AIDS Drug Assistance Program (ADAP)
What Is ADAP Assist?
ADAP Assist is co-pay assistance for ADAP clients who have:
- Private insurance
- Employer based insurance, or
- Insurance through the Federally Facilitated Marketplace (FFM)
When we receive an ADAP application for a client who is insured or eligible for insurance, we ask for premium, formulary, and co-pay information. ADAP needs this information to determine whether the coverage is adequate, meaning the insurance will cover the antiretroviral (ARV) drug therapy. Clients can only enroll in the FFM if they are not enrolled in Medicare or their private or employer based insurance has been deemed inadequate and/or unaffordable.
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Please click on the frequently asked questions below to see their answers.
What medications are available through ADAP Assist?
ADAP Assist provides copayment assistance for all current ADAP Assist clients’ on medications covered by their private insurance, employer based insurance, Medicare or Federally Facilitated Marketplace (FFM). Please note that there are some excluded medications which are detailed under the next tab.
Are there certain medications that ADAP Assist does not cover?
ADAP Assist cannot pay copays for the following medication categories:
- Certain Over The Counter (OTCs) Medications
- Erectile Dysfunction (ED)
- Fertility Agents
- Skin Coloring Agents
- Retinoids (Retin-A, Differin, Accutane, Others)
- Hydroquinone (Eldoquin, Others)
- Prescriptions used for cosmetic purposes
- Ancillary supplies
Please refer to Ramsell for assistance with the OTCs that are covered.
Are there certain medications that require prior authorization?
Some medications available through ADAP Assist require prior authorization. The following medications require prior authorization:
Are there certain medical expenses that ADAP does not cover?
ADAP does not cover inpatient care, emergency care, cosmetic procedures or care, fertility procedures or care, gender reassignment procedures or care, or care related to erectile dysfunction or sexual performance.
What if I have Medicare?
If you are eligible for Medicare, you must sign up for Medicare Part D prescription coverage and provide us with a copy of your Medicare prescription card or a copy of a letter from the company that provides your drug plan. You are also required to provide a copy of the current determination letter from the Social Security Administration (SSA) Medicare Prescription Drug Assistance Program that shows you are not eligible or only partially eligible for Extra Help (low-income subsidy [LIS]). ADAP will provide a 45 day provisional enrollment pending receipt of a copy of your Medicare prescription card and/or your LIS determination letter.
What pharmacies can I use?
ADAP Assist clients may choose to use the pharmacy of their choice. Clients are responsible to ensure the pharmacy is in network with his or her private insurance, employer based insurance, Medicare or Federally Facilitated Marketplace (FFM) health plan and our prescription benefit manager (PBM), Ramsell . Ensuring the client’s pharmacy of choice is in both networks helps assure all applicable copayments can be adjudicated using the pharmacy point-of-sale system.
How do I use my prescription card from Ramsell?
ADAP Assist clients will receive a prescription card in the mail. They will show their prescription card to the pharmacist when filling their prescription. It gives important information about ADAP Assist eligibility. Pharmacists will connect with Ramsell by computer to check eligibility and get approval to fill prescriptions.
Do I need a copy of my prescriptions from my doctor?
Yes. Clients on ADAP Assist are responsible for ensuring their pharmacy of choice receives their prescriptions. Clients on ADAP Assist may have their physician fax their prescriptions to the pharmacy of choice or provide the original signed Medical Provider Page (MPP) from the ADAP application to their pharmacy. If the ADAP Assist client was utilizing Avella Specialty Pharmacy, he or she can have their preferred pharmacy contact Avella Specialty Pharmacy to request their prescriptions be transferred. If the prescriptions are for controlled substances, clients should ask their physician for assistance in transferring the prescription or request new prescriptions be issued. ADAP will fax prescriptions to Avella Specialty Pharmacy for ADAP Assist clients upon request.
Do I need to complete my ADAP renewal?
Yes. Full renewal is due during the clients’ birthday month and a one-page self-attestation renewal is due during the clients’ ½ birthday every year.
Can I use mail order options?
Yes. Clients on ADAP Assist may elect to fill though a mail order pharmacy. However, the client must ensure that the mail order pharmacy is in network for his or her private insurance, employer based insurance, Medicare or Federally Facilitated Marketplace (FFM) health plan and our prescription benefit manager (PBM), Ramsell. Any shipping/mailing fees are the responsibility of the client. Please note that due to federal regulations, clients on ADAP Assist can only receive one month (30 day supply) of medication at a time.
Can I get a 90 day supply?
Yes. If the primary insurer requires a 90 day supply, ADAP can pay the remaining copay for up to a 90 day supply. Please verify the pharmacy is in the processing network for ADAP Assist prior to submitting the prescription.
I know someone on the regular ADAP program. Will they be able to fill medications through an ADAP assist pharmacy?
No. Clients on traditional ADAP are still required to fill their medications through Avella Specialty Pharmacy.
What if I have additional questions?
If you have any further questions or concerns about the ADAP Assist Program or Ramsell, you may call us at (800) 334-1540 or (602) 364-3610. Please ask to speak to the ADAP coordinator.
What if I have been prescribed medication for the treatment of Hepatitis C?