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

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.

Figure 1

Consistency of state ADAP prescription drug coverage with clinical guidelines for the treatment of modifiable cardiovascular risk factors. No coverage for any risk factor, At least partially consistent coverage for at least one risk factor, Consistent coverage for all four risk factors.

Figure 2

State variation in ADAP prescription drug coverage for diabetes mellitus. No coverage, Partially consistent with clinical guidelines, Consistent with clinical guidelines.

Figure 3

State variation in ADAP prescription drug coverage for hypertension. No coverage, Partially consistent with clinical guidelines, Consistent with clinical guidelines.

Figure 4

State variation in ADAP prescription drug coverage for hyperlipidemia. No coverage, Partially consistent with clinical guidelines, Consistent with clinical guidelines.

Figure 5

State variation in ADAP prescription drug coverage for smoking cessation. No coverage, Partially consistent with clinical guidelines, Consistent with clinical guidelines.