This is the accessible text file for GAO report number GAO-06-646 
entitled 'Ryan White CARE Act: Improved Oversight Needed to Ensure AIDS 
Drug Assistance Programs Obtain Best Prices for Drugs' which was 
released on April 26, 2006. 

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Report to Congressional Requesters: 

United States Government Accountability Office: 

GAO: 

April 2006: 

Ryan White Care Act: 

Improved Oversight Needed to Ensure AIDS Drug Assistance Programs 
Obtain Best Prices for Drugs: 

AIDS Drug Assistance Programs: 

GAO-06-646:

GAO Highlights: 

Highlights of GAO-06-646, a report to congressional requesters.

Why GAO Did This Study: 

The CARE Act authorized grants to the states and certain territories 
for AIDS Drug Assistance Programs (ADAP) to purchase and provide 
HIV/AIDS drugs to eligible individuals. An ADAP’s coverage—who and what 
is covered—is determined by each ADAP’s eligibility and other program 
criteria, and ADAPs may establish waiting lists for eligible 
individuals. ADAPs may purchase their drugs through the 340B federal 
drug pricing program, which provides discounts on certain drugs to 
covered entities. The Health Resources and Services Administration 
(HRSA) oversees ADAPs and is responsible for monitoring the prices they 
pay.

GAO was asked to examine (1) coverage differences among ADAPs, (2) how 
the prices ADAPs reported paying for HIV/AIDS drugs compare to 340B 
prices, (3) how HRSA monitors the drug prices ADAPs pay, and (4) how 
the 340B prices compare to other selected federal drug pricing programs.

What GAO Found: 

Variation in each ADAP’s program design and funding from various 
sources contributes to differences in coverage among the 52 ADAPs GAO 
reviewed. Each ADAP has considerable flexibility in designing 
eligibility and other program criteria to determine who will be covered 
by the program. Consequently, an individual eligible for ADAP services 
in one state may not be eligible for services in another. ADAPs varied 
in the extent to which they received funding from sources in addition 
to the CARE Act ADAP base grants, such as state funds or transfers of 
funds from other CARE Act grants. Eligibility and other program design 
criteria also varied among ADAPs that had waiting lists of eligible 
individuals in fiscal year 2004, as did the amount and sources of 
additional funding for those ADAPs.

In their quarterly reports to HRSA, some ADAPs reported prices that 
were above the 340B price for some of the 10 drugs GAO compared. These 
10 drugs accounted for 73 percent of ADAP drug spending. If ADAPs 
choose to use the 340B program, they may purchase drugs from 
manufacturers either through the direct purchase option, receiving the 
340B price up front, or through the 340B rebate option, paying full 
price and receiving a rebate later. The 340B prices are not disclosed 
to ADAPs, but participating manufacturers agree to sell at the 340B 
prices. However, all 25 ADAPs that used the 340B direct purchase option 
reported a price that was above the 340B price. All but 3 of the 27 
ADAPs using the 340B rebate option reported prices higher than the 340B 
price for one or more drugs. These prices may not have been the final 
prices these ADAPs paid, however, because they may not have included 
all rebates eventually received.

HRSA is responsible for monitoring whether ADAPs obtain the best prices 
available for drugs. HRSA has identified the 340B prices as a measure 
of an ADAP’s economical use of grant funds. However, HRSA does not 
routinely determine whether the prices ADAPs report are no higher than 
the 340B prices. Also, quarterly reports do not reflect the rebates 
eventually received by ADAPs using the rebate option to purchase drugs. 
Without considering the final ADAP rebate amount on a drug purchase, 
HRSA cannot determine whether the final drug prices paid were at or 
below the 340B price.

ADAPs that purchase drugs at 340B prices paid more for some drugs than 
certain federal agencies did for the same drugs under the federal 
ceiling price program. ADAPs do not have access to this program. The 
340B prices were also higher than some of the prices available through 
the 340B prime vendor program, which negotiates drug prices on behalf 
of participating 340B entities including ADAPs. The 340B prices, 
including the 340B prime vendor prices, were lower than the Medicaid 
rebate program prices available to state Medicaid programs, for each of 
the drugs GAO could compare.

What GAO Recommends:

GAO recommends that HRSA require ADAPs to report the final prices they 
paid for drug purchases, net of rebates, and that HRSA routinely 
determine whether these prices paid are at or below the 340B prices. 
HRSA stated that these steps would be labor intensive and it lacks 
capacity to carry out such oversight. We believe there are cost-
effective processes HRSA could use.

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Marcia Crosse at (202) 
512-7119 or crossem@gao.gov.

[End of Section] 

Contents: 

Letter: 

Background: 

Results in Brief: 

Variation in Program Design and Funding Contributes to Coverage 
Differences among ADAPs: 

Some ADAPs Reported HIV/AIDS Drug Prices that Were Higher than the 340B 
Prices: 

HRSA Does Not Routinely Determine Whether Drug Prices ADAPs Report 
Paying Are Higher than the 340B Prices: 

HIV/AIDS Drug Prices Are Sometimes Higher Under the 340B Program than 
Some Federal Programs: 

Conclusions: 

Recommendations for Executive Action: 

Agency Comments and Our Evaluation: 

Appendix I: Prenatal HIV Testing and Perinatal HIV Transmission Rates 
within States: 

Background: 

Prenatal HIV Testing Encouraged to Reduce HIV Perinatal Transmission: 

Appendix II: State Approaches to Identifying and Notifying Partners of 
HIV-Infected Individuals of Possible HIV Exposure: 

Background: 

States Use Various Approaches to Elicit Information and Notify Partners 
of Possible HIV Exposure: 

Appendix III: Scope and Methodology: 

Appendix IV: Comments from the Health Resources and Services 
Administration: 

Appendix V: GAO Contact and Staff Acknowledgments: 

Related GAO Products: 

Tables: 

Table 1: Key CARE Act Title II Grants through which ADAPs May Receive 
Funds: 

Table 2: ADAP Program Eligibility by Income Ceiling, Reported for ADAP 
Grant Year 2004: 

Table 3: Program Eligibility and Other Criteria, Reported for ADAP 
Grant Year 2004: 

Table 4: Number of Drugs Included in ADAP Formularies and ADAPs that 
Cover Fuzeon, Reported for ADAP Grant Year 2004: 

Table 5: Additional ADAP Funding Sources and Amounts by ADAP, Fiscal 
Year 2004: 

Table 6: Total Additional ADAP Funding as a Percentage of the CARE Act 
ADAP Base Grants and Total Additional Funding Per ELC by ADAP, Fiscal 
Year 2004: 

Table 7: ADAPs with Waiting Lists and Number of Months Each Had Waiting 
Lists, Fiscal Year 2004: 

Table 8: Ranking of 13 ADAPs with Waiting Lists among the 46 ADAPs that 
Received Additional Funding Per ELC; Fiscal Year 2004: 

Table 9: 25 340B Direct Purchase ADAPs that Reported Prices for the Top 
10 HIV/AIDS Drugs that Were Above 340B Prices; 2003: 

Table 10: Ranking of Top 10 HIV/AIDS Drugs from Lowest (1) to Highest 
(5) Unit Price Across Drug Programs; 2003: 

Table 11: Percentage of Unit Price Increases or Decreases from 2000 to 
2003 for Top 10 HIV/AIDS Drugs: 

Abbreviations: 

ADAP: AIDS Drug Assistance Program: 
AIDS: acquired immunodeficiency syndrome: 
AMP: average manufacturer price: 
CARE Act: Ryan White Comprehensive AIDS Resources Emergency Act of 
1990: 
CDC: Centers for Disease Control and Prevention: 
CMS: Centers for Medicare & Medicaid Services: 
ELC: estimated living AIDS case: 
EMA: eligible metropolitan area: 
FCP: federal ceiling price: 
FDA: Food and Drug Administration: 
FSS: federal supply schedule: 
HAART: highly active antiretroviral therapy: 
HHS: Department of Health and Human Services: 
HIV: human immunodeficiency virus: 
HRSA: Health Resources and Services Administration: 
IOM: Institute of Medicine: 
NASTAD: National Alliance of State and Territorial AIDS Directors: 
NDC: national drug code: 
OIG: Office of Inspector General: 
OPA: Office of Pharmacy Affairs: 
PCRS: partner counseling and referral services: 
STD: sexually transmitted disease: 
VA: Department of Veterans Affairs: 

United States Government Accountability Office: 

Washington, DC 20548: 

April 26, 2006: 

The Honorable Michael B. Enzi: 
Chairman Committee on Health, Education, Labor, and Pensions: 
United States Senate: 

The Honorable Mark E. Souder: 
Chairman Subcommittee on Criminal Justice, Drug Policy, and Human 
Resources: 
Committee on Government Reform: 
House of Representatives: 

The Honorable Tom Coburn, M.D. 
The Honorable Judd Gregg: 
United States Senate: 

Since the first cases of acquired immunodeficiency syndrome (AIDS) were 
identified in the United States nearly 25 years ago, advancements in 
prescription drug treatments have significantly reduced AIDS mortality 
and slowed the progression from a human immunodeficiency virus (HIV) - 
positive diagnosis to AIDS.[Footnote 1] The introduction of combination 
drug treatments--highly active antiretroviral therapy (HAART)--in 1996 
was followed by a decline in the number of AIDS deaths and new AIDS 
cases in the United States for the first time since the beginning of 
the epidemic.[Footnote 2] While drug treatments have extended the 
lifespan of those living with HIV/AIDS, the number of new HIV 
infections has not decreased. The Department of Health and Human 
Services's (HHS) Centers for Disease Control and Prevention (CDC) 
estimates approximately 40,000 people are newly infected annually. CDC 
also estimates that between 1,039,000 and 1,185,000 people in the 
United States were living with HIV/AIDS at the end of 2003. The number 
of people with HIV/AIDS is likely to have risen since then, and CDC 
estimates that, as of December 2004, it included 415,193 individuals 
with AIDS. 

The Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE 
Act),[Footnote 3] administered by HHS's Health Resources and Services 
Administration (HRSA), was enacted to address the needs of 
jurisdictions, health care providers, and people with HIV/AIDS and 
their family members.[Footnote 4] Title II of the CARE Act[Footnote 5] 
authorizes AIDS Drug Assistance Program (ADAP) grants to states, 
including the District of Columbia, and certain territories[Footnote 6] 
specifically to operate ADAPs. ADAPs purchase and provide HIV/AIDS 
drugs to infected individuals who meet eligibility requirements. Each 
state and territory is given broad authority under the CARE Act to 
design its own program. The scope of an ADAP's coverage--who and what 
is covered--is determined by each ADAP's program design, which includes 
criteria for who is eligible to receive drugs, and other criteria such 
as the number and types of drugs it will provide. There are no uniform 
program design criteria across ADAPs. 

ADAPs are a critical source of prescription drugs for low-income people 
with HIV/AIDS who have no or limited prescription drug coverage and are 
the programs of last resort for these individuals.[Footnote 7] In 
fiscal year 2005, CARE Act funding for ADAP grants was $787.5 million. 
As the number of people who know their HIV-positive status grows, the 
number of people with HIV/AIDS needing to rely on ADAPs will likely 
increase. Some ADAPs have struggled to meet the demand for their 
services. Limited resources have contributed to ADAPs establishing 
waiting lists for eligible individuals and taking other measures that 
restrict access. 

Grants under Title II of the CARE Act are subject to conditions set out 
by HRSA in the notice of grant award, including conditions related to 
ADAP drug prices.[Footnote 8] One of these conditions identifies 340B 
drug prices as the measure of ADAPs' economical use of grant funds. 
Under Section 340B of the Public Health Service Act, drug manufacturers 
provide discounts on certain outpatient drugs to covered 
entities;[Footnote 9] a 340B price, sometimes referred to as a 340B 
ceiling price, is established for each covered drug that entities 
purchase. ADAPs are allowed to purchase drugs through the Section 340B 
program and are required to submit quarterly HIV/AIDS drug pricing 
reports to HRSA that indicate what they paid for drugs. Other federal 
drug pricing programs are used by federal agencies to purchase HIV/AIDS 
drugs, including the federal supply schedule (FSS) and federal ceiling 
price (FCP) programs. State Medicaid programs receive rebates from drug 
manufacturers for purchases of certain outpatient drugs including HIV/ 
AIDS drugs through the federal Medicaid drug rebate program. ADAPs are 
not authorized by statute to purchase drugs under these other drug 
pricing programs. 

As Congress prepares for the reauthorization of CARE Act programs, you 
asked us to examine certain aspects of ADAPs. Specifically, we are 
reporting on (1) how each ADAP's program design and funding sources 
contribute to differences in coverage among ADAPs, including those 
ADAPs with waiting lists, (2) how the prices that ADAPs report to HRSA 
they paid for HIV/AIDS drugs compare to the 340B prices, (3) how HRSA 
monitors the drug prices ADAPs pay, and (4) how the 340B prices for 
HIV/AIDS drugs compare to prices under selected federal drug pricing 
programs. You also asked us to provide information on state prenatal 
HIV testing and perinatal HIV transmission rates, and state approaches 
to identifying and notifying partners of HIV-infected individuals; this 
information is provided in appendixes I and II, respectively. 

To report on these issues, we reviewed the 1990 CARE Act, and 
subsequent amendments, HRSA policy manuals, HHS's Office of Inspector 
General (OIG) reports on the CARE Act and ADAPs, Institute of Medicine 
(IOM) reports on the CARE Act, and other related reports, and 
documents. We interviewed HRSA and HHS OIG officials, as well as 
officials from the National Alliance of State and Territorial AIDS 
Directors (NASTAD) and the Association of State and Territorial Health 
Officials. 

We reviewed 52 ADAPs to determine what program design elements 
contribute to the coverage differences among ADAPs.[Footnote 10] We 
analyzed and compared data ADAPs reported to HRSA for grant year 2004 
on program design elements such as eligibility income levels for 
individuals, enrollment caps, the number of drugs covered, and funding 
from various sources during fiscal year 2004.[Footnote 11] We also 
analyzed and compared these data among ADAPs with waiting lists of 
eligible individuals. 

To compare the prices that ADAPs reported paying for HIV/AIDS drugs to 
340B prices for such drugs, we first determined which HIV/AIDS drugs 
were the top ten by ADAP expenditure using 2002 data, the most recently 
available expenditure data at the time of our analysis. These drugs 
accounted for 73 percent of ADAP drug spending. We then compared the 
prices ADAPs reported paying for the top ten HIV/AIDS drugs to the 340B 
program prices for those same drugs. For this comparison, we used the 
2003 340B program prices and the purchase prices that 52 ADAPs provided 
in their quarterly reports submitted to HRSA for 2003. At the time of 
our analysis, 2003 was the most recent full year of ADAP drug price 
data. 

To determine how HRSA monitors the prices ADAPs pay for HIV/AIDS drugs, 
we interviewed HRSA officials. To determine how the 340B prices compare 
with prices under selected federal drug pricing programs, we used the 
2003 prices for the 340B drug pricing program from HRSA and compared 
them to FSS and FCP program prices from the Department of Veterans 
Affairs (VA), which administers these pricing programs. To determine 
how the 340B prices compare with the Medicaid prices, we calculated 
prices state Medicaid agencies paid including rebates states received 
under HHS's Centers for Medicare & Medicaid Services' (CMS) Medicaid 
drug rebate program. We found the data from these sources to be 
sufficient and reliable for our analyses. 

Appendix III provides a more detailed explanation of the scope and 
methodology for this report. We performed our work from July 2004 
through April 2006, in accordance with generally accepted government 
auditing standards. 

Background: 

In 1990, Congress passed the CARE Act to address the needs of 
jurisdictions, health care providers, and people with HIV/AIDS and 
their family members. The CARE Act authorizes grants to eligible 
metropolitan areas (EMA) under Title I, and to states and territories 
under Title II.[Footnote 12] Title II of the CARE Act authorizes the 
grants by which states and certain territories receive funds 
specifically to operate ADAPs. ADAPs purchase HIV/AIDS drugs for 
enrolled low-income people who are uninsured or underinsured. Each 
state and territory is responsible for and has significant flexibility 
in determining its ADAP eligibility criteria for who receives services, 
the services it provides, and which drugs to include in its 
formularies. 

States and certain territories receive ADAP base grants distributed by 
a formula based on each grantee's proportion of total estimated living 
AIDS cases (ELC).[Footnote 13] The ADAP grant program, administered by 
HRSA's HIV/AIDS Bureau, distributed $787.5 million or 38 percent of the 
about $2.1 billion in CARE Act funding for fiscal year 2005. ADAPs may 
receive funds from various other Title II grants awarded to states and 
territories, including Title II base grants and Severe Need grants. 
(See table 1.) Severe Need grants are made to states and certain 
territories with a need for funding to increase access to drugs. 

Table 1: Key CARE Act Title II Grants through which ADAPs May Receive 
Funds: 

Grant: Base Grant;
Purpose: Support primary and home-based health care, insurance 
coverage, medications, support services, and early intervention 
services, such as HIV counseling, testing, and referral; 
Eligible grantees: States and territories[A]; 
Distribution: Distributed based 80 percent on each grantee's proportion 
of all ELCs and 20 percent on each grantee's proportion of all ELCs 
located outside EMAs.[B] Minimum grants of $200,000 are provided for 
states with less than 90 ELCs; $500,000 for states with 90 or more 
ELCs; and $50,000 for territories. 

Grant: ADAP Base Grant;
Purpose: Provide medications, drug treatment adherence and support 
efforts,[C] and health insurance coverage with prescription drug 
benefits; 
Eligible grantees: States and certain territories[D]; 
Distribution: Distributed based on each grantee's proportion of all 
ELCs. 

Grant: Severe Need Grant;
Purpose: Provide increased access to HIV/AIDS drugs; 
Eligible grantees: States and certain territories[D] with a severe need 
for a grant to increase access to medications; 
Distribution: Distributed based on each grantee's proportion of all 
ELCs; grantees must agree to match 25 percent of their severe need 
grant and not to impose ADAP eligibility requirements stricter than 
those in place on January 1, 2000.[E]. 

Source: HRSA. 

[A] In addition to the 50 states, base grants are authorized for the 
District of Columbia, the Commonwealth of Puerto Rico, Guam, the Virgin 
Islands, American Samoa, the Commonwealth of the Northern Mariana 
Islands, the Republic of the Marshall Islands, the Federated States of 
Micronesia, and the Republic of Palau. 

[B] Under Title I of the CARE Act, EMAs are metropolitan areas with a 
population of at least 500,000 and more than 2,000 reported AIDS cases 
in the last 5 calendar years. 

[C] Drug treatment adherence and support efforts are intended to 
increase individuals' ability to comply with the treatment regimen, for 
example, by providing care for depression. 

[D] In addition to the 50 states, these grants are authorized for the 
District of Columbia, the Commonwealth of Puerto Rico, Guam, and the 
Virgin Islands. 

[E] To be eligible for a Severe Need grant, a jurisdiction must have 
met one of four eligibility criteria as of January 1, 2000. It must 
have limited (1) the eligibility of ADAP enrollees to those with 
incomes at or below 200 percent of the federal poverty level, (2) the 
number of ADAP enrollees by using medical eligibility restrictions, (3) 
the number of antiretroviral drugs covered in its drug formulary, or 
(4) the number of opportunistic infection medications to less than 10 
in its drug formulary. (Opportunistic infections are illnesses such as 
parasitic, viral, and fungal infections, and some types of cancer, some 
of which usually do not cause disease in people with normal immune 
systems.) In addition, a jurisdiction must also have agreed to provide 
a 25 percent match and not impose eligibility requirements more 
restrictive than those in place on January 1, 2000. According to HRSA, 
grantees can provide funds or in-kind services to meet the matching 
requirements.

[End of table] 

ADAPs serve as the HIV/AIDS drug assistance program of last resort for 
individuals who, for example, cannot afford to pay for drugs, do not 
have insurance coverage for drugs, or do not qualify for other federal 
programs such as Medicaid that provide HIV/AIDS services to eligible 
individuals. Medicaid is the largest source of federal funding for HIV/ 
AIDS health care services. In fiscal year 2005, Medicaid provided an 
estimated $5.7 billion in HIV/AIDS health care assistance.[Footnote 14] 
Because Medicaid funds HIV/AIDS health care services, including drugs, 
to eligible individuals, state eligibility determinations for Medicaid 
are important in determining eligibility for ADAPs that provide HIV/ 
AIDS services as a last resort.[Footnote 15] Individuals who have 
received HIV/AIDS drugs through their state Medicaid programs and who 
are dual eligibles--eligible for both Medicaid and Medicare--will be 
affected by the Medicare Part D prescription drug benefit implemented 
in January 2006. Rather than receiving their drug coverage under 
Medicaid, dual eligibles will be covered by private insurance plans 
provided through Part D. Since Medicaid drug benefits vary from state 
to state, and Medicare Part D plans vary, which dual eligibles, if any, 
will be able to receive ADAP drug coverage as a last resort will also 
vary. 

Unlike Medicaid, under which states receive more federal funds when 
their expenditures increase, due, for example, to greater enrollment, 
ADAPs do not receive additional federal funds when they have more 
eligible individuals than funds to provide services. When an ADAP 
cannot cover everyone it determines is eligible for its services, it 
may, but is not required to, establish a waiting list. ADAPs may 
establish waiting lists anytime that they determine it is necessary and 
the number of ADAPs with waiting lists is not constant. Since ADAPs may 
also cap the number of individuals they are willing to enroll for 
services, the ADAPs with waiting lists may not represent all eligible 
individuals who are not being served. During fiscal year 2004, there 
were 14 ADAPs that reported having waiting lists for at least part of 
the year.[Footnote 16] 

When eligible individuals are on ADAP waiting lists, there are limited 
drug assistance options available to help those who qualify until they 
can be served by the ADAP. If they do not qualify for these options, 
the result can be an interruption of needed drug treatment. According 
to HHS's HIV treatment guidelines, if an individual's HAART regimen is 
interrupted, the individual can develop drug resistance upon resuming 
treatment.[Footnote 17] Individuals who develop drug resistance can 
transmit drug-resistant strains of the HIV virus. Among the drug 
assistance options are pharmaceutical manufacturers' patient assistance 
programs that provide free or cost-reduced drugs, non-ADAP pharmacy 
assistance programs using Title I funds,[Footnote 18] and state-
sponsored pharmacy assistance programs. An ADAP-eligible individual's 
ability to use these options may be limited by factors such as 
availability in a particular state, financial and medical eligibility 
criteria for the individual, and coverage duration. 

ADAPs and the 340B Drug Pricing Program: 

Section 340B of the Public Health Service Act requires drug 
manufacturers, as a condition of their payment under Medicaid, to sign 
a pharmaceutical pricing agreement with the Secretary of Health and 
Human Services. Drug manufacturers agree to charge covered entities, 
including ADAPs, that participate in the 340B drug pricing program 
prices for certain outpatient drugs that do not exceed an amount 
determined by statutory formula--the 340B price.[Footnote 19] HRSA's 
Office of Pharmacy Affairs (OPA), within the Healthcare Systems Bureau, 
administers the 340B program and calculates the 340B prices on a 
quarterly basis,[Footnote 20] which are below the average manufacturer 
price (AMP).[Footnote 21] ADAPs are eligible to participate in the 340B 
drug pricing program and receive 340B drug prices for the HIV/AIDS 
drugs they cover.[Footnote 22] Like the other covered entities, an 
ADAP's participation in the 340B program is voluntary--they may choose, 
for example, to negotiate drug prices themselves with drug companies. 
For an ADAP to purchase drugs through the 340B program, it must inform 
both OPA and the HIV/ AIDS Bureau's Division of Service Systems to 
activate its status as a 340B covered entity. 

ADAPs participating in the 340B program have options for how they 
purchase drugs. Generally, ADAPs can purchase drugs through either the 
340B direct purchasing option (sometimes referred to as point-of- 
purchase) or through the 340B rebate option. ADAPs choose one of these 
options when they activate their status as a 340B entity. Under the 
direct purchase option, ADAPs purchase drugs from drug manufacturers or 
through a third-party such as a drug purchasing agent. Using the 340B 
direct purchase option, ADAPs receive the 340B price discount up front. 
Under the rebate option, ADAPs typically contract with entities such as 
a pharmacy network or pharmacy benefits management company for the 
purchase of covered drugs. ADAPs later request a 340B rebate from the 
drug manufacturers. ADAPs that have activated their 340B status and are 
using the 340B direct purchase option can also use the 340B prime 
vendor to negotiate for them.[Footnote 23] The prime vendor assists 
covered entities by negotiating drug prices at or below the 340B drug 
prices. Participation in this program is voluntary, but ADAPs that 
utilize the 340B rebate option or those that negotiate prices 
themselves and do not participate in the 340B drug pricing program are 
not eligible to participate in the prime vendor program. 

Grants under Title II of the CARE Act are subject to conditions set out 
in the notice of grant award, including conditions related to ADAP drug 
prices. One of these conditions identifies 340B prices as the measure 
of ADAPs' economical use of grant funds. Specifically, the notice 
states that "HHS and Congress expect that states will use every means 
at their disposal to secure the best price available for all products 
on their ADAP formularies in order to achieve maximum results with 
these funds." Further, the notice requires grantees to "adopt at least 
one defined cost-saving practice for their ADAP program that is equal 
to or more economical than the 340B Drug Pricing Program and its Prime 
Vendor Program."[Footnote 24] For example, ADAPs may negotiate prices 
with drug manufacturers that are at or below the 340B prices for the 
same drugs. However, HHS does not disclose to ADAPs or the prime vendor 
what the 340B prices are for the drugs they purchase because of 
statutory provisions relating to the confidentiality of certain drug 
pricing information.[Footnote 25] All ADAPs submit quarterly HIV/AIDS 
drug pricing reports to the HIV/AIDS Bureau that indicate what they 
paid. The Bureau can request that OPA compare the ADAP price reports to 
the 340B prices, but OPA does not share its price comparisons with the 
Bureau due to the confidentiality of the 340B prices. If a state or 
territory does not comply with the grant conditions, HRSA can either 
restrict the use of its current grant funds or deny the state or 
territory future grant funds. 

Other Federal Drug Pricing Programs: 

Federal agencies and state Medicaid programs purchase drugs subject to 
other statutory provisions regarding prices. The FSS has prices 
available to all federal government purchasers for the drugs listed on 
the schedule. Another program, FCP, is the maximum price that drug 
manufacturers can charge four agencies--the Department of Defense, the 
VA, the Public Health Service, and the Coast Guard--for brand-name 
drugs listed on the FSS, even if the FSS prices are higher.[Footnote 
26] State Medicaid programs receive rebates on their covered drugs, 
including HIV/AIDS drugs, through the federal Medicaid drug rebate 
program. The minimum Medicaid rebate amount is 15.1 percent of AMP. 
ADAPs are not authorized to purchase drugs under these drug pricing 
programs, except for the District of Columbia ADAP, which purchases 
drugs using the FCP. 

Results in Brief: 

Variation in ADAPs' program design and funding amounts from the CARE 
Act and other sources contributes to differences in coverage among the 
52 ADAPs we reviewed. ADAP program eligibility and other design 
criteria, including income ceilings, program enrollment caps, and drug 
formularies, that states and territories establish vary considerably. 
For example, each ADAP determines a maximum income level, or income 
ceiling, as a criterion for an individual's eligibility for enrollment. 
ADAPs reported income ceilings for the 2004 grant year that ranged from 
125 percent of the federal poverty level in North Carolina to 556 
percent in Massachusetts. Also, of the 52 ADAPs, 16 reported that they 
have limits on the assets that individuals enrolled in the program are 
allowed to have. Twelve ADAPs reported having caps on program 
enrollment or on amounts expended per individual for HIV/AIDS drugs. 
The total number of drugs ADAPs included on their formularies ranged 
from 20 in Colorado to 1,000 in Massachusetts, New Hampshire, and New 
Jersey. Because of the variation in program criteria, an individual 
eligible for ADAP services in one state may not be eligible for 
services in another. The funding that some ADAPs reported receiving 
from sources other than the ADAP base grant, such as transfers from 
Title II base grants, and states' or other governmental entities' 
funds, also varied among ADAPs for fiscal year 2004. Funding from these 
various sources significantly increased funds available to cover 
individuals for some ADAPs. For example, the California ADAP, which had 
an ADAP base grant of about $89.6 million, received about $123.5 
million in total additional funding. Eligibility and other program 
design criteria also varied among ADAPs that had waiting lists of 
eligible individuals in fiscal year 2004, as did the amount and sources 
of additional funding for those ADAPs. 

Some ADAPS reported prices to HRSA for some of the top 10 HIV/AIDS 
drugs that were higher than the 340B program prices. Drug manufacturers 
that agree to participate in the 340B drug pricing program agree to 
sell HIV/AIDS drugs to 340B entities, including ADAPs that participate 
in the program, at prices no higher than 340B prices. ADAPs are 
expected to secure the best price available for drugs on their 
formularies whether they use the 340B program, including the 340B prime 
vendor, or negotiate drug prices on their own with drug manufacturers. 
In our analysis using the top 10 HIV/AIDS drugs by ADAP expenditures, 
we found that in calendar year 2003 all of the 25 ADAPs that used the 
340B direct purchase option reported prices to HRSA that were higher 
than the 340B price for at least one of the top 10 drugs. For example, 
7 of the 25 ADAPs reported purchasing the drug Viramune at prices 
higher than the 340B price. Of the 27 ADAPs that used the 340B rebate 
option to purchase drugs in 2003, all except 3 ADAPs reported paying 
drug prices that were higher than the 340B prices for many of the top 
10 drugs. However, the prices that ADAPs using the rebate option report 
to HRSA for each drug they purchase may not reflect the rebates that 
they eventually receive and therefore may not be the final prices these 
ADAPs pay for the drugs. 

Although HRSA is responsible for monitoring whether ADAPs are complying 
with grant conditions, it does not routinely compare the drug prices 
ADAPs pay to 340B prices. A HRSA HIV/AIDS Bureau official said that the 
Bureau has occasionally asked OPA to compare the prices ADAPs report 
they paid for drugs to the 340B prices and provide the results. Bureau 
and OPA officials also said that they are discussing plans for OPA to 
begin making routine comparisons of drug prices. However, the ADAP drug 
price information that OPA currently uses to make its comparisons is 
not complete. The prices ADAPs report paying do not include all rebates 
they receive under the 340B rebate option. Also, OPA does not 
systematically check whether the prices obtained by the 340B prime 
vendor program are at or below the 340B prices. Without the final ADAP 
rebate amount on a drug purchase, HRSA cannot determine whether the 
final drug prices paid were at or below the 340B price. 

The 340B program prices were higher for some of the top 10 drugs than 
the 340B prime vendor prices and the prices federal agencies paid for 
the same drugs under the FSS and FCP drug pricing programs. Using the 
top 10 HIV/AIDS drugs by ADAP expenditures, we compared 2003 drug 
prices under the 340B prime vendor, FSS, FCP, and Medicaid rebate drug 
pricing programs to the 340B prices. We found that the FCP and 340B 
prime vendor prices were lower than the 340B prices for 6 of the 7 
drugs that had prices available under all five programs. The 6 HIV/AIDS 
drugs were Combivir, Epivir, Sustiva, Trizivir, Zerit, and Ziagen. The 
Medicaid rebate program prices, available to state Medicaid programs, 
were the highest of all the drug pricing programs for 3 of the 7 drugs 
for which we had prices from all programs. The 3 drugs were Norvir, 
Sustiva, and Trizivir. 

We are making recommendations to the Administrator of the Health 
Resources and Services Administration to require that all ADAPs report 
final prices they paid for drugs that reflect any discounts or rebates 
received, and to routinely determine whether the prices ADAPs paid for 
the drugs they purchased were at or below the 340B prices. In 
commenting on these recommendations, HRSA stated that it would like to 
verify final drug prices but this would be labor intensive because 
reports ADAPs currently provide do not contain the needed information. 
HRSA further stated that it lacks the resources to conduct a 
comprehensive price comparison, but is making efforts to develop 
systems to allow ADAPs to check drug prices. We believe that, while 
monitoring the prices paid for all the drugs on each ADAP's formulary 
might be challenging, HRSA could use a cost-effective, automated 
process to compare ADAP reported prices to 340B prices for selected 
drugs and could modify its schedule of ADAP reports to allow for rebate 
reconciliation. 

Variation in Program Design and Funding Contributes to Coverage 
Differences among ADAPs: 

The program eligibility and other criteria that ADAPs establish and 
additional funding that some ADAPs receive vary and contribute to 
coverage differences among the 52 ADAPs we reviewed. As a result, an 
individual eligible for ADAP services in one state may not be eligible 
in another state. Also, some of the ADAPs received funding from sources 
other than ADAP base grants, such as Severe Need grants, transfers from 
Title I grants or Title II base grants, and contributions from their 
state or territory. The additional funding that some ADAPs received in 
fiscal year 2004 significantly increased funds available to support 
ADAP enrollees and services. Eligibility and other program design 
criteria varied among ADAPs that had waiting lists of eligible 
individuals in fiscal year 2004, as did the amount and sources of 
additional funding for those ADAPs. This variation among ADAPs with 
waiting lists contributes to coverage differences, just as it does 
among all ADAPs. 

Variation in ADAPs' Eligibility and Other Program Criteria Contributes 
to Coverage Differences among ADAPs: 

ADAP program eligibility and other criteria, including income ceilings, 
copayments, and drug formularies, that states and territories establish 
vary considerably and contribute to coverage differences among ADAPs. 
According to the National ADAP Monitoring Project,[Footnote 27] some 
ADAPs use these criteria and others that can limit access to their 
services to contain program costs. Because these criteria vary among 
ADAPs, a person determined eligible and who receives certain ADAP 
services in one jurisdiction may not be eligible or receive the same 
ADAP services in another. 

Income level is one program eligibility criterion that varies among 
ADAPs. Each ADAP has an income ceiling, which is the maximum income an 
individual can have and be eligible for the program. Among the 52 ADAPs 
included in our review, income ceilings reported to HRSA for the 2004 
grant year ranged from the most restrictive at 125 percent of the 
federal poverty level,[Footnote 28] or $11,638, in North Carolina to 
the most generous at 556 percent, or $51,764, in Massachusetts. (See 
table 2.) Eleven ADAPs had income ceilings that were 200 percent or 
less of the federal poverty level. Sixteen ADAPs reported income 
ceilings that were 400 percent or greater than the federal poverty 
level. 

Table 2: ADAP Program Eligibility by Income Ceiling, Reported for ADAP 
Grant Year 2004: 

ADAP: Alabama;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: $23,275; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 250%. 

ADAP: Alaska[B];
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 34,890; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: Arizona;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: Arkansas;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: California;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 37,240; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 400%. 

ADAP: Colorado;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: Connecticut;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 37,240; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 400%. 

ADAP: Delaware;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 46,550; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 500%. 

ADAP: District of Columbia;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 37,240; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 400%. 

ADAP: Florida;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 32,585; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 350%. 

ADAP: Georgia;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: Hawaii[C];
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 42,800; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 400%. 

ADAP: Idaho;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 18,620; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 200%. 

ADAP: Illinois;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 37,240; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 400%. 

ADAP: Indiana;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: Iowa;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 18,620; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 200%. 

ADAP: Kansas;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: Kentucky;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: Louisiana;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 18,620; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 200%. 

ADAP: Maine;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: Maryland;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 37,240; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 400%. 

ADAP: Massachusetts;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 51,764; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 556%. 

ADAP: Michigan;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 41,895; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 450%. 

ADAP: Minnesota;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: Mississippi;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 37,240; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 400%. 

ADAP: Missouri;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: Montana;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 30,723; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 330%. 

ADAP: Nebraska;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 18,620; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 200%. 

ADAP: Nevada;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 37,240; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 400%. 

ADAP: New Hampshire;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: New Jersey;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 46,550; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 500%. 

ADAP: New Mexico;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: New York;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 45,340; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 487%. 

ADAP: North Carolina;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 11,638; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 125%. 

ADAP: North Dakota;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 37,240; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 400%. 

ADAP: Ohio;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 46,550; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 500%. 

ADAP: Oklahoma;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 18,620; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 200%. 

ADAP: Oregon;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 18,620; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 200%. 

ADAP: Pennsylvania;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 35,378; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 380%. 

ADAP: Puerto Rico[D];
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 18,620; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 200%. 

ADAP: Rhode Island;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: South Carolina;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: South Dakota;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: Tennessee;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: Texas;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 18,620; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 200%. 

ADAP: Utah;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 37,240; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 400%. 

ADAP: Vermont;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 18,620; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 200%. 

ADAP: Virginia;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: Washington;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: West Virginia;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 23,275; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 250%. 

ADAP: Wisconsin;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 27,930; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 300%. 

ADAP: Wyoming;
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Dollars: 18,620; 
Eligibility income ceiling and its percent of the federal poverty 
level[A]: Percent: 200%. 


Source: GAO analysis of ADAP data. 

Note: The ADAP 2004 grant year covered April 1, 2004, through March 31, 
2005. 

[A] The HHS 2004 federal poverty level for a single person was $9,310 
except as noted. 

[B] The HHS 2004 federal poverty level for Alaska was $11,630. 

[C] The HHS 2004 federal poverty level for Hawaii was $10,700. 

[D] The HHS 2004 federal poverty level was not defined for Puerto Rico; 
we calculated the eligibility income ceiling for Puerto Rico by 
multiplying Puerto Rico's 200 percent income ceiling by the federal 
poverty level of $9,310. 

[End of table] 

Of the 52 ADAPs we reviewed, 29 reported to HRSA that their programs 
had one or more program design limitations, which also contributed to 
coverage differences among ADAPs for grant year 2004. These included a 
limit on an individual's assets, copayment requirements, caps on 
program enrollment, or caps on expenditures per individual enrollee. 
(See table 3.) Sixteen ADAPs reported that they have a limit on assets 
that enrollees are allowed to have, 9 reported having a copayment for 
drugs provided, 7 reported having a cap on the number of individuals 
enrolled, and 5 reported having a cap on amounts expended per enrollee 
for HIV/AIDS drugs. Eight ADAPs reported using more than one of these 
criteria. 

Table 3: Program Eligibility and Other Criteria, Reported for ADAP 
Grant Year 2004: 

ADAP: Alabama;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Alaska;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Arizona;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Arkansas;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: X; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: California;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: X;
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Colorado;
Enrollee asset limitation[A]: X; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: X; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Connecticut;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Delaware;
Enrollee asset limitation[A]: X; 
Copayments[B]: X;
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: District of Columbia;
Enrollee asset limitation[A]: X; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Florida;
Enrollee asset limitation[A]: X; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Georgia;
Enrollee asset limitation[A]: X; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Hawaii;
Enrollee asset limitation[A]: X; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Idaho;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: X; 
Caps on expenditures per enrollee[D]: X. 

ADAP: Illinois;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: X. 

ADAP: Indiana;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Iowa;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Kansas;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: X;
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Kentucky;
Enrollee asset limitation[A]: X; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Louisiana;
Enrollee asset limitation[A]: X; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Maine;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Maryland;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: X;
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Massachusetts;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Michigan;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Minnesota;
Enrollee asset limitation[A]: X; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Mississippi;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Missouri;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: X. 

ADAP: Montana;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: X; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Nebraska;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Nevada;
Enrollee asset limitation[A]: X; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: New Hampshire;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: New Jersey;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: New Mexico;
Enrollee asset limitation[A]: X; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: New York;
Enrollee asset limitation[A]: X; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: North Carolina;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: X; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: North Dakota;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Ohio;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Oklahoma;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: X; 
Caps on expenditures per enrollee[D]: X. 

ADAP: Oregon;
Enrollee asset limitation[A]: X; 
Copayments[B]: X;
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Pennsylvania;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Puerto Rico;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Rhode Island;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: South Carolina;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: X;
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: South Dakota;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: X; 
Caps on expenditures per enrollee[D]: X. 

ADAP: Tennessee;
Enrollee asset limitation[A]: X; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Texas;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: X;
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Utah;
Enrollee asset limitation[A]: X; 
Copayments[B]: X;
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Vermont;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Virginia;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Washington;
Enrollee asset limitation[A]: X; 
Copayments[B]: X;
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: West Virginia;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Wisconsin;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Wyoming;
Enrollee asset limitation[A]: [Empty]; 
Copayments[B]: [Empty];
Caps on number of enrollees[C]: [Empty]; 
Caps on expenditures per enrollee[D]: [Empty]. 

ADAP: Total ADAPs;
Enrollee asset limitation[A]: 16; 
Copayments[B]: 9;
Caps on number of enrollees[C]: 7; 
Caps on expenditures per enrollee[D]: 5. 

Sources: GAO analysis of HRSA and ADAP data. 

Note: The ADAP 2004 grant year covered April 1, 2004, through March 31, 
2005. 

[A] An enrollee asset limitation is a maximum amount of assets, as 
defined by each ADAP, that an individual may have and be eligible to 
receive drug assistance from the respective ADAP. The asset limitations 
were reported as either the ADAP had a limitation or it did not, or by 
the dollar amount of the ADAP's limit. For those ADAPs reporting a 
dollar amount, the range was from $2,500 in Colorado to $25,000 in 
Florida, Minnesota, and New York. 

[B] A copayment is money that an individual must pay to receive the 
ADAP's drug assistance. The copayments were reported as either the ADAP 
had a fixed or sliding scale copayment or it did not. 

[C] The cap on the number of enrollees is a maximum number of eligible 
individuals who will be able to receive the ADAP's drug assistance. The 
caps were reported as either the ADAP had a cap or it did not, or by 
the number of ADAP enrollees allowed. For the 5 ADAPs that reported an 
enrollee cap number, the range was from 75 in South Dakota to 3,600 in 
North Carolina. 

[D] A cap on expenditures per enrollee is the maximum dollar amount for 
drug assistance that an ADAP will provide an eligible individual. The 
caps were reported as either the ADAP had a cap or it did not, or by 
the dollar amount of the ADAP's cap. For the five ADAPs that reported 
an expenditure cap, the range was from $1,200 per month in Idaho to 
$24,000 per year in Illinois. 

[End of table] 

The number and type of drugs covered under ADAPs' drug formularies vary 
and can also contribute to coverage differences among ADAPs. ADAPs are 
not required to cover particular drugs or a minimum number of drugs. 
The Food and Drug Administration (FDA) has approved 27 HIV/AIDS drugs 
in four drug classes.[Footnote 29] According to NASTAD, the majority of 
ADAPs cover several drugs in three of the classes.[Footnote 30] In the 
ADAP 2004 grant year, 26 ADAPs reported that they covered Fuzeon, which 
is the only FDA-approved drug in the fourth class of drugs--fusion 
inhibitors.[Footnote 31] (See table 4.) The more drugs an ADAP covers 
under its formulary, the more likely it is that eligible individuals 
will receive the prescribed drugs they need, and that individuals who 
develop resistance to a particular HIV/AIDS drug regimen will have 
other drug treatment options available. In grant year 2004, the number 
of drugs included in ADAPs' formularies ranged from 20 drugs in 
Colorado to 1,000 drugs in Massachusetts, New Hampshire, and New 
Jersey.[Footnote 32] Thirty-nine ADAPs reported they had 100 or fewer 
drugs, including 15 with fewer than 50 drugs on their formularies. 

Table 4: Number of Drugs Included in ADAP Formularies and ADAPs that 
Cover Fuzeon, Reported for ADAP Grant Year 2004: 

ADAPs: Alabama;
Drugs in formulary: 32;
Fuzeon included: [Empty]. 

ADAPs: Alaska;
Drugs in formulary: 63;
Fuzeon included: [Empty]. 

ADAPs: Arizona;
Drugs in formulary: 46;
Fuzeon included: Yes. 

ADAPs: Arkansas;
Drugs in formulary: 46;
Fuzeon included: Yes. 

ADAPs: California;
Drugs in formulary: 152;
Fuzeon included: [Empty]. 

ADAPs: Colorado;
Drugs in formulary: 20;
Fuzeon included: [Empty]. 

ADAPs: Connecticut;
Drugs in formulary: 176;
Fuzeon included: Yes. 

ADAPs: Delaware;
Drugs in formulary: 241;
Fuzeon included: [Empty]. 

ADAPs: District of Columbia;
Drugs in formulary: 67;
Fuzeon included: [Empty]. 

ADAPs: Florida;
Drugs in formulary: 57;
Fuzeon included: Yes. 

ADAPs: Georgia;
Drugs in formulary: 51;
Fuzeon included: [Empty]. 

ADAPs: Hawaii;
Drugs in formulary: 89;
Fuzeon included: [Empty]. 

ADAPs: Idaho;
Drugs in formulary: 39;
Fuzeon included: [Empty]. 

ADAPs: Illinois;
Drugs in formulary: 74;
Fuzeon included: Yes. 

ADAPs: Indiana;
Drugs in formulary: 77;
Fuzeon included: Yes. 

ADAPs: Iowa;
Drugs in formulary: 37;
Fuzeon included: Yes. 

ADAPs: Kansas;
Drugs in formulary: 52;
Fuzeon included: Yes. 

ADAPs: Kentucky;
Drugs in formulary: 45;
Fuzeon included: [Empty]. 

ADAPs: Louisiana;
Drugs in formulary: 21;
Fuzeon included: Yes. 

ADAPs: Maine;
Drugs in formulary: 36;
Fuzeon included: Yes. 

ADAPs: Maryland;
Drugs in formulary: 99;
Fuzeon included: Yes. 

ADAPs: Massachusetts;
Drugs in formulary: 1,000;
Fuzeon included: [Empty]. 

ADAPs: Michigan;
Drugs in formulary: 178;
Fuzeon included: Yes. 

ADAPs: Minnesota;
Drugs in formulary: 131;
Fuzeon included: [Empty]. 

ADAPs: Mississippi;
Drugs in formulary: 45;
Fuzeon included: Yes. 

ADAPs: Missouri;
Drugs in formulary: 272;
Fuzeon included: Yes. 

ADAPs: Montana;
Drugs in formulary: 105;
Fuzeon included: [Empty]. 

ADAPs: Nebraska;
Drugs in formulary: 100;
Fuzeon included: [Empty]. 

ADAPs: Nevada;
Drugs in formulary: 59;
Fuzeon included: [Empty]. 

ADAPs: New Hampshire;
Drugs in formulary: 1,000;
Fuzeon included: [Empty]. 

ADAPs: New Jersey;
Drugs in formulary: 1,000;
Fuzeon included: Yes. 

ADAPs: New Mexico;
Drugs in formulary: 65;
Fuzeon included: [Empty]. 

ADAPs: New York;
Drugs in formulary: 495;
Fuzeon included: Yes. 

ADAPs: North Carolina;
Drugs in formulary: 55;
Fuzeon included: Yes. 

ADAPs: North Dakota;
Drugs in formulary: 85;
Fuzeon included: [Empty]. 

ADAPs: Ohio;
Drugs in formulary: 74;
Fuzeon included: [Empty]. 

ADAPs: Oklahoma;
Drugs in formulary: 48;
Fuzeon included: [Empty]. 

ADAPs: Oregon;
Drugs in formulary: 62;
Fuzeon included: Yes. 

ADAPs: Pennsylvania;
Drugs in formulary: 600;
Fuzeon included: Yes. 

ADAPs: Puerto Rico;
Drugs in formulary: 63;
Fuzeon included: [Empty]. 

ADAPs: Rhode Island;
Drugs in formulary: 65;
Fuzeon included: Yes. 

ADAPs: South Carolina;
Drugs in formulary: 52;
Fuzeon included: Yes. 

ADAPs: South Dakota;
Drugs in formulary: 41;
Fuzeon included: [Empty]. 

ADAPs: Tennessee;
Drugs in formulary: 80;
Fuzeon included: Yes. 

ADAPs: Texas;
Drugs in formulary: 31;
Fuzeon included: [Empty]. 

ADAPs: Utah;
Drugs in formulary: 39;
Fuzeon included: Yes. 

ADAPs: Vermont;
Drugs in formulary: 80;
Fuzeon included: [Empty]. 

ADAPs: Virginia;
Drugs in formulary: 62;
Fuzeon included: Yes. 

ADAPs: Washington;
Drugs in formulary: 125;
Fuzeon included: Yes. 

ADAPs: West Virginia;
Drugs in formulary: 30;
Fuzeon included: [Empty]. 

ADAPs: Wisconsin;
Drugs in formulary: 67;
Fuzeon included: Yes. 

ADAPs: Wyoming;
Drugs in formulary: 73;
Fuzeon included: [Empty]. 

ADAPs: Total ADAPs;
Drugs in formulary: 52;
Fuzeon included: 26. 

Sources: GAO analysis of HRSA and ADAP data. 

Notes: Fuzeon is a fusion inhibitor medication for individuals who have 
used other anti-HIV drugs but still have ongoing HIV viral replication; 
it was approved by the FDA in 2003. Fuzeon is to be used with a 
combination of medications for individuals with limited treatment 
options.

[End of table] 

Variation in Funding Amounts from Sources Other than the ADAP Base 
Grant Can Contribute to Coverage Differences among ADAPs: 

Most ADAPs received funding from various sources, in addition to ADAP 
base grants. The amounts of funding and sources varied among ADAPs. The 
additional funding that ADAPs received can contribute to differences in 
the number of individuals served and the level of services provided. In 
fiscal year 2004, 46 of 52 ADAPs we reviewed reported receiving 
additional funds from sources that included Severe Need grants, 
transfers from Title II base grants, transfers from Title I grants, 
contributions from the state or territory, and other sources. Nineteen 
ADAPs received funds from three or more of the additional funding 
sources. (See table 5.) 

Table 5: Additional ADAP Funding Sources and Amounts by ADAP, Fiscal 
Year 2004: 

ADAP: Alabama;
Title II Severe Need grant[A]: Severe Need grant: $824,913; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: $206,228; 
Title II base grant transfer[B]: $0; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: $2,500,000; 
Other funding sources[E]: $0; 
Total additional ADAP funding: $3,531,141. 

ADAP: Alaska;
Title II Severe Need grant[A]: Severe Need grant: 0; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 50,000; 
Other funding sources[E]: 0;
Total additional ADAP funding: 50,000. 

ADAP: Arizona;
Title II Severe Need grant[A]: Severe Need grant: 0; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0; 
Contributions from jurisdiction funds[D]: 1,000,000; 
Other funding sources[E]: 78,546; 
Total additional ADAP funding: 1,078,546. 

ADAP: Arkansas;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 330,810; 
Other funding sources[E]: 393,000; 
Total additional ADAP funding: 723,810. 

ADAP: California;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 12,168,628; 
Title I grant transfer from EMA[C]: 0; 
Contributions from jurisdiction funds[D]: 63,934,245; 
Other funding sources[E]: 47,370,750; 
Total additional ADAP funding: 123,473,623. 

ADAP: Colorado;
Title II Severe Need grant[A]: Severe Need grant: 660,427; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 165,107; 
Title II base grant transfer[B]: 136,000; 
Title I grant transfer from EMA[C]: 560,254; 
Contributions from jurisdiction funds[D]: 934,134; 
Other funding sources[E]: 3,212,522; 
Total additional ADAP funding: 5,668,444. 

ADAP: Connecticut;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0; 
Contributions from jurisdiction funds[D]: 606,678; 
Other funding sources[E]: 0;
Total additional ADAP funding: 606,678. 

ADAP: Delaware;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 0; 
Other funding sources[E]: 832,382; 
Total additional ADAP funding: 832,382. 

ADAP: District of Columbia;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0; 
Contributions from jurisdiction funds[D]: 400,000; 
Other funding sources[E]: 0;
Total additional ADAP funding: 400,000. 

ADAP: Florida;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 1,916,336; 
Title I grant transfer from EMA[C]: 0; 
Contributions from jurisdiction funds[D]: 9,000,000; 
Other funding sources[E]: 0;
Total additional ADAP funding: 10,916,336. 

ADAP: Georgia;
Title II Severe Need grant[A]: Severe Need grant: 2,789,298; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 697,324; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 1,540,022; 
Contributions from jurisdiction funds[D]: 11,305,339; 
Other funding sources[E]: 0;
Total additional ADAP funding: 16,331,983. 

ADAP: Hawaii;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 440,535; 
Other funding sources[E]: 0;
Total additional ADAP funding: 440,535. 

ADAP: Idaho;
Title II Severe Need grant[A]: Severe Need grant: 54,663; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 13,666; 
Title II base grant transfer[B]: 261,150; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 163,461; 
Other funding sources[E]: 300,000; 
Total additional ADAP funding: 792,940. 

ADAP: Illinois;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0; 
Contributions from jurisdiction funds[D]: 7,000,000; 
Other funding sources[E]: 5,619,843; 
Total additional ADAP funding: 12,619,843. 

ADAP: Indiana;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 2,720,419; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 0; 
Other funding sources[E]: 102,331; 
Total additional ADAP funding: 2,822,750. 

ADAP: Iowa;
Title II Severe Need grant[A]: Severe Need grant: 0; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 0; 
Other funding sources[E]: 0;
Total additional ADAP funding: 0. 

ADAP: Kansas;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0[F,H]; 
Contributions from jurisdiction funds[D]: 400,000; 
Other funding sources[E]: 550,000; 
Total additional ADAP funding: 950,000. 

ADAP: Kentucky;
Title II Severe Need grant[A]: Severe Need grant: 481,282; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 120,320; 
Title II base grant transfer[B]: 100,000; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 90,000; 
Other funding sources[E]: 199,462; 
Total additional ADAP funding: 991,064. 

ADAP: Louisiana;
Title II Severe Need grant[A]: Severe Need grant: 1,628,705; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 407,176; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0; 
Contributions from jurisdiction funds[D]: 0; 
Other funding sources[E]: 422,638; 
Total additional ADAP funding: 2,458,519. 

ADAP: Maine;
Title II Severe Need grant[A]: Severe Need grant: 0; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 57,638; 
Other funding sources[E]: 125,327; 
Total additional ADAP funding: 182,965. 

ADAP: Maryland;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 65,250; 
Title I grant transfer from EMA[C]: 105,925; 
Contributions from jurisdiction funds[D]: 0; 
Other funding sources[E]: 2,100,000; 
Total additional ADAP funding: 2,271,175. 

ADAP: Massachusetts;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 104,819; 
Contributions from jurisdiction funds[D]: 747,990; 
Other funding sources[E]: 1,900,000; 
Total additional ADAP funding: 2,788,809. 

ADAP: Michigan;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0; 
Contributions from jurisdiction funds[D]: 0; 
Other funding sources[E]: 5,500,000; 
Total additional ADAP funding: 5,500,000. 

ADAP: Minnesota;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0; 
Contributions from jurisdiction funds[D]: 1,100,000; 
Other funding sources[E]: 2,743,522; 
Total additional ADAP funding: 3,843,522. 

ADAP: Mississippi;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 1,093,008; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 750,000; 
Other funding sources[E]: 0;
Total additional ADAP funding: 1,843,008. 

ADAP: Missouri;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 771,167; 
Title I grant transfer from EMA[C]: 1,549,422; 
Contributions from jurisdiction funds[D]: 669,000; 
Other funding sources[E]: 1,913,547; 
Total additional ADAP funding: 4,921,136. 

ADAP: Montana;
Title II Severe Need grant[A]: Severe Need grant: 36,525; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 9,131; 
Title II base grant transfer[B]: 178,548; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 0; 
Other funding sources[E]: 7,120; 
Total additional ADAP funding: 231,324. 

ADAP: Nebraska;
Title II Severe Need grant[A]: Severe Need grant: 130,445; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 32,611; 
Title II base grant transfer[B]: 74,000; 
Title I grant transfer from EMA[C]: 0[F]; Contributions from 
jurisdiction funds[D]: 115,938; 
Other funding sources[E]: 160,000; 
Total additional ADAP funding: 512,994. 

ADAP: Nevada;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 65,250; 
Contributions from jurisdiction funds[D]: 1,350,947; 
Other funding sources[E]: 0;
Total additional ADAP funding: 1,416,197. 

ADAP: New Hampshire;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0[F,H]; 
Contributions from jurisdiction funds[D]: 0; 
Other funding sources[E]: 0;
Total additional ADAP funding: 0. 

ADAP: New Jersey;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0; 
Contributions from jurisdiction funds[D]: 0; 
Other funding sources[E]: 13,050,000; 
Total additional ADAP funding: 13,050,000. 

ADAP: New Mexico;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 0; 
Other funding sources[E]: 0;
Total additional ADAP funding: 0. 

ADAP: New York;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 2,524,145; 
Title I grant transfer from EMA[C]: 5,870,000; 
Contributions from jurisdiction funds[D]: 33,000,000; 
Other funding sources[E]: 64,500,000; 
Total additional ADAP funding: 105,894,145. 

ADAP: North Carolina;
Title II Severe Need grant[A]: Severe Need grant: 1,511,429; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 377,857; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 8,355,195; 
Other funding sources[E]: 3,338,000; 
Total additional ADAP funding: 13,582,481. 

ADAP: North Dakota;
Title II Severe Need grant[A]: Severe Need grant: 0; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0; 
Title II base grant transfer[B]: 85,400; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 0; 
Other funding sources[E]: 32,000; 
Total additional ADAP funding: 117,400. 

ADAP: Ohio;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 300,000; 
Contributions from jurisdiction funds[D]: 7,843; 
Other funding sources[E]: 20,000; 
Total additional ADAP funding: 327,843. 

ADAP: Oklahoma;
Title II Severe Need grant[A]: Severe Need grant: 419,165; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 104,791; 
Title II base grant transfer[B]: 486,486; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 786,000; 
Other funding sources[E]: 361,000; 
Total additional ADAP funding: 2,157,442. 

ADAP: Oregon;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0; 
Contributions from jurisdiction funds[D]: 300,000; 
Other funding sources[E]: 5,650,000; 
Total additional ADAP funding: 5,950,000. 

ADAP: Pennsylvania;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0; 
Contributions from jurisdiction funds[D]: 10,452,000; 
Other funding sources[E]: 6,044,000; 
Total additional ADAP funding: 16,496,000. 

ADAP: Puerto Rico;
Title II Severe Need grant[A]: Severe Need grant: 2,661,337; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[I]; 
Title II base grant transfer[B]: 3,455,671; 
Title I grant transfer from EMA[C]: 0; 
Contributions from jurisdiction funds[D]: 2,093,000; 
Other funding sources[E]: 0;
Total additional ADAP funding: 8,210,008. 

ADAP: Rhode Island;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 0; 
Other funding sources[E]: 700,000; 
Total additional ADAP funding: 700,000. 

ADAP: South Carolina;
Title II Severe Need grant[A]: Severe Need grant: 1,382,225; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 345,556; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 500,000; 
Other funding sources[E]: 0;
Total additional ADAP funding: 2,227,781. 

ADAP: South Dakota;
Title II Severe Need grant[A]: Severe Need grant: 0; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0; 
Title II base grant transfer[B]: 330,744; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 0; 
Other funding sources[E]: 0;
Total additional ADAP funding: 330,744. 

ADAP: Tennessee;
Title II Severe Need grant[A]: Severe Need grant: 0; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 0; 
Other funding sources[E]: 0;
Total additional ADAP funding: 0. 

ADAP: Texas;
Title II Severe Need grant[A]: Severe Need grant: 5,943,843; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 1,485,961; 
Title II base grant transfer[B]: 500,000; 
Title I grant transfer from EMA[C]: 0; 
Contributions from jurisdiction funds[D]: 28,538,504; 
Other funding sources[E]: 0;
Total additional ADAP funding: 36,468,308. 

ADAP: Utah;
Title II Severe Need grant[A]: Severe Need grant: 0; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 0; 
Other funding sources[E]: 0;
Total additional ADAP funding: 0. 

ADAP: Vermont;
Title II Severe Need grant[A]: Severe Need grant: 0; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 175,000; 
Other funding sources[E]: 130,000; 
Total additional ADAP funding: 305,000. 

ADAP: Virginia;
Title II Severe Need grant[A]: Severe Need grant: 1,707,470; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 426,867; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0; 
Contributions from jurisdiction funds[D]: 2,612,200; 
Other funding sources[E]: 0;
Total additional ADAP funding: 4,746,537. 

ADAP: Washington;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 800,487; 
Contributions from jurisdiction funds[D]: 4,842,484; 
Other funding sources[E]: 925,000; 
Total additional ADAP funding: 6,567,971. 

ADAP: West Virginia;
Title II Severe Need grant[A]: Severe Need grant: 153,553; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 38,388; 
Title II base grant transfer[B]: 75,000; 
Title I grant transfer from EMA[C]: 0[F,H]; 
Contributions from jurisdiction funds[D]: 0; 
Other funding sources[E]: 180,000; 
Total additional ADAP funding: 446,941. 

ADAP: Wisconsin;
Title II Severe Need grant[A]: Severe Need grant: 374,441; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 93,610; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0[F,H]; 
Contributions from jurisdiction funds[D]: 186,658; 
Other funding sources[E]: 855,317; 
Total additional ADAP funding: 1,510,026. 

ADAP: Wyoming;
Title II Severe Need grant[A]: Severe Need grant: 0[G]; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: 0[G]; 
Title II base grant transfer[B]: 0; 
Title I grant transfer from EMA[C]: 0[F]; 
Contributions from jurisdiction funds[D]: 0; 
Other funding sources[E]: 0;
Total additional ADAP funding: 0. 

ADAP: Total;
Title II Severe Need grant[A]: Severe Need grant: $20,759,721; 
Title II Severe Need grant[A]: State matching funds for Severe Need 
grant: $4,524,593; 
Title II base grant transfer[B]: $26,941,952; 
Title I grant transfer from EMA[C]: $10,932,179; 
Contributions from jurisdiction funds[D]: $194,795,599; 
Other funding sources[E]: $169,334,307; 
Total additional ADAP funding: $427,288,351. 

Sources: GAO analysis of HRSA and ADAP data. 

[A] To be eligible for a Severe Need grant, a jurisdiction must have 
met one of four eligibility criteria as of January 1, 2000. It must 
have limited (1) the eligibility of ADAP enrollees to those with 
incomes at or below 200 percent of the federal poverty level, (2) the 
number of ADAP enrollees by using medical eligibility restrictions, (3) 
the number of antiretroviral drugs covered in its drug formulary, or 
(4) the number of opportunistic infection medications to less than 10 
in its drug formulary. (Opportunistic infections are illnesses such as 
parasitic, viral, and fungal infections, and some types of cancer, some 
of which usually do not cause disease in people with normal immune 
systems.) In addition, a jurisdiction must also have agreed to provide 
a 25 percent match and not impose eligibility requirements more 
restrictive than those in place on January 1, 2000. According to HRSA, 
grantees can provide funds or in-kind services to meet the matching 
requirements. 

[B] The Title II base grant transfers are CARE Act funds that were 
awarded to the state or territory where the ADAP is located, and that 
the respective state or territory decides to provide or transfer to the 
ADAP program. 

[C] Title I grant transfers from EMAs are CARE Act funds that were 
awarded to EMAs in the state or territory where the ADAP is located, 
and that the EMA decides to provide or transfer to the ADAP program. 

[D] Contributions from jurisdiction funds are additional funds provided 
by the state or territory where the ADAP is located to the ADAP 
program. 

[E] Other funding sources may include drug rebates ADAPs receive from 
manufacturers against prices paid for drug purchases. These rebates do 
not actually constitute additional funding. However, we were unable to 
identify the amounts attributable to drug rebates in these ADAPs' 
reports. 

[F] State did not have an EMA. 

[G] State was not eligible for a grant. 

[H] The state did not have its own EMA but a portion of the state was 
included in an EMA in another state. 

[I] HRSA officials told us that the agency did not require Puerto Rico 
to provide matching funds.

[End of table] 

The number of ADAPs that reported receiving funding from sources other 
than ADAP base grants and the amounts they received for fiscal year 
2004 varied: 

² Severe Need grants: Fifteen states and Puerto Rico received Severe 
Need grant funds for their ADAPs ranging from about $37,000 in Montana 
to about $6 million in Texas.[Footnote 33] The total amount of funds 
from Severe Need grants these ADAPs received was about $20.8 million. 

² Title II base grant transfers: Eighteen ADAPs reported receiving 
transfers from their respective jurisdiction's Title II base grants. 
These transfers ranged from $65,250 in Maryland to about $12.2 million 
in California. The total amount of these transfers was about $26.9 
million. 

² Title I grant transfers from EMAs: Nine ADAPs reported receiving 
Title I fund transfers from the EMAs in their states ranging from 
$65,250 in Nevada to about $6 million for New York. The total amount of 
Title I grantee transfers was about $10.9 million. 

² Contributions from state and Puerto Rico funds: Thirty-five ADAPs 
reported receiving contributions from their respective jurisdiction's 
non-CARE Act funds ranging from about $8,000 in Ohio to about $64 
million in California. For example, states can appropriate funds to be 
used by their respective ADAPs. The total amount of these contributions 
was about $194.8 million--the largest total amount received from the 
various sources. 

Other sources: Thirty-two ADAPs reported receiving funding from other 
sources[Footnote 34] ranging from about $7,000 in Montana to $64.5 
million in New York. The total amount of funds received from these 
sources was about $169.3 million. 

Among the ADAPs that reported receiving funding from sources other than 
ADAP base grants, the total dollar amounts received ranged from $50,000 
in Alaska to about $123.5 million in California. Six ADAPs--Iowa, New 
Hampshire, New Mexico, Tennessee, Utah, and Wyoming--did not report 
receiving any additional funding. 

The amount of additional funding some ADAPs received significantly 
increased their funds available to support ADAP enrollees and services. 
The increases in funding per ELC and as a percent of the ADAP base 
grant varied among the ADAPs. (See table 6.) For example, the highest 
amount of additional funding received per ELC was $3,604, or 171 
percent of the ADAP base grant, in Idaho. The lowest amount of 
additional funding received--excluding the 6 ADAPs with no additional 
funds--per ELC was $61, or 3 percent of the ADAP base grant, in the 
District of Columbia. Of the 46 ADAPs that received additional funding, 
8 ADAPs--California, Colorado, Idaho, Minnesota, North Carolina, North 
Dakota, Oregon, and South Dakota--received total additional funding 
that was more than 100 percent of the ADAP base grants to their states. 
Ten ADAPs--Alaska, Arizona, Connecticut, District of Columbia, Florida, 
Louisiana, Maryland, Massachusetts, Ohio, and South Carolina--received 
total additional funding that was less than 20 percent of the ADAP base 
grants to their states. 

Table 6: Total Additional ADAP Funding as a Percentage of the CARE Act 
ADAP Base Grants and Total Additional Funding Per ELC by ADAP, Fiscal 
Year 2004: 

ADAP: Alabama;
Total additional ADAP funding: $3,531,141; 
ADAP base grant: $7,004,635;
Total additional ADAP funding as percentage of the ADAP base grant: 50; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: 
Dollars: $1,064; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
18. 

ADAP: Alaska;
Total additional ADAP funding: 50,000; 
ADAP base grant: 472,602;
Total additional ADAP funding as percentage of the ADAP base grant: 11; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 223; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
42. 

ADAP: Arizona;
Total additional ADAP funding: 1,078,546; 
ADAP base grant: 8,392,903;
Total additional ADAP funding as percentage of the ADAP base grant: 13; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 271; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
41. 

ADAP: Arkansas;
Total additional ADAP funding: 723,810; 
ADAP base grant: 3,116,716;
Total additional ADAP funding as percentage of the ADAP base grant: 23; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 494; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
34. 

ADAP: California;
Total additional ADAP funding: 123,473,623; 
ADAP base grant: 89,623,465;
Total additional ADAP funding as percentage of the ADAP base grant: 
138; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
2,907; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
4. 

ADAP: Colorado;
Total additional ADAP funding: 5,668,444; 
ADAP base grant: 5,607,928;
Total additional ADAP funding as percentage of the ADAP base grant: 
101; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
2,133; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
8. 

ADAP: Connecticut;
Total additional ADAP funding: 606,678; 
ADAP base grant: 11,315,018;
Total additional ADAP funding as percentage of the ADAP base grant: 5; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 113; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
44. 

ADAP: Delaware;
Total additional ADAP funding: 832,382; 
ADAP base grant: 3,202,722;
Total additional ADAP funding as percentage of the ADAP base grant: 26; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 548; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
32. 

ADAP: District of Columbia;
Total additional ADAP funding: 400,000; 
ADAP base grant: 13,842,594;
Total additional ADAP funding as percentage of the ADAP base grant: 3; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 61; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
46. 

ADAP: Florida;
Total additional ADAP funding: 10,916,336; 
ADAP base grant: 80,386,630;
Total additional ADAP funding as percentage of the ADAP base grant: 14; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 287; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
40. 

ADAP: Georgia;
Total additional ADAP funding: 16,331,983; 
ADAP base grant: 23,684,951;
Total additional ADAP funding as percentage of the ADAP base grant: 69; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
1,455; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
14. 

ADAP: Hawaii;
Total additional ADAP funding: 440,535; 
ADAP base grant: 2,084,512;
Total additional ADAP funding as percentage of the ADAP base grant: 21; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 446; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
36. 

ADAP: Idaho;
Total additional ADAP funding: 792,940; 
ADAP base grant: 464,163;
Total additional ADAP funding as percentage of the ADAP base grant: 
171; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
3,604; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
1. 

ADAP: Illinois;
Total additional ADAP funding: 12,619,843; 
ADAP base grant: 25,746,254;
Total additional ADAP funding as percentage of the ADAP base grant: 49; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
1,034; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
20. 

ADAP: Indiana;
Total additional ADAP funding: 2,822,750; 
ADAP base grant: 6,529,924;
Total additional ADAP funding as percentage of the ADAP base grant: 43; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 912; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
24. 

ADAP: Iowa;
Total additional ADAP funding: 0; 
ADAP base grant: 1,305,985;
Total additional ADAP funding as percentage of the ADAP base grant: 0; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 0; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: --
. 

ADAP: Kansas;
Total additional ADAP funding: 950,000; 
ADAP base grant: 2,045,495;
Total additional ADAP funding as percentage of the ADAP base grant: 46; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 991; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
22. 

ADAP: Kentucky;
Total additional ADAP funding: 991,064; 
ADAP base grant: 4,086,741;
Total additional ADAP funding as percentage of the ADAP base grant: 24; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 512; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
33. 

ADAP: Louisiana;
Total additional ADAP funding: 2,458,519; 
ADAP base grant: 13,829,935;
Total additional ADAP funding as percentage of the ADAP base grant: 18; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 375; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
39. 

ADAP: Maine;
Total additional ADAP funding: 182,965; 
ADAP base grant: 833,383;
Total additional ADAP funding as percentage of the ADAP base grant: 22; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 463; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
35. 

ADAP: Maryland;
Total additional ADAP funding: 2,271,175; 
ADAP base grant: 25,746,254;
Total additional ADAP funding as percentage of the ADAP base grant: 9; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 186; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
43. 

ADAP: Massachusetts;
Total additional ADAP funding: 2,788,809; 
ADAP base grant: 14,684,416;
Total additional ADAP funding as percentage of the ADAP base grant: 19; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 401; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
37. 

ADAP: Michigan;
Total additional ADAP funding: 5,500,000; 
ADAP base grant: 11,002,763;
Total additional ADAP funding as percentage of the ADAP base grant: 50; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
1,055; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
19. 

ADAP: Minnesota;
Total additional ADAP funding: 3,843,522; 
ADAP base grant: 3,010,727;
Total additional ADAP funding as percentage of the ADAP base grant: 
128; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
2,693; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
6. 

ADAP: Mississippi;
Total additional ADAP funding: 1,843,008; 
ADAP base grant: 5,795,703;
Total additional ADAP funding as percentage of the ADAP base grant: 32; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 671; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
30. 

ADAP: Missouri;
Total additional ADAP funding: 4,921,136; 
ADAP base grant: 7,409,723;
Total additional ADAP funding as percentage of the ADAP base grant: 66; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
1,401; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
15. 

ADAP: Montana;
Total additional ADAP funding: 231,324; 
ADAP base grant: 310,145;
Total additional ADAP funding as percentage of the ADAP base grant: 75; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
1,574; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
12. 

ADAP: Nebraska;
Total additional ADAP funding: 512,994; 
ADAP base grant: 1,107,661;
Total additional ADAP funding as percentage of the ADAP base grant: 46; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 977; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
23. 

ADAP: Nevada;
Total additional ADAP funding: 1,416,197; 
ADAP base grant: 4,738,678;
Total additional ADAP funding as percentage of the ADAP base grant: 30; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 631; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
31. 

ADAP: New Hampshire;
Total additional ADAP funding: 0; 
ADAP base grant: 755,319;
Total additional ADAP funding as percentage of the ADAP base grant: 0; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 0; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: --
. 

ADAP: New Jersey;
Total additional ADAP funding: 13,050,000; 
ADAP base grant: 34,877,598;
Total additional ADAP funding as percentage of the ADAP base grant: 37; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 789; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
25. 

ADAP: New Mexico;
Total additional ADAP funding: 0; 
ADAP base grant: 2,127,024;
Total additional ADAP funding as percentage of the ADAP base grant: 0; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 0; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: --
. 

ADAP: New York;
Total additional ADAP funding: 105,894,145; 
ADAP base grant: 124,956,784; 
Total additional ADAP funding as percentage of the ADAP base grant: 85; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
1,788; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
9. 

ADAP: North Carolina;
Total additional ADAP funding: 13,582,481; 
ADAP base grant: 12,834,095;
Total additional ADAP funding as percentage of the ADAP base grant: 
106; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
2,233; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
7. 

ADAP: North Dakota;
Total additional ADAP funding: 117,400; 
ADAP base grant: 92,543;
Total additional ADAP funding as percentage of the ADAP base grant: 
127; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
2,730; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
5. 

ADAP: Ohio;
Total additional ADAP funding: 327,843; 
ADAP base grant: 10,909,930;
Total additional ADAP funding as percentage of the ADAP base grant: 3; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 63; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
45. 

ADAP: Oklahoma;
Total additional ADAP funding: 2,157,442; 
ADAP base grant: 3,655,707;
Total additional ADAP funding as percentage of the ADAP base grant: 59; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
1,279; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
17. 

ADAP: Oregon;
Total additional ADAP funding: 5,950,000; 
ADAP base grant: 4,225,989;
Total additional ADAP funding as percentage of the ADAP base grant: 
141; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
2,971; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
3. 

ADAP: Pennsylvania;
Total additional ADAP funding: 16,496,000; 
ADAP base grant: 27,090,216;
Total additional ADAP funding as percentage of the ADAP base grant: 61; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
1,285; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
16. 

ADAP: Puerto Rico;
Total additional ADAP funding: 8,210,008; 
ADAP base grant: 22,598,388;
Total additional ADAP funding as percentage of the ADAP base grant: 36; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 767; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
27. 

ADAP: Rhode Island;
Total additional ADAP funding: 700,000; 
ADAP base grant: 1,911,506;
Total additional ADAP funding as percentage of the ADAP base grant: 37; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 773; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
26. 

ADAP: South Carolina;
Total additional ADAP funding: 2,227,781; 
ADAP base grant: 11,736,984;
Total additional ADAP funding as percentage of the ADAP base grant: 19; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 400; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
38. 

ADAP: South Dakota;
Total additional ADAP funding: 330,744; 
ADAP base grant: 204,654;
Total additional ADAP funding as percentage of the ADAP base grant: 
162; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
3,410; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
2. 

ADAP: Tennessee;
Total additional ADAP funding: 0; 
ADAP base grant: 12,018,438;
Total additional ADAP funding as percentage of the ADAP base grant: 0; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 0; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: --
. 

ADAP: Texas;
Total additional ADAP funding: 36,468,308; 
ADAP base grant: 50,471,351;
Total additional ADAP funding as percentage of the ADAP base grant: 72; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
1,524; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
13. 

ADAP: Utah;
Total additional ADAP funding: 0; 
ADAP base grant: 1,980,565;
Total additional ADAP funding as percentage of the ADAP base grant: 0; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 0; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: --
. 

ADAP: Vermont;
Total additional ADAP funding: 305,000; 
ADAP base grant: 382,007;
Total additional ADAP funding as percentage of the ADAP base grant: 80; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
1,685; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
11. 

ADAP: Virginia;
Total additional ADAP funding: 4,746,537; 
ADAP base grant: 14,498,751;
Total additional ADAP funding as percentage of the ADAP base grant: 33; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 691; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
29. 

ADAP: Washington;
Total additional ADAP funding: 6,567,971; 
ADAP base grant: 7,966,718;
Total additional ADAP funding as percentage of the ADAP base grant: 82; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
1,739; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
10. 

ADAP: West Virginia;
Total additional ADAP funding: 446,941; 
ADAP base grant: 1,303,875;
Total additional ADAP funding as percentage of the ADAP base grant: 34; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 723; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
28. 

ADAP: Wisconsin;
Total additional ADAP funding: 1,510,026; 
ADAP base grant: 3,179,514;
Total additional ADAP funding as percentage of the ADAP base grant: 47; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
1,002; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
21. 

ADAP: Wyoming;
Total additional ADAP funding: 0; 
ADAP base grant: 160,347;
Total additional ADAP funding as percentage of the ADAP base grant: 0; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 0; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: --
. 

ADAP: Total;
Total additional ADAP funding: $427,288,351; 
ADAP base grant: $ 727,320,929; 
Total additional ADAP funding as percentage of the ADAP base grant: 
59%; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Total 
additional ADAP funding per ELC with rank among 46 ADAPs: Dollars: 
[Empty]; 
Total additional ADAP funding per ELC with rank among 46 ADAPs: Rank: 
[Empty]. 

Sources: HRSA and GAO analysis. 

Note: A dash indicates an ADAP that did not receive additional funding 
and could not be ranked.

[End of table] 

ADAPs with Waiting Lists Also Varied in Program Design and Additional 
Funding Sources and Amounts: 

The eligibility and other program design criteria and additional 
funding ADAPs received varied among ADAPs with waiting lists and can 
contribute to coverage differences. When an ADAP cannot cover everyone 
it determines is eligible for its services, it may, but is not required 
to, establish a waiting list. HRSA's HIV/AIDS Bureau does not have 
guidance on what conditions should trigger an ADAP to establish a 
waiting list. In fiscal year 2004, 14 ADAPs had waiting lists of 
individuals they determined were ADAP eligible but the programs were 
unable to serve.[Footnote 35] (See table 7.) Due to the lack of 
reliable data on both the number of unduplicated individuals on a list 
and the length of time individuals spend on waiting lists, we could not 
determine, for example, the exact number of individuals during a 
specific period who were on waiting lists. Based on data ADAPs with 
waiting lists reported to HRSA for fiscal year 2004, the average number 
of individuals on waiting lists for a particular ADAP and among ADAPs 
varied.[Footnote 36] For example, Montana's monthly average ranged from 
5 to 14 individuals during fiscal year 2004, while North Carolina's 
monthly average ranged from 38 to 861. We do not know whether any ADAP 
turned away individuals who would have been eligible without 
establishing a waiting list. 

Table 7: ADAPs with Waiting Lists and Number of Months Each Had Waiting 
Lists, Fiscal Year 2004: 

ADAPs: Alabama;
Number of Months: 12. 

ADAPs: Alaska;
Number of Months: 10. 

ADAPs: Arkansas;
Number of Months: 4. 

ADAPs: Colorado;
Number of Months: 10. 

ADAPs: Idaho;
Number of Months: 9. 

ADAPs: Indiana;
Number of Months: 2. 

ADAPs: Iowa;
Number of Months: 5. 

ADAPs: Kentucky;
Number of Months: 12. 

ADAPs: Montana;
Number of Months: 11. 

ADAPs: Nebraska;
Number of Months: 3. 

ADAPs: North Carolina;
Number of Months: 12. 

ADAPs: Oregon;
Number of Months: 2. 

ADAPs: South Dakota;
Number of Months: 12. 

ADAPs: West Virginia;
Number of Months: 12. 

Sources: HRSA and GAO analysis.

[End of table] 

Eligibility and other program design criteria reported for ADAP grant 
year 2004 varied among ADAPs with waiting lists. For example, for: 

² Income ceilings: Among the 14 ADAPs with waiting lists, income 
ceilings ranged from the most restrictive at 125 percent of the poverty 
level, or $11,638 in North Carolina to the most generous at 330 percent 
of the poverty level, or $30,723 in Montana. 

² Enrollment and service caps: Among the 14 ADAPs with waiting lists, 6 
ADAPs capped the number of enrollees, and two capped the amount they 
expend per individual for all HIV/AIDS drugs. 

² Drug formularies: Among the 14 ADAPs with waiting lists, the total 
number of drugs on their formularies ranged from 20 drugs in Colorado 
to 105 drugs in Montana. 

In fiscal year 2004, the majority of ADAPs received funding from other 
sources in addition to ADAP base grants. The majority of ADAPs with 
waiting lists--13 of 14--also received additional funding. For example, 
for: 

² Severe Need grants: Among the 14 ADAPs with waiting lists, 8 received 
funds from Severe Need grants.[Footnote 37] 

² Title II base grant transfers: Among the 14 ADAPs with waiting lists, 
8 received transfers of Title II base grant funds. 

² Title I grant transfers from EMAs: Among the 14 ADAPs with waiting 
lists, only one ADAP--Colorado--received a Title I transfer. 

² Contributions from state and Puerto Rico funds: Among the 14 ADAPs 
with waiting lists, 9 received these contributions. 

² Other sources: Among the 14 ADAPs with waiting lists, 10 ADAPs 
reported receiving funding from other sources.[Footnote 38],[Footnote 
39] Among those 10 ADAPs, the amount of funds from other sources ranged 
from about $7,000 in Montana to about $5.6 million in Oregon. 

Of the 13 ADAPs with waiting lists that received additional funding in 
fiscal year 2004, 5--Colorado, Idaho, North Carolina, Oregon, and South 
Dakota--were among the 10 ADAPs that received the most additional 
funding per ELC. (See table 8.) Idaho at $3,604 per ELC, South Dakota 
at $3,410 per ELC, and Oregon at $2,971 per ELC respectively ranked the 
highest among the 46 ADAPs that received additional funding. The rank 
order of the remaining 10 ADAPs with waiting lists among all ADAPs that 
received additional funding ranged from seventh--North Carolina at 
$2,233 per AIDS case--to forty-second--Alaska at $223 per ELC. 

Table 8: Ranking of 13 ADAPs with Waiting Lists among the 46 ADAPs that 
Received Additional Funding Per ELC; 
Fiscal Year 2004: 

ADAPs with waiting lists that received additional funding: Idaho; 
Rank among 46 ADAPs by additional funding per ELC: 1; 
Additional funding per ELC: $3,604. 

ADAPs with waiting lists that received additional funding: South 
Dakota; 
Rank among 46 ADAPs by additional funding per ELC: 2; 
Additional funding per ELC: 3,410. 

ADAPs with waiting lists that received additional funding: Oregon; 
Rank among 46 ADAPs by additional funding per ELC: 3; 
Additional funding per ELC: 2,971. 

ADAPs with waiting lists that received additional funding: North 
Carolina; 
Rank among 46 ADAPs by additional funding per ELC: 7; 
Additional funding per ELC: 2,233. 

ADAPs with waiting lists that received additional funding: Colorado; 
Rank among 46 ADAPs by additional funding per ELC: 8; 
Additional funding per ELC: 2,133. 

ADAPs with waiting lists that received additional funding: Montana; 
Rank among 46 ADAPs by additional funding per ELC: 12; 
Additional funding per ELC: 1,574. 

ADAPs with waiting lists that received additional funding: Alabama; 
Rank among 46 ADAPs by additional funding per ELC: 18; 
Additional funding per ELC: 1,064. 

ADAPs with waiting lists that received additional funding: Nebraska; 
Rank among 46 ADAPs by additional funding per ELC: 23; 
Additional funding per ELC: 977. 

ADAPs with waiting lists that received additional funding: Indiana; 
Rank among 46 ADAPs by additional funding per ELC: 24; 
Additional funding per ELC: 912. 

ADAPs with waiting lists that received additional funding: West 
Virginia; 
Rank among 46 ADAPs by additional funding per ELC: 28; 
Additional funding per ELC: 723. 

ADAPs with waiting lists that received additional funding: Kentucky; 
Rank among 46 ADAPs by additional funding per ELC: 33; 
Additional funding per ELC: 512. 

ADAPs with waiting lists that received additional funding: Arkansas; 
Rank among 46 ADAPs by additional funding per ELC: 34; 
Additional funding per ELC: 494. 

ADAPs with waiting lists that received additional funding: Alaska; 
Rank among 46 ADAPs by additional funding per ELC: 42; 
Additional funding per ELC: 223. 

Sources: GAO analysis of HRSA and ADAP data.

[End of table] 

Some ADAPs Reported HIV/AIDS Drug Prices that Were Higher than the 340B 
Prices: 

Some ADAPs reported prices to HRSA that they paid for some of the top 
10 HIV/AIDS drugs purchased during 2003 that were higher than the 340B 
program prices.[Footnote 40] However, the reported prices may not be 
the final prices paid by ADAPs that receive rebates on the purchase 
price of their drugs. States and territories are expected to use every 
means at their disposal to secure the best price possible for HIV/AIDS 
drugs and are also required to adopt at least one cost-saving practice 
that is equal to or more economical: 

than the 340B and prime vendor programs.[Footnote 41] While HRSA has 
identified 340B prices as the measure of cost effectiveness, HHS does 
not provide ADAPs with the 340B prices to use as a guide when 
purchasing HIV/AIDS drugs due to statutory provisions regarding the 
confidentiality of information used to determine them. Drug 
manufacturers that participate in the 340B program are aware of the 
340B prices, and as a condition of their participation in the Medicaid 
program, have agreed to sell HIV/AIDS drugs to those ADAPs that use the 
340B direct purchase or rebate options at prices no greater than the 
340B prices.[Footnote 42] We found that among both the 25 ADAPs that 
used the direct purchase option and the 27 that used the rebate option 
to purchase their drugs in 2003, nearly all of the ADAPs reported drug 
prices that were higher than the 340B prices for at least one of the 
top 10 drugs. 

All of the 25 ADAPs that used the 340B direct purchase option to buy 
HIV/AIDS drugs in 2003 reported prices that were higher than the 340B 
prices for at least one of the top 10 HIV/AIDS drugs.[Footnote 43] (See 
table 9.) For example, 7 ADAPs reported prices that were above the 340B 
price for Viramune. Three ADAPs reported prices that were more than the 
340B price for at least 8 of the 10 drugs--Delaware (10), Oklahoma (9), 
and Kentucky (8). All 25 ADAPs reported prices that were more than the 
340B price for the drug Norvir. Since ADAPs are not provided the 340B 
prices, they may be unknowingly paying more than the 340B price for a 
drug.[Footnote 44] Because the 340B, the 340B prime vendor, the FCP, 
and Medicaid drug prices are not public, we indicate only whether a 
reported price is above the 340B price. 

Table 9: 25 340B Direct Purchase ADAPs that Reported Prices for the Top 
10 HIV/AIDS Drugs that Were Above 340B Prices; 
2003: 

ADAP: Alabama;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: [Empty];
Viracept: [Empty];
Viramune: [Empty];
Viread: [Empty];
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Arizona;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: [Empty];
Viracept: [Empty];
Viramune: [Empty];
Viread: [Empty];
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Arkansas;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: X;
Trizivir: [Empty];
Viracept: [Empty];
Viramune: [Empty];
Viread: X;
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Colorado;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: X;
Trizivir: [Empty];
Viracept: [Empty];
Viramune: [Empty];
Viread: [Empty];
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Delaware;
Combivir: X;
Epivir: X;
Norvir[A]: X;
Sustiva: X;
Trizivir: X;
Viracept: X;
Viramune: X;
Viread: X;
Zerit: X;
Ziagen: X. 

ADAP: District of Columbia;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: [Empty];
Viracept: [Empty];
Viramune: N/A;
Viread: [Empty];
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Florida;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: [Empty];
Viracept: [Empty];
Viramune: [Empty];
Viread: [Empty];
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Georgia;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: [Empty];
Viracept: [Empty];
Viramune: [Empty];
Viread: [Empty];
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Hawaii;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: [Empty];
Viracept: [Empty];
Viramune: [Empty];
Viread: X;
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Iowa;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: [Empty];
Viracept: [Empty];
Viramune: [Empty];
Viread: [Empty];
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Illinois;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: [Empty];
Viracept: [Empty];
Viramune: X;
Viread: [Empty];
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Kentucky;
Combivir: X;
Epivir: X;
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: X;
Viracept: X;
Viramune: N/A;
Viread: X;
Zerit: X;
Ziagen: X. 

ADAP: Louisiana;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: [Empty];
Viracept: [Empty];
Viramune: [Empty];
Viread: [Empty];
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Mississippi;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: X;
Trizivir: [Empty];
Viracept: [Empty];
Viramune: [Empty];
Viread: N/A;
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Montana;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: [Empty];
Viracept: [Empty];
Viramune: [Empty];
Viread: X;
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Nebraska;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: [Empty];
Viracept: [Empty];
Viramune: [Empty];
Viread: [Empty];
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: New Mexico;
Combivir: X;
Epivir: X;
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: [Empty];
Viracept: [Empty];
Viramune: X;
Viread: [Empty];
Zerit: X;
Ziagen: X. 

ADAP: Nevada;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: X;
Viracept: [Empty];
Viramune: [Empty];
Viread: [Empty];
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Ohio;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: [Empty];
Viracept: [Empty];
Viramune: [Empty];
Viread: [Empty];
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Oklahoma;
Combivir: X;
Epivir: X;
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: X;
Viracept: X;
Viramune: X;
Viread: X;
Zerit: X;
Ziagen: X. 

ADAP: Puerto Rico;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: [Empty];
Viracept: [Empty];
Viramune: X;
Viread: X;
Zerit: X;
Ziagen: [Empty]. 

ADAP: South Carolina;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: [Empty];
Viracept: [Empty];
Viramune: [Empty];
Viread: [Empty];
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Tennessee;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: [Empty];
Viracept: [Empty];
Viramune: X;
Viread: [Empty];
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Texas;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: N/A;
Trizivir: [Empty];
Viracept: [Empty];
Viramune: N/A;
Viread: [Empty];
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Virginia;
Combivir: [Empty];
Epivir: [Empty];
Norvir[A]: X;
Sustiva: [Empty];
Trizivir: [Empty];
Viracept: [Empty];
Viramune: X;
Viread: [Empty];
Zerit: [Empty];
Ziagen: [Empty]. 

ADAP: Total;
Combivir: 4;
Epivir: 4;
Norvir[A]: 25;
Sustiva: 4;
Trizivir: 4;
Viracept: 3;
Viramune: 7;
Viread: 7;
Zerit: 5;
Ziagen: 4. 

Sources: HRSA and GAO analysis. 

N/A = ADAP did not purchase the drug. 

Notes: An empty table cell indicates that the ADAP purchased the drug 
and paid at or below the 340B price for that drug. To compare the 
prices that ADAPs reported paying for HIV/AIDS drugs to 340B prices for 
such drugs, we first determined which HIV/AIDS drugs were the top 10 by 
ADAP expenditure using 2002 data, the most recently available 
expenditure data. We then compared the prices ADAPs reported they paid 
for the top 10 HIV/AIDS drugs to the 340B program prices for those same 
drugs. For this comparison, we used the 2003 340B program prices and 
the purchase prices that 52 ADAPs provided in their quarterly reports 
submitted to HRSA for 2003. At the time of our analysis, 2003 was the 
most recent full calendar year of ADAP drug price data. 

[A] In December 2003, Abbott Laboratories, the manufacturer of Norvir, 
an HIV/AIDS protease inhibitor, substantially increased the wholesale 
price per patient. In February 2004, Abbott Laboratories announced a 
permanent Norvir price freeze for ADAPs at the price in place prior to 
the December 2003 re-pricing. 

[End of table] 

Among the 27 ADAPs that reported they used the 340B rebate option in 
2003, most reported prices for the top 10 HIV/AIDS drugs that were 
above the 340B prices. The 3 ADAPs that reported HIV/AIDS drug prices 
at or below the 340B prices, and the number of drugs they purchased at 
these prices were Kansas (3), Washington (3), and Pennsylvania (1). 
ADAPs using the 340B rebate option report the prices they paid for 
drugs to HRSA, but these reports may not reflect the drug rebates ADAPs 
may eventually receive that would determine the final amount paid for 
the drug. The ADAPs that use the 340B rebate option almost always 
reported HIV/AIDS drug prices higher than the 340B prices. An OPA 
official told us that there is no reporting that reconciles the rebate 
savings an ADAP may receive against the price it pays for a drug. 

ADAPs that negotiate their own HIV/AIDS drug discounts with drug 
manufacturers, or use the 340B prime vendor to negotiate drug discounts 
for them, are expected to negotiate prices equal to or less than the 
340B prices.[Footnote 45] However, HHS does not disclose to the ADAPs 
or the 340B prime vendor what the 340B prices are that they should not 
exceed. A HRSA official told us that the ADAPs' and the 340B prime 
vendor's negotiating position is disadvantaged because they rely on the 
drug manufacturers they negotiate with to tell them whether the 
negotiated prices are equal to or better than the 340B prices. 

In 2003, 10 ADAPs joined together to negotiate HIV/AIDS drug prices 
directly with drug manufacturers. These ADAPs formed a task force under 
the auspices of NASTAD to directly negotiate drug prices with eight 
drug manufacturers for HIV/AIDS antiretroviral drug discounts on behalf 
of all ADAPs.[Footnote 46] According to the ADAP task force 
representatives we interviewed, the negotiated drug discounts they 
agreed to were the total of the 340B discount plus whatever additional 
discounts they could negotiate