X0955520

Adap shortfall relief - Pennsylvania allocates all Ryan White Part B (RWPB) grant funds to the AIDS Drug Assistance Program (ADAP).

We then use the 340B rebates that we collect on the purchased prescriptions to fund additional ADAP clients and all our RWPB programming, which includes seven regional grantees.

The program has experienced several factors over the past few years that has resulted in the program being overspent.

Historically, the program collects over $80 million each year in 340B rebates.

This combined with our grant funds creates a total program budget of around $140 million.

The Ryan White Program is a needs-based program with specific allowable services.

With such a large budget, we were charged with actively pursuing ways to spend down funding each year.

This caused us to create broad eligibility criteria, challenge our regional grantees to expand services, providers, and do additional outreach and education.

The difficulty expending funds during and after the COVID pandemic combined with a large rebate deposit late in FY21 meant we were unable to spend the rebates in the time remaining, causing us to spend no formula grant funds in FY22.

We were only able to negotiate receiving $14 million in carryover, resulting in $25 million being returned to HRSA.

Medicaid unwinding has also had an impact on the ADAP program.

There are a record number of individuals enrolled and are assisting an increased number of uninsured clients.

Uninsured clients cost the program more money for medication purchases, which diminishes/eliminates the benefit of a 340B rebate.

There has also been a steady increase in medication claims per person and an increase in the costs per medication.

As program costs have increased, the Ryan White formula grant funding has remained level.

Our 340B rebate earnings have increased, but not comparable to the increase in medication expenditures.

All these factors have created a situation where our rebate funds cannot keep up with the current expenses.

In October 2025, we reduced ADAP and Part B eligibility from 500% FPIG to 350% FPIG due to our budgetary issues.

We have also implemented more structured eligibility verification requirements and have provided clearer guidance about the completion of Medicaid (MA) applications for MA eligible clients to ensure ADAP resources are being utilized by individuals who have the greatest need.

All these efforts are working towards preventing an ADAP waiting list.

Pennsylvania utilizes all Ryan White Part B grant funding (less Minority AIDS Initiative and Emerging Community funds) to fund ADAP.

340B rebate funding is also primarily reinvested into ADAP, except for funding used for other Ryan White Part B allowable expenditures.

To utilize more 340B rebate funding within ADAP, our Part B regional contracts have been reduced by 25% and other expenditures have been moved to other funding sources as identified and allowed.

ADAP ERF would be used to continue our current ADAP programming.

This funding would supplement the current funding (RWPB base and ADAP grants) that is fully allocated to the ADAP.

With additional funding, we will be able to reduce the likelihood of further eligibility decreases, caps, and waitlists.

Pennsylvania Department Of Health

NOT APPLICABLE

93.917 - HIV Care Formula Grants

HRSA Office of Federal Assistance Management (OFAM) [HHS - HRSA]

Pennsylvania United States

State-Wide

Ryan White HIV/AIDS Program AIDS Drug Assistance Program (ADAP) Emergency Relief Fund (ERF)  (HRSA-26-012)

Amendment Since initial award the total obligations have increased 152% from $1,268,496 to $3,194,404.