Aids drug assistance program (adap) November 2013 Estimate Package 2014-15 governor’s budget ron Chapman, md, mph

10. 
    For Covered California premiums for OA-PCIP clients, ADAP applied the same computations as above for LIHP and ADAP-only clients, except that ADAP used the distribution of FPL for 92 OA-PCIP clients, resulting in an estimate of $103,879. (Table 31, next page).
    

11. 
    To estimate the cost of drug deductibles and co-pays for LIHP and ADAP-only clients in Covered California, ADAP multiplied the estimated number of clients in each FPL by the monthly Covered California drug co-pays by six months, added the applicable drug deductible and then summed up the total drug deductibles and co-pays. The average monthly drug deductible and co-pay was $42 ($36,115 / six months and then divided by 145 clients). Deductibles and co-pays shown in Table 32 were multiplied by the average number of drug prescriptions per month per client for ADAP-only clients in FY 2012-13 (2.3 for brand and 1.2 for generic).
    

Table 33 summarizes the unadjusted premiums, drug deductibles and copays, and averted drug expenditures for LIHP and ADAP-only clients. Loss rebate was included for the five LIHP clients (39 percent of $170,265 = $66,403).

12. 
    For Covered California drug deductibles and co-pays for OA-PCIP clients, multiplied the $42 monthly average by six months by the 73 clients for an estimate of $18,489 (Table 34).
    

13. 
    ADAP-only clients who previously transitioned to LIHP (n = 5, Group 1) and current OA-PCIP clients (n = 73) eligible for Covered California were assumed to transition to Covered California on January 1, 2014 with no delays. For ADAPonly clients (Group 2, in yellow) potentially eligible for Covered California who exceeded the LIHP upper limits of their residing counties or from counties that did not implement LIHP ($1.7 million in savings for 140 clients out of the totals in Step f) (Table 35), reductions in savings were calculated to accommodate a ramp-up period. ADAP assumed that 25 percent of the 140 clients would enroll in January, followed by 25 percent each in February and March, and the remaining 25 percent in April (Tables 36 and 37, page 71). This resulted in a 25 percent reduction of the initial savings and number of clients for these ADAP-only clients (for expenditures, $1.7 million X 12.50 percent = $420,690, and no reduction in clients since they would all enroll by the end of the FY). Therefore, this ramp-up period resulted in a reduction of $420,690 and zero clients from the overall unadjusted savings estimated. The same 25 percent reduction was also applied to premiums ($263,559 X 25 percent = $65,890) and drug deductibles and co-pays ($34,921 X 25 percent= $8,730) for the 140 clients.
    

TABLE 37: NON-LIHP, ADAP-ONLY ADJUSTED FOR RAMP-UP (Group 2)
LINE ITEM	CLIENTS	EXPEND$	REBATE REVENUE	NET
Premiums	140	$197,669	$0	$197,669
Drug Deduct & Co-Pays	140	$26,191	$0	$26,191
Averted Drug Expend$	140	-$1,262,070	$0	-$1,262,070
TOTAL	140	-$1,038,209	$0	-$1,038,209

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