: Enrollment of Eligible Clients in Health Care Exchanges in January 2014Rebate Total Estimates for Year = $6.8M
Net Expenditures Estimate = $34.7 M
Division of Disease Prevention, Office of Epidemiology, Virginia Department of Health, January 2013
$41.6M
$13.2M
$27.2M
$1.2M
Exchanges