Prescription Drug Coverage

Common Pitfalls

Losing eligibility for a Patient Assistance Program (PAP)

Many programs require you to reapply each time you need a prescription, while others require an annual application. You should check with each Patient Assistance Program for specific requirements. To stay enrolled in a PAP, you need to understand and follow the requirements of that particular program.

Confusing eligibility between Patient Assistance Programs

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

Not considering Patient Assistance Programs

Many individuals are not aware of Patient Assistance Programs because they may have other coverage, such as private health coverage, Medi-Cal or Medicare Part D. In some instances, you may be able use a PAP when your current coverage does not cover a particular medication(s).

Failing to accept employer-sponsored health coverage

Sometimes an individual is enrolled in a health insurance plan that does not include prescription coverage. Under these circumstances, you may want to apply for the AIDS Drug Assistance Program (ADAP). While this is a great benefit, you will only be covered for drugs related to HIV/AIDS treatment. If you have the opportunity to enroll in employer-sponsored health coverage, then you may be able to receive full prescription coverage for all conditions. Also, the ADAP program has income limits that are not present in private health coverage offered through an employer.

Not applying for ADAP because you are not eligible for Medi-Cal

If you are enrolled in Medi-Cal, you can be eligible for the AIDS Drug Assistance Program (ADAP). If you are not eligible for Medi-Cal, you can still be eligible for ADAP if you meet the Program's requirements.

Not knowing when to use ADAP to cover a share of cost

Many individuals use the AIDS Drug Assistance Program to cover a Medi-Cal share of cost. This involves the pharmacy billing ADAP for the individuals' share of cost as they fill or refill prescriptions. This process allows them to be able to access Medi-Cal without incurring any expenses. The best way to do this is at the beginning of the month so that you will have Medi-Cal available to you for the rest of the month at no cost.

Not knowing about all of your prescription options

ADAP may not be the most cost-effective approach for prescription drugs. You should consider all of your options before making a decision to use ADAP.

Other options that may be available to you include:

In some cases large retailers with pharmacies may offer the best price.

Learn more