The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #59911

Jeffrey Levi, PhD, Center for Health Services Research and Policy, George Washington University, 2021 K Street, NW Suite 800, Washington, DC 20006, 202-530-2363, jlevi@gwu.edu

This paper discusses the policy options available to federal officials as they consider how to expand access to HIV-related pharmaceuticals for those who are uninsured or under-insured, with a particular emphasis on discretionary programs. The context of this discussion is a growing number of people living with HIV in care, fewer people with HIV becoming disabled (and therefore fewer moving from discretionary programs to entitlement programs such as Medicaid), and lower mortality rates (increasing demand for treatments). The AIDS Drug Assistance Program (ADAP) is the principal means for expanding access to therapies, along with the other parts of the Ryan White CARE Act. Short-term options are explored, ranging from voluntary reprioritization of funding within the CARE Act and criteria for establishing waiting lists (and other forms of rationing). Longer-term options that might require strong administrative or legislative steps are also considered, ranging from creating a federally-defined core set of services within the CARE Act to federally mandated or negotiated price reductions for pharmaceuticals used in ADAP. Options beyond the CARE Act, such as broader access to private and public insurance programs are also explored.

Learning Objectives:

• An understanding of the interrelationship of mandatory and discretionary programs for financing HIV care and an understanding of policy options for expanding access to HIV therapies in the context of very tight fiscal constraints.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.