State Variation in AIDS Drug Assistance Program Prescription Drug Coverage for Modifiable Cardiovascular Risk Factors

Thanks to potent antiviral medications, people infected with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are living longer. One-quarter of people with HIV/AIDS are age 50 and older.

Three-quarters of HIV infected people are uninsured and rely on state AIDS Drug Assistance Programs (ADAPs) for their prescription drugs. With funding mostly from the federal government, each state determines the composition of their own prescription drug formulary.

Given an increasing proportion of deaths attributable to cardiovascular disease among HIV-infected people (10%), researchers surveyed ADAP formularies from 50 states, Washington D.C., the Commonwealth of Puerto Rico and the U.S. Virgin Islands (53 “states”). They compared state ADAP coverage for four modifiable cardiovascular factors against recommended clinical practice guidelines and found wide variations.

Key Findings:

  • Type 2 diabetes—15 states provided drug coverage consistent with guidelines; 11 states partially consistent; 27 states no coverage.
  • Hypertension—13 states consistent; 8 partially consistent; 32 no coverage.
  • Hyperlipidemia—8 states consistent. 28 states partially consistent. 17 states no coverage.
  • Smoking cessation—4 states consistent; 25 states partially consistent; 24 no coverage.

Just four states—Massachusetts, New Jersey, New York and Pennsylvania—provided first-line prescription drug coverage for all four cardiovascular risk factors.