Despite a significant drop in the number of patients on Florida’s AIDS Drug Assistance Program waiting list there are still concerns about that number rising over the coming months.

The AIDS Drug Assistance Program, known as ADAP, is a federally funded nationwide payer of last resort for people who cannot afford their HIV/AIDS medications. The program has been in a funding crisis since 2010, which prompted many states, including Florida, to implement cost containment measures such as waiting lists.

Rep. Alcee Hastings, D-Fort Lauderdale, issued a letter Friday urging Gov. Rick Scott to “support its ADAP, as well as its Medicaid program, to the greatest extent allowed by its current budgetary considerations.”

“Thousands of low-income, uninsured, and underinsured Floridians living with HIV/AIDS are counting on you to support the State’s ADAP and Medicaid program, thereby ensuring that they have reliable access to the drugs they need to stay alive,” Hastings writes. “Without further support from the State, I am deeply concerned that Florida’s ADAP waiting list may begin growing again in the coming months due to insufficient funding.”

Florida had the longest ADAP waiting list in the U.S. through 2011. Hastings’ letter points out that “Florida ranks third-highest among the 50 states in cumulative reported AIDS cases. Florida’s consistently high rate of HIV/AIDS poses a serious public health concern.”

According to the National Alliance of State and Territorial AIDS Directors (.pdf), as of last week 850 Floridians were on the ADAP waiting list. Florida Bureau of HIV/AIDS data (.pdf) released in late January showed over 1,260 people on the ADAP waiting list.

The National Alliance numbers show that more than 4,100 people across 12 states are on waiting lists. Florida’s current waiting list makes up 21 percent of the national total.

Michael Rajner, a South Florida AIDS activist, tells The Florida Independent that in December’s ADAP work group meeting with the state, “it was reported that the ADAP list would grow by approximately 300 people each month.”

“One of the things I’m very concerned about is that [the] Bureau of HIV/AIDS came out with a zero tolerance policy with individuals having to be re-enrolled by a certain date, otherwise they are completely cut off and forced to go on the waiting list, and it smacks of a lack of short sightedness,” Rajner says.

Rajner adds that the “bureau doesn’t have a standard way of making certain clients are communicated to,” adding that “ADAP is rolled out in various ways throughout the state.”

“If you’re getting your medication through the Health Department pharmacy you get that reminder that your eligibility is due,” Rajner says. “If you go to CVS there is no reminder to say, ‘You’re at 30 days; your eligibility is due.’ There is no intervention. It is not equitable as far as how they are reaching out to all clients. And the bureau has acknowledged they don’t have that in place but they have no plans to change that either.”

Rajner explains that “there is an approximate one month wait for clients to actually get an appointment for eligibility  into the [ADAP] program, so they are already having capacity issues to get clients in to do their re-enrollment.” Rajner says the state’s HIV/AIDS bureau is “not able to step up on how to ensure clients remain in care. They are not focusing too much on clients.”

According to Rajner, there is a substantial number of people living with HIV “who have mental health issues with substance abuse issues, with cognitive challenges.”

“For those individuals, you need to ensure there are interventions in place to ensure they remain in care, maximize health outcomes and suppress the virus in the community,” Rajner says.