Ryan White CARE Act: AIDS Drug Assistance Programs, Perinatal HIV Transmission, and Partner Notification Page: 2 of 11
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SGAO
aAccountabiity Integrity-Reliability
Highlights
Highlights of GAO-06-681T, a testimony
before the Subcommittee on Federal
Financial Management, Government
Information, and International Security,
Committee on Homeland Security and
Governmental Affairs, U.S. Senate
Why GAO Did This Study
Despite progress in HIV/AIDS drug
treatments and the reduction of
AIDS mortality in the United States,
challenges remain concerning the
availability of these drugs for
individuals with HIV/AIDS and the
prevention of new cases. The
CARE Act authorizes grants to the
states and certain territories
specifically for AIDS Drug
Assistance Programs (ADAP) to
purchase and provide HIV/AIDS
drugs to eligible individuals. In its
report issued today, Ryan White
CARE Act: Improved Oversight
Needed to Ensure AIDS Drug
Assistance Programs Obtain Best
Prices for Drugs (GAO-06-646),
GAO examines the program design
of ADAPs in the 50 states, the
District of Columbia, and Puerto
Rico, their funding sources, and
drug purchasing. GAO also reports
on state approaches to reducing
perinatal HIV transmissions and
identifying and notifying partners
of HIV-infected individuals.
In its report, GAO recommends
that HRSA require ADAPs to report
the final prices they paid for drugs,
net of any rebates, and that HRSA
routinely determine whether these
prices are at or below the 340B
prices. In commenting on these
recommendations, HRSA stated
that these steps would be labor
intensive and it lacks capacity to
carry out such oversight.www.gao.gov/cgi-bin/getrpt?GAO-06-681 T.
To view the full product, including the scope
and methodology, click on the link above.
For more information, contact Marcia Crosse
at (202) 512-7119 or crossem@gao.gov.RYAN WHITE CARE ACT
AIDS Drug Assistance Programs,
Perinatal HIV Transmission, and Partner
Notification
What GAO Found
Variation in ADAPs' program design and funding amounts from CARE Act
grants and other funding sources contribute to differences in coverage-who
is eligible and what drugs are covered by an ADAP-among the 52 ADAPs
GAO reviewed. In order to make maximum use of the funding they receive,
ADAPs are expected to secure the best price available for the drugs on their
formularies. ADAPs may, but are not required to, purchase their drugs
through the 340B federal drug pricing program, under which drug
manufacturers provide discounts on certain drugs to covered entities. The
Health Resources and Services Administration (HRSA) has identified the
340B prices as a measure of ADAPs' economical use of grant funds, but the
Department of Health and Human Services does not disclose 340B prices to
the ADAPs. GAO found that some ADAPs reported prices that were higher
than the 340B prices for selected HIV/AIDS drugs. However, these reported
prices may not have reflected any rebates ADAPs eventually received. While
HRSA is responsible for monitoring whether ADAPs obtain the best prices
available for drugs, it does not routinely compare the drug prices ADAPs
report to 340B prices.
All 50 states, the District of Columbia, and Puerto Rico have policies or have
enacted laws regarding HIV testing of pregnant women to help reduce
perinatal HIV transmission. The majority of states have adopted a policy of
voluntary prenatal HIV testing of pregnant women that is consistent with
guidelines issued by the Centers for Disease Control and Prevention (CDC).
GAO contacted 8 states to discuss the approach they use to test pregnant
women for HIV, and these states use one of two approaches. Consistent with
additional CDC recommendations on testing, three states routinely include
HIV tests in standard prenatal testing, but a woman can refuse to be tested
for HIV. In the other 5 states, a woman must consent to an HIV test, usually
in writing, before the test can be performed. Six of the 8 states GAO
contacted report that the number of HIV-positive newborns has declined.
However, only 3 states GAO contacted collect the data needed to determine
statewide perinatal HIV transmission rates.
GAO contacted 12 states regarding their approaches to identifying partners
of HIV-infected individuals and notifying them of their possible exposure to
the virus. These states used various approaches in conducting HIV partner
notification activities as part of their partner counseling and referral
services. These activities include eliciting partner information from HIV-
infected individuals, but the participation of these individuals varies and not
all partners can be reached to be notified. Of the 12 states contacted, 10 have
statutory or regulatory provisions that require or permit certain health care
entities or workers to notify partners, including spouses, without the
consent of the known HIV-infected individual. In the remaining two states,
public health officials or the health department may notify partners only
with the consent of the HIV-infected individual.,United States Government Accountability Office
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United States. Government Accountability Office. Ryan White CARE Act: AIDS Drug Assistance Programs, Perinatal HIV Transmission, and Partner Notification, text, April 26, 2006; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc292645/m1/2/: accessed March 28, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.