Journal of General Internal Medicine

, Volume 26, Issue 12, pp 1426–1433

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

  • Oni J. Blackstock
  • Karen H. Wang
  • David A. Fiellin
Original Research

DOI: 10.1007/s11606-011-1807-5

Cite this article as:
Blackstock, O.J., Wang, K.H. & Fiellin, D.A. J GEN INTERN MED (2011) 26: 1426. doi:10.1007/s11606-011-1807-5

ABSTRACT

BACKGROUND

In the United States, mortality from cardiovascular disease has become increasingly common among HIV-infected persons. One-third of HIV-infected persons in care may rely on state-run AIDS Drug Assistance Programs (ADAPs) for cardiovascular disease-related prescription drugs. There is no federal mandate regarding ADAP coverage for non-HIV medications.

OBJECTIVE

To assess the consistency of ADAP coverage for type 2 diabetes, hypertension, hyperlipidemia, and smoking cessation using clinical guidelines as the standard of care.

DESIGN

Cross-sectional survey of 53 state and territorial ADAP formularies.

MAIN MEASURES

ADAPs covering all first-line drugs for a cardiovascular risk factor were categorized as “consistent” with guidelines, while ADAPs covering at least one first-line drug, but not all, for a cardiovascular risk factor, were categorized as “partially consistent”. ADAPs without coverage were categorized as “no coverage”.

KEY RESULTS

Of 53 ADAPs, four (7.5%) provided coverage consistent with guidelines (coverage for all first-line drugs) for all four cardiovascular risk factors. Thirteen (24.5%) provided no coverage for all four risk factors. Thirty-six (68%) provided at least partially consistent coverage for at least one surveyed risk factor. State ADAPs provided coverage consistent with guidelines most frequently for type 2 diabetes (28%), followed by hypertension (25%), hyperlipidemia (15%) and smoking cessation (8%). Statins (66%) were most commonly covered and nicotine replacement therapies (9%) least often. Many ADAPs provided no first-line treatment coverage for hypertension (60%), type 2 diabetes (51%), smoking cessation (45%), and hyperlipidemia (32%).

CONCLUSIONS

Consistency of ADAP coverage with guidelines for the surveyed cardiovascular risk factors varies widely. Given the increasing lifespan of HIV-infected persons and restricted ADAP budgets, we recommend ADAP coverage be consistent with guidelines for cardiovascular risk factors.

KEY WORDS

AIDSHIVpublic assistanceAIDS drug assistance programcardiovascular disease

Supplementary material

11606_2011_1807_MOESM1_ESM.doc (58 kb)
ESM 1(DOC 58 kb)

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Oni J. Blackstock
    • 1
    • 2
    • 3
  • Karen H. Wang
    • 1
    • 3
  • David A. Fiellin
    • 3
    • 4
    • 5
  1. 1.Robert Wood Johnson Foundation Clinical Scholars ProgramYale School of MedicineNew HavenUSA
  2. 2.Department of Veterans Affairs/VA Connecticut Healthcare SystemWest HavenUSA
  3. 3.Department of Internal MedicineYale School of MedicineNew HavenUSA
  4. 4.Department of Investigative MedicineYale School of MedicineNew HavenUSA
  5. 5.Center for Interdisciplinary Research on AIDSYale UniversityNew HavenUSA