What are the changes? These decisions were not taken lightly, in fact, they were forced upon us due to the financial situation. If we don’t take these actions, the program would be facing a $16.4 million deficit by the end of the fiscal year. The planned changes will impact current and potential future clients, and are designed to maintain core services for those most in need both financially and medically. ODH will be working with case managers and clients to assist those affected in identifying other resources including patient assistance programs. Some strategies being used are implementing a waiting list, reducing the number of medications on the formulary, aggressive pursuit of rebates, revising eligibility requirements and eliminating some services. Changes to the program include: Eligibility - click for eligibility guidelines in .pdf • Eligibility criteria will take into account a combination of both financial and medical need. After the financial assessment, the controlling factor will be based on the results of medical tests, to provide services to the most vulnerable clients. Clients who meet the criteria for medical exceptions may be enrolled. • Existing clients, who are specifically impacted by financial eligibility changes effective July 1, will be notified and given the opportunity to provide updated financial documents within 30 days. • New program applicants above 300 percent federal poverty level will not be eligible for HIV medications from the Ryan White program. Case managers will assist them in applying for Patient Assistance programs sponsored by the pharmaceutical manufacturers. • Client eligibility will be reviewed every six months for access to medications. • You have to be >18 years of age to be in the program. If a person is younger than 18, they are referred to BCMH and Ryan White Part D programs. • Medical exceptions:      o Clients who are diagnosed with AIDS (EVER had a CD4+ T Lymphocyte      count lower than 200 OR had an opportunistic infection)      o Pregnant women, and women post partum.      o Clients being actively treated for co-morbid HBV infection      o By being on the waiting list clients gain access to medications and      services from programs like:      o PAPs,      o Best Rx,      o High Risk Pool,      o Prescription Hope,      o FQHCs, • Eligibility determination will change from annually to every six months. • All Ohioans diagnosed with HIV regardless of income level will be eligible for Ryan White case management services. Implementation of a waiting list for new applicants • New potential clients at 300 percent poverty level and below, applying to the program, will be prioritized based on medical eligibility, effective July 1. Applicants who do not meet medical eligibility criteria will be placed on a waiting list. Change in drug formulary - click for .pdf of changes • The revised formulary will still exceed national public health service guidelines for HIV care. • All currently available antiretroviral agents will remain on the formulary. • Medications removed from the formulary, for health problems including cardiac conditions, management of diabetes, management of acid reflux and diarrhea, while clearly important in the care of all clients, were removed to preserve resources to pay for HIV medications. Criteria for Formulary Changes • All currently available antiretroviral agents were recommended to remain on the formulary so as not to limit treatment options. However, with the understanding that some agents are more expensive than others, an exception process should be instituted for some agents. This would allow for review of those cases by medical professionals to ensure that these agents are being used in a judicious and medically appropriate fashion. • With respect to opportunistic infection treatment and prophylaxis, the only medications recommended for removal from the formulary were those that were deemed redundant, or those that provided no other clinical benefit over other available agents (i.e., their only benefit would have been in dosing regimen, etc.). Again, some agents, because of their cost, were recommended for release by exception process only, again to ensure their use only in a judicious and medically appropriate fashion. • All vaccines, given their effective role as preventive agents, were recommended to remain on the formulary in unrestricted form. • Because of the well established impact of untreated mental illness on adherence, the recommendation was made to keep those mental health medications that are currently available in a generic form on the formulary. It should be noted that many of these agents are also available at retail pharmacies at a drastically reduced price (e.g., $4/30-day supply, $10/90-day supply). • All other agents (such as medications for cardiac conditions, management of diabetes, management of acid reflux/diarrhea, etc.), while clearly important in the care of all patients (including those with HIV), were not viewed to be related directly to HIV and were therefore given lowest priority for funding with Ryan White HIV/AIDS Care Program monies. Other program reductions • Elimination of non-core services (e.g. housing, utilities, transportation, nutrition). • Reduction of dental services except for emergencies. • Reductions in internal ODH funding. OTHER MESSAGES Some of the details of implementation are still being worked out. An initial notification is taking place this week – either through mail or by phone. Letters to all affected parties – clients, providers, case managers, etc. – will be mailed, beginning next week. ODH will continue to work with those affected to help ensure continuity of care by helping them access patient assistance programs and other resources in the community. We have been working on a resource packet for clients and case managers to help them through this process. This website contains HIV prevention messages that may not be appropriate for all audiences.