ADAP Problems Persist Throughout CA

California officials still haven't fixed problems with the state's AIDS Drug Assistance Program, months after issues with the system emerged.

According to the California Department of Public Health, the trouble with ADAP, which is supposed to help thousands of people get the care they need to stay alive, started after it switched to new contractors last July.

In a February update to HIV advocates in San Francisco, the state Office of AIDS said, "The highest priority" is supporting ADAP enrollment staff and clients to ensure "uninterrupted access to medications and health insurance assistance while at the same time addressing systems issues with the ADAP enrollment portal. Many OA and CDPH Information Technology managers and staff, as well as CDPH executive staff, are regularly working over 10 hours a day and on weekends to address these issues, and have been for months."

Courtney Mulhern-Pearson, director of state and local affairs at the San Francisco AIDS Foundation, said in an interview, "In my opinion, they need to do a whole system redesign."

A.J. Boggs, the new contractor that oversees ADAP's enrollment system, "doesn't appear to be able to fulfill the terms of that contract. ... That's where the biggest problems have been," she added.

Clarke Anderson, A.J. Boggs' CEO, has previously declined to answer questions from the Bay Area Reporter.

"This is a critical issue that needs to be resolved," Mulhern-Pearson said. "It's taking valuable staff time away from other projects," specifically in the Office of AIDS.

She noted that the California HIV Alliance, a coalition that includes the SFAF, the San Francisco health department, Project Inform, and other agencies, told the state last June that advocates were worried about changes planned under the new contractors.

"We are concerned that the amount of time that has been allotted for system beta testing and enrollment worker training is not adequate," the coalition said in a June 14 letter to Dr. Gilberto F. Chavez, the state's epidemiologist and deputy director for infections diseases. "The Office of AIDS has notified us that the new system is still being developed, beta testing has not yet begun, and enrollment worker training will not begin until just weeks before the July 1 transition. Further, the system is transitioning from one to three contractors, which will require additional coordination to effectively serve clients. ... We know from past experience with transitions that even the best planned system will have glitches. A new system of this size, serving tens of thousands of Californians living with HIV, will require additional time to be beta tested with enrollment workers prior to a full scale transition."

The coalition asked for a three-month delay in the transition.

In response to emailed questions from the B.A.R. this week, CDPH spokespeople said, "We have taken steps to have a complete resolution soon," but they wouldn't say when exactly the problems would be fixed. They also wouldn't say whether the contracts with A.J. Boggs or others would be canceled, or if the companies would be penalized, but CDPH is "carefully exploring longer term options" while working with the contractors.

The contract with the state's previous ADAP contractor, Ramsell, expired in June 2016. In 2015, before the expiration, separate requests for proposals were sent out for enrollment and pharmaceutical services in an effort "to increase competition among [Pharmacy Benefits Managers], thereby potentially lowering the administrative fees and drug reimbursement rates," according to CDPH. Ramsell has filed two lawsuits against the health department. A spokeswoman with the company didn't respond to an interview request.

Gay state Senator Scott Wiener (D-San Francisco) said he's meeting with CDPH Director Dr. Karen Smith Thursday (February 16) to discuss the problems with ADAP.

"It is my hope and expectation that she'll let me know exactly what they're doing to fix the problem in a prompt manner," Wiener said.

In an emailed statement to the B.A.R., gay Assemblyman Evan Low (D-Campbell), chair of the state's California LGBT Legislative Caucus, said, "We are very concerned about the recent changes" at ADAP. "Barriers in access have produced tremendous anxiety and distress for our communities. For many enrolled in the program, this is a matter of life and death. The caucus is closely monitoring this situation and we are working with our LGBT coalitions, in addition to the Department of Public Health, to address these issues moving forward."