ADAP (AIDS Drug Assistance Programs) is federally created state-managed drug safety net for people living with HIV/AIDS. ADAP can help pay for your HIV medications.
The requirements vary by state. However, certain aspects of ADAP are the same no matter what state you live in: clients must be HIV positive, must be a resident of the state, must have an income of less than a certain amount per year and be under insured or uninsured. ADAP can even be used for people who have Medicare. ADAP generally does not apply to people with both Medicare and Medicaid.
Aspects of ADAP that vary state to state are:
- Eligibility (for example, maximum amount of income). In order to qualify for ADAP:
- You must be HIV positive -- and provide clinical documentation of HIV infection. Some states require additional clinical eligibility criteria relating either to specific CD4 counts or amount of viral load.
- Your income must fall below a certain level, the amount of which varies from state to state. You don't need to be near poverty as you do with Medicaid.
- You must have limited or no prescription drug coverage.
- You must be a resident of the state in which you seek medications.
- Formulary coverage (the list of covered drugs although each ADAP must have at least one drug in each class of antiretroviral medication)
- ADAP benefits: As a general matter, ADAPs provide FDA-approved HIV-related prescription drugs to people with HIV/AIDS. ADAPs also pay for health insurance that includes HIV treatments.
- Drugs and supplements
- Formularies (the drugs covered by a particular program) and benefits differ from state to state.
- ADAPs are required to cover at least one medication from each approved current or future antiretroviral drug class.
- Some states cover pricey supplements like Juven that even private health insurance plans usually don't.
- Private Health Insurance
- ADAP is permitted to purchase health insurance and pay premiums, co-payments and/or deductibles for people who are eligible for ADAP -- provided the insurance has comparable formulary benefits to ADAP. A majority of the states pay your share of health insurance premiums, or the entire premium if you have the insurance independently.
- ADAP can serve as a bridge between heal care and services funded by The Ryan White Program, Medicaid, Medicare, and private insurance.
- If you have Medicare:
- ADAP can be used to pay part D premiums, deductibles, coinsurance and co-payments if you do not qualify to have premiums paid by Full Low Income Subsidy. (SeeMedicare.)
- If ADAP pays costs, the costs will not count toward your "True Out of Pocket Costs" needed to reach Part D's catastrophic coverage levels.
- You may be dis-enrolled if you receive both Medicare and Medicaid because you already have guaranteed drug coverage.
- Drugs and supplements
For contact information for the program, eligibility, benefits provided by the program, and other state assistance programs, see whichever of the following works for you:
- ADAP Advocacy Association ,
- AIDS Treatment Data Network's "The Access Project" at: www.atdn.org/access/states/index.html .
- HIV Positive Magazine at http://www.hivpositivemagazine.co m. Click on ADAP Criteria and Formulary
- Your local HIV/AIDS organization, or through a social worker, hospital or your doctor.
For more detailed information about ADAP see the Health Resources and Services Admnistration (HRSA) manual about ADAP, by clicking here .
- Some states have a waiting list to participate in ADAP. If that is your situation:
- If you don't have health insurance: While waiting to qualify for ADAP, find out if you can qualify for Medicaid or Medicare, private health insurance, or other state or other assistance program. To learn more, see:How To Obtain Health Insurance.
- If you do have health insurance: Do not drop your health insurance until you find out if your state will cover at least part of the premium (and maybe even the whole premium.) You may also be able to get drugs through one of the drug assistance programs for free or at a very low price. To learn more, see: Compassionate Use And Expanded Access Programs.
- A financial planner or tax expert may have advice about decreasing your taxable income so you qualify for ADAP next year.