State variation in AIDS drug assistance program prescription drug coverage for modifiable cardiovascular risk factors

J Gen Intern Med. 2011 Dec;26(12):1426-33. doi: 10.1007/s11606-011-1807-5. Epub 2011 Aug 12.

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Acquired Immunodeficiency Syndrome / drug therapy
  • Cardiovascular Agents / economics
  • Cardiovascular Agents / therapeutic use*
  • Cardiovascular Diseases / economics
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / prevention & control*
  • Cross-Sectional Studies
  • Humans
  • Insurance Coverage / economics
  • Insurance Coverage / standards
  • Insurance Coverage / statistics & numerical data*
  • Insurance, Pharmaceutical Services / economics
  • Insurance, Pharmaceutical Services / standards
  • Insurance, Pharmaceutical Services / statistics & numerical data*
  • Medical Assistance / economics
  • Medical Assistance / standards
  • Medical Assistance / statistics & numerical data*
  • Prescription Drugs / economics
  • Prescription Drugs / therapeutic use
  • Risk Factors
  • United States / epidemiology

Substances

  • Cardiovascular Agents
  • Prescription Drugs