Note: Click on any of the following questions to read its answer.
Q. |
What is the AIDS Drug Assistance Program (ADAP)? |
A. |
The Arizona Department of Health Services (ADHS) is responsible for the administration of Arizona’s AIDS Drug Assistance Program (ADAP) for our state. ADAP provides access to medications used to treat HIV and prevent the onset of related opportunistic infections for low-income individuals living with HIV/AIDS. Currently, ADAP serves 900 clients statewide each month. |
Q. |
How is ADAP funded? |
A. |
ADAP currently receives funds from two sources: Ryan White HIV/AIDS Treatment Modernization Act ‘Part B’ and state funding. |
Q. |
How are medications purchased? |
A. |
Under a wholesale license issued by the Arizona State Board of Pharmacy, ADHS purchases medications from a wholesaler, stores inventory and distributes the medications. |
Q. |
How are medications distributed? |
A. |
Medications are sent directly to pharmacies. In Maricopa/Pinal counties, The Apothecary Shop acts as an agent for ADAP to distribute the medications. In other parts of the state, medication is sent to local pharmacies. |
Q. |
How do you qualify for ADAP? |
A. |
You must be HIV-infected and a resident of Arizona. Annual income is set at 300% of federal poverty level. For example, you cannot have an income of more than $30,630 for a family unit of one. You cannot be eligible for AHCCCS (Arizona’s version of Medicaid) nor have any other benefits that could pay for the medications. To ensure that Ryan White ‘Part B’ is the payer of last resort for ADAP, all individuals applying for ADAP are screened for AHCCCS eligibility, which means all applicants must have AHCCCS denial letters. You will be required to provide documentation of Arizona residency. |
Q. |
Do you have to wait for an AHCCCS denial letter before submitting an ADAP application? |
A. |
No. We will provide up to 30 days of medication to an ADAP-eligible client as long as you have an appointment scheduled with AHCCCS. However, we cannot provide further medication without your denial form or letter. |
Q. |
Where do you get an application? |
A. |
You can get an application and assistance with filling out your application through your doctor, case manager, or health department. For additional information on program eligibility and to download an application visit www.azdhs.gov/phs/hiv/adap.htm. |
Q. |
Is there a prior authorization procedure for Fuzeon? |
A. |
Yes. Your physician can download the application for Patient Access to Fuzeon at www.azdhs.gov/phs/hiv/adap.htm. |
Q. |
What if my medical provider disagrees with a decision made by ADAP staff regarding ADAP medications that were prescribed? |
A. |
Your medical provider can download the ADAP Formulary Committee Provider Dispute Policy and Procedures. To review the Dispute Policy, visit www.azdhs.gov/phs/hiv/adap.htm. |
Q. |
What medications are available through ADAP? |
A. |
See the ‘Formulary’ table (in this section below) for the list of the many drugs available through ADAP. New medications are occasionally added to the list. If you do not see one of your medications on this list, it may still be available through ADAP. |
Q. |
What is Medicare Part D (Medicare Rx)? |
A. |
On January 1, 2006, Medicare began offering a new prescription drug benefit called Medicare Part D (Medicare Rx). All Medicare beneficiaries are eligible for this drug coverage program. This program offers comprehensive drug coverage for HIV medications in addition to other medications you may be taking. |
Q. |
What if I get help from AHCCCS with my Medicare Part B premiums? |
A. |
If you currently get help with your Medicare Part B premiums, you also qualify for extra help with the Medicare Part D program. This means that you will not pay premiums, deductibles or co-insurance associated with Part D. You will be responsible for a small co-pay of up to $5.35 per prescription. You may select an enhanced Medicare drug plan, but if you do, you may be responsible for additional costs. You are already deemed eligible for the extra help. If you are unsure if you qualify for the extra help, please call Medicare at (800) 633‑4227. You should be enrolled in a prescription drug plan. |
Q. |
What if I do not get help from AHCCCS with my Medicare Part B premiums and my monthly income is $1,103 or less? |
A. |
If you currently are not getting help from AHCCCS with your Medicare Part B premiums and your monthly income is $1,1037 or less, you may be eligible for extra help through Social Security Administration (SSA). This means that you will not pay premiums, deductibles or co-insurance associated with Part D. You will be responsible for a small co-pay of up to $5.35 per prescription. You may select an enhanced Medicare drug plan, but if you do, you may be responsible for additional costs. If you have not received any information about extra help yet, please call SSA at (800) 772-1213, visit SSA on the internet at www.socialsecurity.gov or complete an application as soon as possible. If you qualify for the extra help, you will no longer receive medications through ADAP. You will receive them through your Medicare Part D plan. |
Q. |
What if I do not get help with my Medicare Part B premiums, my monthly income is greater than $1,103 and I am an ADAP client? |
A. |
If you are currently receiving assistance from the Arizona ADAP, you will be required to enroll in a Medicare Part D plan and provide proof to ADAP that you have done so. You also will be required to apply for extra help through SSA and give a copy of the SSA determination letter regarding the extra help to ADAP. Once ADAP has proof (copy of your Medicare card indicating you are enrolled in Medicare Part D and a copy of the SSA extra help determination letter), ADAP will assist you by continuing to provide your ADAP medications. |
Q. |
Is Medicare Part D mandatory? |
A. |
No. However, all Arizona ADAP clients who do not get help with Medicare Part B premiums and have a monthly income greater than $1,103 will be required to enroll in Medicare Part D to continue receiving their ADAP medications. Keeping up with all the changes in Medicare can leave you with questions. |
Q. |
Who can I turn to for further information? |
A. |
Contact your case manager, or the agencies listed below:
- Social Security (www.socialsecurity.gov) - (800) 772-1213
- Medicare (www.medicare.gov) - (800) 633-4227
- HIV/AIDS Law Project - (800) 852-9075 x2640
- Arizona State Health Insurance Program (SHIP) - (800) 432-4040
|
Q. |
What if I need more information? |
A. |
If you have questions or would like additional information about the program, please call (602) 364‑3610 or (800) 334‑1540 (within Arizona only). |
Return to Top |