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AIDS Research and Treatment
Volume 2013, Article ID 350169, 7 pages
Review Article

Current Challenges to the United States’ AIDS Drug Assistance Program and Possible Implications of the Affordable Care Act

1Department of Medicine, University of Virginia, Charlottesville, VA 22903, USA
2Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22908-0717, USA
3Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, P.O. Box 801379, Charlottesville, VA 22908, USA

Received 10 May 2012; Revised 8 December 2012; Accepted 5 February 2013

Academic Editor: Glenda Gray

Copyright © 2013 Kathleen A. McManus et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


AIDS Drug Assistance Programs, enacted through the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, are the “payer of last resort” for prescription medications for lower income, uninsured, or underinsured people living with HIV/AIDS. ADAPs face declining funding from the federal government. State funding of ADAP is discretionary, but some states increased their contributions to meet the gap in funding. The demand for ADAP support is increasing as people living with HIV are living longer; the antiretroviral therapy (ART) guidelines have been changed to recommend initiation of treatment for all; the United States is increasing HIV testing goals; and the recession continues. In the setting of increased demand and limited funding, ADAPs are employing cost containment measures. Since 2010, emergency federal funds have bailed out ADAP, but these are not sustainable. In the coming years, providers and policy makers associated with HIV care will need to navigate the implementation of the Affordable Care Act (ACA). Lessons learned from the challenges associated with providing sustainable access to ART for vulnerable populations through ADAP should inform upcoming decisions about how to ensure delivery of ART during and after the implementation of the ACA.