title: 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.
  
  
  METHODS
  Cross-sectional survey of 53 state and territorial ADAP formularies.
  
  
  METHODS
  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".
  
  
  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.
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Oni J
authors.initials: OJ
authors.lastname: Blackstock
authors.forename: Karen H
authors.initials: KH
authors.lastname: Wang
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D002317:Cardiovascular Agents / Q000191:economics / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D008483:Medical Assistance / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D055553:Prescription Drugs / Q000191:economics / Q000627:therapeutic use; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D002317:Cardiovascular Agents; D055553:Prescription Drugs