State Variation in AIDS Drug Assistance Program Prescription Drug Coverage for Modifiable Cardiovascular Risk Factors
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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.
To assess the consistency of ADAP coverage for type 2 diabetes, hypertension, hyperlipidemia, and smoking cessation using clinical guidelines as the standard of care.
Cross-sectional survey of 53 state and territorial ADAP formularies.
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”.
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%).
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.
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- State Variation in AIDS Drug Assistance Program Prescription Drug Coverage for Modifiable Cardiovascular Risk Factors
Journal of General Internal Medicine
Volume 26, Issue 12 , pp 1426-1433
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- public assistance
- AIDS drug assistance program
- cardiovascular disease
- Industry Sectors
- Author Affiliations
- 1. Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, CT, USA
- 2. Department of Veterans Affairs/VA Connecticut Healthcare System, West Haven, CT, USA
- 3. Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, SHM IE-61, New Haven, CT, 06520-8088, USA
- 4. Department of Investigative Medicine, Yale School of Medicine, New Haven, CT, USA
- 5. Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA