An Interview With Steve Bailey: How Virginia Kept the Pills Coming to ADAP Clients on Its Waiting List

September 24, 2012

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No one enjoyed the ADAP waiting list experience, but sometimes adversity produces remarkable things. When the Commonwealth of Virginia had to start wait-listing ADAP-eligible clients in November, 2010, and even disenroll some clients who were already getting their drugs through Virginia's ADAP, the Commonwealth made a commitment: everyone would continue getting drugs, even if it wasn't through the state ADAP program.

Steve Bailey, Director of HIV Care Services in the Virginia Department of Health's Division of Disease Prevention, joins us to tell us how Virginia did that. The Commonwealth's determination was admirable, and the Federal-state-private partnerships the Commonwealth built to get the job done will improve the delivery of HIV health care for years to come. The ADAP waiting lists were not a success story, but Virginia's response certainly was.

PV: Steve, now that ADAP waiting lists seem to be coming to an end -- for the time being -- can you tell us how the Commonwealth of Virginia handled finding alternate sources of drug assistance for the PLWHA it had to put on its waiting list?

Steve Bailey: When we began the waiting list, in November, 2010, we were in an unfortunate position of needing to remove some people from ADAP who had been receiving medication, so we contacted all the pharmaceutical companies that manufacture HIV medications and alerted them that we would need immediate assistance in Virginia for the clients, to ensure that they did not go without medications. We were able to establish individual contacts at each company, who communicated with our AIDS Drugs Assistance Program (or ADAP) staff here at the Virginia Department of Health, and we developed the ability to track each client who was accessing medication assistance. For example, initially we assisted clients in completing applications for various pharmaceutical assistance programs (PAPs), and then we would follow up with the pharmaceutical companies to ensure that every application was approved, and every medication was actually shipped to the client or their provider.

After that point, we knew the need was going to increase exponentially, as we needed to increase the wait list, and we were not able to assist clients with completing all the PAP applications, so we conducted trainings around the state for case managers and medical providers on how to most efficiently complete a PAP application. We then had a couple of panels in Virginia, where we had representatives from pharmaceutical assistance programs actually communicate with contractors and case managers to ensure that everyone understood what the eligibility criteria were, and the most efficient ways to have customers of ours access ADAP.

I think what helped in the relationship with the pharmaceutical assistance programs is that we proactively maintained communications with those companies, to make sure they understood where our wait list was at any given point. We worked out agreements with them to certify people who were on the wait list, so that pharmaceutical companies knew that clients applying for medication were truly clients who would otherwise be accessing ADAP.

That also helped us, by the way, by also setting the expectation that we would know about every client. It helped us accurately document all those people in Virginia in need of medications through ADAP, and that helped us advocate for more efficient systems and funding that we needed to ensure that we could ultimately provide those medications. The pharmaceutical companies helped in their systems to guide clients back to us, so we were aware of clients and could document that need.

So a couple of other things happened with patient assistance resources. It took us about a year, but we did get Welvista in Virginia, and that was a great help to us. As you know, Welvista is a company that provides medications to people on wait lists throughout the nation, and we had to go through some fairly complex systems here in Virginia to ensure that Welvista would be licensed by the Virginia Board of Pharmacy. Welvista worked hard to do that. Their pharmacist actually sat for the licensing exam in Virginia and passed that. And once Welvista was implemented in Virginia, we were able to see a turnaround of patients receiving medication within 24 to 48 hours after submitting their applications to Welvista. Why this was a helpful system as well, this route of patients getting medications through Welvista, is that they had to work with their physicians or case managers to apply. Those applications all came through our ADAP team, so again we were able to accurately document all people on our ADAP wait list and our true need for medications for people living with HIV.

Another thing Welvista helped with, is that every patient assistance program has its own timetable, eligibility criteria, different methods of shipping to a provider or client. What Welvista offered was one application, one process for all the HIV medications the client needed. That really helped clients, not having to track refilling three or four times to ensure that they received their complete regimen. Welvista helped coordinate that, so clients were receiving one shipment of all the medications they needed every month.

Although we had the wait list, we were committed to ensuring that all clients were accessing medications during this time when we could not provide the medications. So for clients on the wait list, we actually contacted them, at minimum every six months. Because periodically we would receive calls from providers and case managers if they had any specific challenges accessing medications, but on at least a six-month basis, our team contacted every client, to ensure that clients were still eligible for ADAP, so that when we were able to open enrollment back up, we could quickly move people into that system, rather than going through an entire eligibility process at the time of transition. But more importantly, we asked our clients, how are you getting your medications, and where are you getting them from? And if we were not able to confirm through the client that they were receiving all the medications they needed, then we facilitated contact with case managers and medical providers, which we were also keeping on record on our wait list, so we knew where clients were receiving their medical care. And we would bring the medical team in to make sure they knew their clients were not receiving the medications they needed, and therefore were able to intervene to get them into the systems that would help them the most.

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This article was provided by National Association of People With AIDS. It is a part of the publication Positive Voice.

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