Q: What is ADAP?
Answer: ADAP provides access to medications used to treat HIV and prevent the onset of related opportunistic infections to low-income individuals with HIV disease who have limited or no coverage from private insurance or Medicaid.
Q: How is ADAP funded?
Answer: ADAP receives funds from Part B of the Ryan White CARE Act.
Q: How are medications purchased?
Answer: Once a client fulfills the application requirements for ADAP, the completed ADAP Medication Request Form is sent to the contract pharmacy where it is filled.
Q: Where do I get an ADAP application?
Answer: You can get an application and assistance with filling out your application through your case manager. If you don’t have a case manager, please call 501-661-2408 or 888-499-6544 to speak to someone about whether you qualify for ADAP.
Q: What is the ADAP Formulary Committee?
Answer: Decisions about what medications are included within the AIDS Drug Assistance Program (ADAP) Formulary are guided by an ADAP Formulary Committee. Members of this Committee (clinicians, case managers, HIV program administrators, consumers and others), provide their expertise and perspectives primarily on issues related to the efficacy and importance of new medications. The also provide advice on activities related to the operation and effectiveness of the program. Their perspectives and best thinking on these issues are integrated with considerations about budgetary status and program/policy regulations and priorities. While final decisions with regard to all of these matters rest with the Department of Health and Human Services, Division of Health, HIV/Services, the ADAP Formulary Committee plays an invaluable role in assuring that “real world” experience and expertise are incorporated into the decisions made by and operation of the ADAP Program.
Q: What medications are available through ADAP?
Answer: There are currently many drugs available on the ADAP Formulary.
Q: How are medications distributed?
Answer: Medications that appear on the Formulary are mailed to the client's home or Case Manager's office, or a client may pick up the prescriptions in person. Regardless of how the client received the medications, the medications must be distributed from the contract pharmacy.
Q: How do I qualify for ADAP?
Answer: You must be HIV-infected and a resident of Arkansas. Annual income is set at 200% of federal poverty level. To ensure that Ryan White Part B is the payer of last resort for ADAP, all individuals applying for ADAP are screened for Medicaid eligibility, which means all applicants must have Medicaid denial letters unless the client is receiving Medicare Part D. All new and re-certified ADAP clients are required to provide documentation of Arkansas residency.
Q: Do I have to wait for a Medicaid Denial letter before submitting an ADAP Application?
Answer: No. We will provide up to thirty days of medication to an ADAP-eligible client as long as you have an appointment scheduled with Medicaid eligibility. However, we cannot provide further medication without your denial form or letter.
Q: What if I have Medicare?
Answer: If you are eligible for Medicare, you must 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 assistance. You must also provide a copy of your Medicare Rx card (Part D).
Q: Are there any medications that require prior authorization?
Answer: Yes. Your physician can download the Application Process for Patient Access to Fuzeon.
Eligibility Criteria for Fuzeon/T-20 Coverage
- A CD4 count <200. If the client is on Fuzeon/T-20 therapy and their CD4 count is not <200 at the point at which the application is submitted to ADAP, coverage will be determined on a case by case basis
- Failure of at least two other HAART regimens
- Resistance testing (test results must be available for review)
- An appropriate regimen proposed as a complement to Fuzeon/T-20
- Demonstration by the client on prior medication regimens and or strong belief on the part of the clinician that the client will be sufficiently adherent to significantly benefit from an optimized regimen that includes Fuzeon/T-20
- Willingness on the part of the clinician to instruct the client on proper administration of the drug, to monitor the client’s use of the drug, and to collect and dispose of the used syringes and needles (i.e., the sharps’ container) monthly
Q: What if my medical provider disagrees with a decision made by ADAP staff regarding ADAP eligibility?
Answer: Your medical provider can download the ADAP Formulary Committee Provider Dispute Policy and Procedures.