Medical Professionals

California AIDS Drug Assistance Program ADAP

The California AIDS Drug Assistance Program (ADAP) was established in 1987 to help ensure that HIV-positive uninsured and under-insured individuals have access to medication. Currently, over 180 drugs are available through ADAP, and there are over 3,000 pharmacies statewide where clients can access these drugs.

Frequently Ask Questions FAQs

printer frienlyprinter friendly

What Are the California ADAP Eligibility Requirements?

A patient may be eligible for California ADAP services if:

  • Patient is a resident of the State of California

  • Patient is at least 18 years of age

  • Patient has an HIV diagnosis (ADAP will only process prescriptions written by a licensed California physician/prescriber)

  • Patient has limited or no prescription drug benefit from another source

  • Patient has a Federal Adjusted Gross Income of not more than $50,000. (To determine their Federal Adjusted Gross Income, instruct your client to refer to their income tax forms or visit www.irs.gov)

Which Documents Are Needed?

  • Proof of California Residence (i.e. rental agreement or utility bill in your name, identifying place of residence)
  • Picture identification (California Driver's License, California Identification card, Passport, School I.D., etc.)
  • Proof of Income (copies of either your most recent Federal or State Income Tax returns, most recent pay stub (3 consecutive months), Public Assistance or Social Security Award Letters)
  • Proof of Medi-Cal application (if available) and/or documentation of any current health insurance coverage (if applicable)
  • Letter of HIV diagnosis from your physician/prescriber. Lab values (CD4 and viral load counts) must be dated within 6 months

What Drugs Are Covered?

There are over 150 FDA approved drugs in the California ADAP program. To view the current list of drugs, or ADAP formulary, please choose one of the options below.

What Prior Authorization Forms are required?

Tropism Assay (Trofile™)

The California Office of AIDS has authorized coverage of the HIV Tropism Assay for ADAP clients with no other insurance coverage. ADAP will only pay for the tropism assay by Monogram Biosciences (Trofile™). Prior authorization is required and clients must have evidence of ARV resistance, intolerance and/or lack of patient acceptability to reasonable alternatives resulting in inability to fully suppress HIV utilizing alternative regimens. Trofile assay results are forwarded directly to Ramsell Public Health Rx from Monogram Biosciences.
Download PDF click to download

Maraviroc (Selzentry™)

Maraviroc is approved for patients with CCR5 mono-tropic HIV confirmed by tropism assay results. Please fill out either section 2 OR section 3, whichever is applicable to your patient.
Download PDF click to download

Fuzeon (Enfuvirtide)

When completing Fuzeon access forms, please be sure to include all requested clinical information including CD4 lab measurements as well as two viral load measurements. IF your patient has never used Fuzeon, please submit TWO detectable viral load measurements within the last six-months in order to provide medical justification for starting Fuzeon. IF your patient has received Fuzeon previously through another insurance payer (e.g. Medi-Cal, Medicare Part D, private insurance), you must provide TWO detectable viral load measurements within a six-month period prior to the date the patient started Fuzeon treatment.
Download PDF click to download

Serostim

Please be sure to fill out Form A, section 1 of the application completely if your patient is a new-start applicant or is receiving Serostim thru another payer source. If you are requesting a refill of Serostim beyond the initial 3-month ADAP approval please fill out Form B.
Download PDF click to download

Peg-Intron

Peg-Intron is available for free through Schering-Plough's Commitment to Care Free Peg-Intron program. Please fill out the Peg-Intron ADAP Access form and fax back to Ramsell Public Health Rx at 800-848-4241.
Download PDF click to download

Treament Exception Request Form

Please do not use this form to request medications that are not on the ADAP formulary. The TER forms will only be reviewed for the following purposes:

  • To request formulary medications that exceed normal, FDA approved dosing guidelines
  • To request formulary medications that have a medical justification outside of the scope of the restrictions and guidelines established by the California Office of AIDS Medical Advisory Committee.

Download PDF click to download

Where Can Patient's Prescriptions be Filled?

A patients can fill their ADAP prescriptions through any one of the more than 3,500 participating pharmacies in Ramsell Public Health Rx's pharmacy network.

To locate the closest pharmacy, call Ramsell Public Health Rx at 1-888-311-7632 or enter your zip code or city in the form on the top right called "Pharmacy Locator".

What Are the Patients' Rights?

A patient has the right to apply, to appeal decisions and to receive confidential, nondiscriminatory, courteous and respectful service.

If you believe a patient has been denied their rights, or treated unfairly or discourteously at any point in the ADAP enrollment process, or while receiving pharmacy services, contact the State Office of AIDS at (916) 449-5900.

Where Can I Get More Information About HIV/AIDS?

Click on the link below to see a list of resources:

• California ADAP HIV/AIDS Resources page.

OurHeart is in Public Health

Enrollment Site Locator

City
Zip
County

Pharmacy Locator

City
Zip
County

News

Ramsell Public Health Rx Secures Delaware ADAP Contract

Oakland, Calif., August 30, 2010 - Ramsell Public Health Rx, a pharmacy benefit and information management company, today announced it is working with the state of Delaware to administer its AIDS Drug Assistance Program (ADAP). With the help of Ramsell’s ADAP Management system, the state program will be handled electronically for the first time, allowing for streamlined coordination and access to critical medication for participants.

More >