Prescription Drug Coverage

Frequently Asked Questions

If you qualify, ADAP may pay for some or all of the cost of HIV/AIDS related medications that other insurance does not cover.

No. Although ADAP is available in all 50 states and Commonwealths, it is not the same everywhere. Each state or Commonwealth is responsible for:

  • Establishing ADAP eligibility;
  • Determining the type, amount, duration and scope of services;
  • Developing a list of covered prescriptions on its formulary; and
  • Administering the Program.

To be eligible for ADAP you must:

  • Be a California resident;
  • Be at least 18 years of age;
  • Have an HIV/AIDS diagnosis;
  • Have a valid prescription from a California licensed physician;
  • Have a Federal Adjusted Gross Income that does not exceed $50,000; and
  • Have limited prescription drug coverage.

ADAP covers some or all of the cost associated with medications commonly used to treat HIV/AIDS and related complications. ADAP benefits will last as long as you meet the eligibility and annual recertification requirements.

You must have an HIV or AIDS diagnosis.

No. What you have in the bank and what you own does not affect your ADAP eligibility. ADAP uses your Federal Adjusted Gross Income to determine financial eligibility. This income must be under $50,000 per year.

You will need the following documents to complete your ADAP application:

  • Proof of California residence (e.g. rental agreement or utility bill).
  • Picture identification (California Driver's License, California Identification card, Passport, School I.D., etc.)
  • Proof of income (Federal or State Income Tax returns with corresponding W2 or 1099 forms, pay stubs, Public Assistance or Social Security Award Letters).
  • Proof of Medi-Cal application (if applicable) and/or documentation of any current health coverage (if applicable).
  • Letter of HIV diagnosis including CD4 count and viral load from a physician.

To apply for the AIDS Drug Assistance Program, contact the local ADAP coordinator in your county to find the nearest enrollment in your area.

In general, ADAP is the payer of last resort. If you are eligible for private health coverage with prescription benefits, ADAP will require you to use those benefits first before paying any copayments, coinsurance, or deductibles. ADAP can also pay for drugs that aren't covered under the insurance plan.

If you are considered to be potentially eligible for Medi-Cal, ADAP will require you to apply for such coverage. If you are eligible for free Medi-Cal, you cannot get ADAP. If you are eligible for Medically Needy Medi-Cal with a Share of Cost, costs that ADAP covers can go towards your share of cost. If you are eligible for other types of Medi-Cal, Medi-Cal will pay first and ADAP second.

If you have Medicare the California Office of AIDS has information about how the programs interact.

To be eligible for ADAP you must continue to meet the financial eligibility requirements for the program. In addition, ADAP requires you to recertify annually.

If you continue to meet the financial eligibility requirements for ADAP and recertify annually, working will not affect your benefits from this program.

If your income increases above 400% of the Federal Poverty level, but stays below $50,000, you will continue to be eligible for ADAP but will have a copayment.

If you do not have all the required documentation for your ADAP application, you may qualify for temporary (30-day) access to prescription benefits. However, you must submit any missing documentation within 30 days of the application date to continue receiving benefits.

It depends. If you have Medi-Cal without Medicare, drugs that ADAP pays for can help meet your share of cost. If you have Medi-Cal and do have Medicare, ADAP will not meet your share-of-cost.

No. ADAP will only cover your County Medi-Cal Services Program for prescriptions on the ADAP formulary.

PhRMA represents American drug and biotechnology companies. Their Medicine Assistance Tool (MAT) is a search engine for Patient Assistance Programs (PAPs) and the prescriptions that are covered. PAPs help uninsured and underinsured individuals get free or discounted prescription drugs.

Drug companies offer Patient Assistance Programs (PAPs) to provide free or discounted prescription drug coverage to uninsured and underinsured people. These include Medicare and Medi-Cal beneficiaries and those who have private health insurance but lack adequate prescription drug coverage.

PAPs are neither federal nor state-run programs. They provide prescription drug assistance to individuals who qualify through pharmaceutical companies.

For the most part, Patient Assistant Programs (PAPs) serve people who are either uninsured or underinsured. Some PAPs offer assistance to Medicare and Medi-Cal beneficiaries. Eligibility requirements for individual PAPs vary widely, so be sure to check each program before applying.

Benefits for PAPs are not standardized. Some offer free or discounted prescription drugs for 3 months, while others offer benefits for 6 months. Many require an annual reassessment. Every program is different, so you should check with each PAP for an explanation of benefits.

Depending upon the PAP, medical eligibility requirements may require you to have a specific diagnosis. Many PAPs, however, do not. Be sure to check with each PAP for specific medical eligibility requirements.

Sometimes. Many PAPs have financial eligibility requirements, while others do not. Because there are no standard financial eligibility requirements among PAPs, you should check with each program for financial requirements.

Before applying for a PAP, you should gather the following information:

  • Age;
  • State of residence;
  • Estimated gross annual household income;
  • Name of prescription drugs; and
  • Type of health insurance and/or prescription coverage (if applicable).

PhRMA’s Medicine Assistance Tool (MAT) is a search engine for Patient Assistance Programs (PAPs) and the prescriptions that are covered. DB101's Prescription Drug Coverage Resources section lists other websites that have PAP finders.

Each PAP has its own timeline for making prescription drug assistance available. Some programs deliver prescription drugs within 3-4 weeks, while others may take several months. It is best to check with each PAP to see when benefits will become available.

To stay enrolled, you need to follow the requirements of that particular program. Many programs require you to reapply each time you need a prescription, while others require an annual application. Because PAPs are not standardized, you should check with the program for specific requirements.

Many PAPs require you to be either a U.S. resident or citizen. However, not all PAPs have residency requirements. It is best to check with each PAP for specific residency requirements.

Most PAPs have requirements that are based upon insurance status. Unless a PAP has income requirements, working should have no effect on your eligibility for a program.

Each PAP is different. You should check with each PAP in which you wish to participate for specific information on eligibility requirements and application procedures.

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