1 (Revised) 2025 ADR Variable Changes Instrument FINAL

HRSA HAB’s AIDS Drug Assistance Program (ADAP) Data Report (ADR) Changes – 2025

OMB No.: 0915-0345
Expiration Date: 4/30/2026

Client Demographics
Current
Reference
ID
CY 2021 Variable

Current Coding

Corresponding
NASTAD Variable

Recommendation

Final Decision on
Variable and Coding

Rationale

2.1

ClientUCI

String

N/A

No change

1

Ethnicity
Race

Same response
options
Same response
options

No change

2

3

Hispanic
Subgroup

N/A

No change

OMB Mandated
Coding

4

Asian Subgroup

1=Hispanic
2=Non-Hispanic
1 = White
2 = Black or African
American
3 = Asian
4 = Native Hawaiian
or Other Pacific
Islander
5 = American Indian
or Alaska Native
1 = Mexican,
Mexican American,
or Chicano/a
2 = Puerto Rican
3 = Cuban
4 = Another
Hispanic, Latino/a,
or Spanish
origin
1 = Asian Indian
2 = Chinese
3 = Filipino
4 = Japanese
5 = Korean
6 = Vietnamese
7 = Other Asian

N/A

No change

OMB Mandated
Coding

No change

1

OMB Mandated
coding
OMB mandated
coding. No
additional
subgroups added
so that race
subgroups align
with OMB
reporting.

HRSA HAB’s AIDS Drug Assistance Program (ADAP) Data Report (ADR) Changes – 2025
5

NHPI Subgroup

1 = Native Hawaiian N/A
2 = Guamanian or
Chamorro
3 = Samoan
4 = Other Pacific
Islander

No change

8

Sex at Birth

No change

9
10

Birth Year
HIV AIDS Status

11

Poverty Level

1= Male
2=Female
3=Unknown
YYYY
Age Groups
2 = HIV-Positive, not
AIDS
3 = HIV-Positive,
AIDS status
unknown
4 = CDC-defined
AIDS
Continuous variable

OMB No.: 0915-0345
Expiration Date: 4/30/2026

OMB Mandated
Coding

No change
No change

No change

2

Aligns with RSR
Reporting.

HRSA HAB’s AIDS Drug Assistance Program (ADAP) Data Report (ADR) Changes – 2025
13

Health Insurance 10 = Private –
Employer
11 = Private –
Individual
8 = Medicare Part
A/B

-Enrolled as
Medicaid
Beneficiaries only
-Dually Eligible for
Medicaid and
Medicare

No change

3

OMB No.: 0915-0345
Expiration Date: 4/30/2026

HRSA HAB’s AIDS Drug Assistance Program (ADAP) Data Report (ADR) Changes – 2025
9 = Medicare Part D
12 = Medicaid, CHIP,
or other public plan
13 = VA, Tricare, or
other military health
care
14 = IHS
15 = Other Plan
16 = No
Insurance/uninsured
17=Medicare Part C
18=High Risk
Insurance
19=Association Plan

-Eligible for
Medicare Part D Full
Subsidy
-Eligible for
Medicare Part D
Partial Subsidy
-Eligible for
Medicare Part D
Standard Benefit
-Private insurance
-No form of
insurance
For Clients with
Private Insurance
Coverage:
-Enrolled in an
individual qualified
health plan (QHP) in
the ACA
Marketplace
-Enrolled in an
individual qualified
health plan (QHP)
off the ACA
Marketplace
-Enrolled in any
other private
insurance (e.g.,
employersponsored
coverage)

4

OMB No.: 0915-0345
Expiration Date: 4/30/2026

HRSA HAB’s AIDS Drug Assistance Program (ADAP) Data Report (ADR) Changes – 2025

OMB No.: 0915-0345
Expiration Date: 4/30/2026

Client-Level Data – Enrollment and Certification
Current
Reference
ID
CY 2021 Variable

Current Coding

Corresponding
NASTAD Variable

Recommendation

Final Decision on
Variable and Coding

14

New
Enrollment

0= No
1= Yes

15

Date Completed
Application
Received

Mm,dd,yyyy

No change

16

Application
Approval
Date
Recertification
Date

Mm,dd,yyyy

No change

17

Mm,dd,yyyy

Rationale

No change

Total number of new
clients enrolled in
your ADAP at any
point during
calendar year. This
this number should
include clients
enrolled in both your
ADAP-funded fullpay medication
program and your
ADAP- funded
insurance program.

This helps us to
understand the
time that it takes
to approve an
application.

Modify variable to:
The variable is
Last Date of Eligibility being modified to
reflect updated
Confirmation
guidance in HRSA
HAB’s Policy

Total number of
unduplicated clients
enrolled in your
ADAP at any point
during calendar year

5

HRSA HAB’s AIDS Drug Assistance Program (ADAP) Data Report (ADR) Changes – 2025

18

Enrollment Status 8 = Enrolled,
at the End of the receiving services
Year
9 = Enrolled, on
waiting list
10 = Enrolled
services not
requested
11 = Disenrolled

2017 who were
successfully
recertified twice in a
12-month period12
of time by ADAP
(this should include
clients enrolled in
both your ADAPfunded full-pay
medication program
and your ADAPfunded insurance
program)?
Total Number of
unduplicated clients
enrolled in your
ADAP at any point
during the calendar
year (this should
include clients
enrolled in both your
ADAP-funded fully
pay medication
program and your
ADAP-funded
insurance program)

OMB No.: 0915-0345
Expiration Date: 4/30/2026

Clarification Notice
(PCN) 21-02. Per
this PCN, ADAPs
are still required to
recertify clients but
are no longer
required to follow
the every “6month”
recertification
criterion.
No change

6

HRSA HAB’s AIDS Drug Assistance Program (ADAP) Data Report (ADR) Changes – 2025
19

Disenrollment
Reason

OMB No.: 0915-0345
Expiration Date: 4/30/2026

No change

9 = Program
eligibility criteria
changed, client no
longer eligible
10 = Client’s
eligibility
changed, client no
longer meets
eligibility criteria
4 = Client did not
recertify
5 = Client did not fill
prescription as
required by program
6 = Client is
deceased
12 = Other
13 = Unknown

Client-Level Data – Insurance Services
Current
Reference
ID
CY 2021 Variable
20

Insurance
Assistance
Received
Flag

Current Coding
0 = No
1 = Yes

Corresponding
NASTAD Variable

Recommendation

Unduplicated
clients served
through an ADAP
funded insurance
program only at
any point in the
calendar year

Final Decision on
Variable and Coding
No change

7

Rationale

HRSA HAB’s AIDS Drug Assistance Program (ADAP) Data Report (ADR) Changes – 2025
1 = Full or Partial

67

Insurance
Assistance Type

Unduplicated total
Premium Payment number of clients
served through
3 = Medication co- ADAP- funded
insurance program
pay/ deductible
including Medicare who had:
Part D co- Insurance, -Premium payment
made on their behalf
co-payment, or
donut hole coverage only
-Deductible/copay/co-insurance
payment made on
their behalf only
-Premium AND
deductible/copay/co-insurance
payment made
on their behalf

21

Insurance
0-100,000
Premium Amount

22

Insurance
Premium Month
Count

OMB No.: 0915-0345
Expiration Date: 4/30/2026

No change

Total ADAP only
expenditures for
Insurance premiums
(private, state highrisk pools, PCIPs,
Medicare Part D,
and/or Medicaid)

No change

0-12

No change

8

Since we will
continue to receive
medication costs, it
would make sense
to also receiving
insurance
assistance costs

HRSA HAB’s AIDS Drug Assistance Program (ADAP) Data Report (ADR) Changes – 2025
23

Medication Copay 0-100,000
or Deductible
Amount

Total ADAP only
expenditures for
Insurance copayments, coinsurance, and
deductibles (private,
State high-risk pools,
Medicare Part D,
and/or Medicaid)

OMB No.: 0915-0345
Expiration Date: 4/30/2026

No change

Client-Level Data – Drug and Drug Expenditure Elements
Current
Reference
ID
CY 2021 Variable

Current Coding

25

Medication
Dispensed Flag

0= No
1= Yes

26

Medication ID

Medication’s 11digit National Drug
Code

27

Medication Start
Dates

Mmddyy

28

N/A

N/A

Corresponding
NASTAD Variable

Recommendation

Unduplicated clients
served with full-pay
medications only at
any point in
the calendar year

Final Decision on
Variable and Coding

Rationale

No change

No change

New variable:
Medication Days (0365)

9

Erroneously
removed in the 2021
ADR. Added back in
for 2022 as it is
needed to assess the

HRSA HAB’s AIDS Drug Assistance Program (ADAP) Data Report (ADR) Changes – 2025

OMB No.: 0915-0345
Expiration Date: 4/30/2026

quality of medication
data reported by
recipients in the
ADR. The variable
indicates the number
of days that
each medication
dispensed to a client
during the reporting
year.
29

Medication Cost

0-100,000

Total ADAP only
expenditures for
Prescription Drugs;
Individual
Medication costs

No change

Client-Level Data – Clinical Information
Current
Reference
ID
CY 2021 Variable

Current Coding

Corresponding
NASTAD Variable

Recommendation

Final Decision on
Variable and Coding

32

CD4 Test Date
CD4 Date

mm,dd,yyyy

No change

33

CD4 Count

0-100,000,000

No change

10

Rationale

HRSA HAB’s AIDS Drug Assistance Program (ADAP) Data Report (ADR) Changes – 2025
34

Viral Load Test
Date

mm,dd,yyyy

N/A

No change

35

VL Count

0-100,000,000

<=200
>200
Unknown/ Unrep
orted

No change

OMB No.: 0915-0345
Expiration Date: 4/30/2026

Grantee Report
Current
Reference
ID
CY 2021 Variable
N/A

Grantee Name

N/A

Grant Number

N/A

DUNS Number

N/A

Grantee Address:
Street
City
State
Zip code

Current Coding

Corresponding
NASTAD variable

Recommendation

Final decision on
Variable and Coding

Rationale

No Change

State/Territory for
which this
information is
reported

No Change
Change from DUNS
On April 4, 2022, the
number to Unique
Federal government
Entity Identifier (UEI) transitioned from
DUNS number to UEI.
As a result, recipients
no longer have to
report a DUNS
number in the ADR.
No Change

11

HRSA HAB’s AIDS Drug Assistance Program (ADAP) Data Report (ADR) Changes – 2025

N/A

N/A

Contact
information of
person
responsible for
submission:
Name
Title
Email
Phone
Fax
ADAP Limits:
Indicate whether
your program has
adopted any of
the following
limits to control
cost

Has your ADAP
experienced an
unexpected
increase
in enrolled clients

No Change

Name of person
completing this
survey; email
address of the
person completing
this survey

No change

Select all that apply:
Waiting list;
Enrollment cap;
Capped number of
prescriptions per
month; Capped
expenditures;
Drug-Specific
Enrollment caps for
ARVs, Heb/C meds;
Formulary
Reduction; Decrease
in financial eligibility
criteria; None of
these limits were
applied to the ADAP
during the reporting
period
Yes/No

No change

12

OMB No.: 0915-0345
Expiration Date: 4/30/2026

HRSA HAB’s AIDS Drug Assistance Program (ADAP) Data Report (ADR) Changes – 2025

N/A

N/A

N/A

If yes, how many Integer
new clients were
enrolled
If your ADAP has
capped
expenditures,
enter the
monetary cap per
client
If your ADAP has Month
capped
Annual
expenditures,
enter whether
the cap applies
monthly/annually
If your ADAP has
adopted drugspecific
enrollment caps,
indicate the
medications for
which you
have enrollment
caps.

No change
No Change

No Change

No Change

13

OMB No.: 0915-0345
Expiration Date: 4/30/2026

HRSA HAB’s AIDS Drug Assistance Program (ADAP) Data Report (ADR) Changes – 2025
N/A

N/A

ADAP income
eligibility

% (of FPL)

Drug pricing cost- Select all that apply:
saving strategies • 340B Rebate
• 340B Direct
Purchase
• 340 B Direct
Purchase Prime
vendor
• Department of
defense

Full-Pay Medications
Program
• 100% FPL
• 200% FPL
• 250% FPL
• 300% FPL
• 350% FPL
• 400% FPL
• 450% FPL
• 500% FPL
• Other

No Change

ADAP Funded
Insurance Program
• 100% FPL
• 200% FPL
• 250% FPL
• 300% FPL
• 350% FPL
• 400% FPL
• 450% FPL
• 500% FPL
• Other

No Change

14

OMB No.: 0915-0345
Expiration Date: 4/30/2026

*NASTAD collects a
separate question:
How client’s income
is calculated (check all
that apply)

HRSA HAB’s AIDS Drug Assistance Program (ADAP) Data Report (ADR) Changes – 2025
N/A

ADAP funding
received during
the reporting
period

Enter amounts
received for:
Total contributions
from Part A
EMA(s)/TGA(s)

Amount Received or
Anticipated*:
FYXXX Part A
contribution allotted
to ADAP

No Change

Total contributions *Would be included
from Part C and/or D in Other ADAP funds
Funding

No change

State General
funding
contributions
Carry-over of Ryan
White funds from
previous year

No Change

Manufacturer
Rebates and
Program Income
Reinvested in the
ADAP

All Insurance
Reimbursements,
excluding Medicaid

State general
revenue funding
allocated to ADAP
Federal carry-over to
be used for ADAP –
from prior Part B
base or ADAP
awards
Estimated
rebates/wholesaler
credits to be used
for ADAP, including
rebates on partial
payments (for both
rebate and direct
purchase states)
Private Insurance
Reimbursements;
Other (e.g.
Medicare and the
Veterans
Administration)

No Change

No change

No change

15

OMB No.: 0915-0345
Expiration Date: 4/30/2026

HRSA HAB’s AIDS Drug Assistance Program (ADAP) Data Report (ADR) Changes – 2025
Medicaid
Reimbursements
N/A

Expenditures
Category

N/A

ADAP Formulary

N/A

Does your ADAP
have an open
formulary,
inclusive of all
FDA approved
medications

Enter total
expenditures for:
• Full pay
medication
assistance
• Dispensing costs
• Other
administrative
costs
• Health insurance
assistance
(including co-pays,
deductibles and
premiums)
List of generic, brand
name, and check box
indicating that
medication
was added to the
formulary during the
reporting year and
the date indicating
when the
medication was
added
Yes/No

Medicaid
Reimbursements,
including back-billing
Total ADAP Program
Expenditures:
Prescription drugs
Prescription
dispensing costs
Insurance Premiums
Insurance
Deductibles
Insurance Copayments
Program Insurance

OMB No.: 0915-0345
Expiration Date: 4/30/2026

No change
No change

No change

No change

16

Explore costs
associated with
uploading a
standardized list of
drugs on formulary

HRSA HAB’s AIDS Drug Assistance Program (ADAP) Data Report (ADR) Changes – 2025

OMB No.: 0915-0345
Expiration Date: 4/30/2026

Public Burden Statement:
The purpose of this data collection is to evaluate the national impact of the RWHAP ADAP by providing deidentified clientlevel data on individuals being served, services being delivered, and costs associated with these services. An agency may not
conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently
valid OMB control number. The OMB control number for this information collection is 0915-0318 and it is valid until
4/30/2026. This information collection is mandatory (through increased Authority under the Public Health Service Act,
Section 311(c) (42 USC 243(c)) and title XXVI (42 U.S.C. §§ 300ff-11 et seq.). Public reporting burden for this collection of
information is estimated to average 6 hours per response for the recipient report, and 81 hours for the client report. This
includes the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of
information. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 13N82, Rockville,
Maryland, 20857 or paperwork@hrsa.gov.

17