McManus Kathleen A, Engelhard Carolyn L, Dillingham Rebecca
Department of Medicine, University of Virginia, Charlottesville, VA 22903, USA.
AIDS Res Treat. 2013;2013:350169. doi: 10.1155/2013/350169. Epub 2013 Mar 18.
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.
艾滋病药物援助计划是根据1990年的《瑞安·怀特综合艾滋病资源紧急法案》制定的，为低收入、未参保或保险不足的艾滋病毒/艾滋病患者提供处方药，是“最后的支付方”。艾滋病药物援助计划面临联邦政府资金减少的问题。各州对该计划的资金投入是可自由支配的，但一些州增加了投入以填补资金缺口。随着艾滋病毒感染者寿命延长，抗逆转录病毒疗法（ART）指南已改为建议对所有人开始治疗，美国提高了艾滋病毒检测目标，且经济衰退仍在持续，对艾滋病药物援助计划支持的需求正在增加。在需求增加而资金有限的情况下，艾滋病药物援助计划正在采取成本控制措施。自2010年以来，联邦紧急资金一直在救助艾滋病药物援助计划，但这些资金不可持续。在未来几年，与艾滋病毒治疗相关的提供者和政策制定者将需要应对《平价医疗法案》（ACA）的实施。从通过艾滋病药物援助计划为弱势群体提供可持续的抗逆转录病毒疗法所面临的挑战中吸取的经验教训，应能为即将到来的关于如何在《平价医疗法案》实施期间及之后确保抗逆转录病毒疗法供应的决策提供参考。
