Those constraints are most often reflected in restrictive financial eligibility criteria and limited formularies. Other factors include the availability of affordable private insurance, insurance high-risk pools, and whether or not the State limits the extent to which private insurers may cap prescription benefits. ADAP funding has increased dramatically in recent years. As the number of FDA-approved HIV treatments has increased, States have added some or all of the newer drugs within the limits of available resources. The availability of new, effective drugs, combined with the greatly increased cost of new medications, has affected the expansion of formularies.
States determine which drugs to include on their formularies.
There is considerable variation in the number of drugs on ADAP formularies, ranging from 17 to more than 400, with approximately 80 percent of the States covering 30 or more drugs. Many ADAPs were established to operate under a pharmacy reimbursement model similar to Medicaid. This allows patients to go to a participating pharmacy, show their ADAP cards, and have their prescriptions filled. Alternatively, States with a system of pharmacies attached to a network of public health clinics use that system to purchase and distribute drugs for ADAP clients. A few ADAPs directly purchase drugs and mail them to clients.