IN PRINT: The Adoption of Mental Health Drugs on State AIDS Drug Assistance Program Formularies April 2011

The Adoption of Mental Health Drugs on
State AIDS Drug Assistance Program Formularies

Published in the American Journal of Public Health (see link to full article in gray box below).

By Erika G. Martin and Colleen L. Barry

James W. Fossett and Michelle N. MeyerColleen L. Barry

ABSTRACT: Antiretroviral drugs have dramatically reduced the rate of HIV-related deaths. As HIV treatment has shifted from acute care to chronic care, providers and advocates have stressed the value of also treating mental illnesses in people with HIV. A large proportion of people with HIV are afflicted with mental illnesses, which can hamper treatment or sustained medical care if not addressed.

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Erika G. Martin is an Institute Fellow and an assistant professor at the Rockefeller College of Public Affairs & Policy. Colleen L. Barry is an associate professor at the Johns Hopkins Bloomberg School of Public Health. Their full article is published in the April 14, 2011 online issue of the American Journal of Public Health. (Membership is required to access the full article.)

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Approximately 30 percent of HIV-infected individuals in the United States receive antiretroviral medications through state AIDS Drug Assistance Programs (ADAPs), which are financed and maintained through the federal Ryan White HIV/AIDS Program. ADAPs, and the Ryan White Program more generally, are ‘‘payers of last resort’’ for individuals who have gaps in private insurance coverage, who have not progressed to AIDS and thus do not meet Medicaid and Medicare disability requirements, or who do not meet income requirements for Medicaid eligibility. ADAPs have considerable discretion in their program design. While some federal requirements exist, other decisions are left to the states, including those concerning: program enrollment, financing mechanisms, the breadth of reimbursable services, and pharmaceuticals allowed for treatment, which are listed on official state drug formularies.

This article examines the state-level factors associated with ADAP drug formulary adoption of medications to treat mental illness. Expert interviews identified potential factors associated with quicker inclusion of mental health drugs on ADAP formularies, and we empirically tested the associations between these factors and the timing of formulary adoption of these drugs from 1997 to 2008.

The results showed a wide variation across states in formulary adoption of psychotropic drugs. We found that the relative size of a state’s federal Ryan White funding allocation, its political orientation and its concentration of psychiatrists were all significantly associated with the length of time it took state ADAP formularies to include psychotropic drugs. Specifically, states with a larger allocation of federal dollars per patient, a Democratic political orientation and a higher concentration of psychiatrists were quicker to approve the use of psychotropic drugs to treat HIV patients for patients receiving drug coverage through ADAPs.

Understanding these and other factors that may contribute to the variation in adoption of psychotropic drugs on state ADAP formularies is vital given the importance of treating mental health conditions as a component of comprehensive HIV care.


The Nelson A. Rockefeller Institute of Government, the public policy research arm of the State University of New York, conducts fiscal and programmatic research on American state and local governments. It works closely with federal, state, and local government agencies nationally and in New York, and draws on the State University’s rich intellectual resources and on networks of public policy academic experts throughout the country.