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 Asked Questions
• What Are the California ADAP Eligibility Requirements
• What Documents Are Needed?
• What Drugs Are Covered?
• What Prior Authorization Forms are Required?
• Where Can Your Patient's Prescriptions be Filled?
• What Are Your Patients' Rights?
Our Heart is in Public Health
What Are the California ADAP Eligibility Requirements
Your patient may be eligible for California ADAP services if:
- They are a resident of the State of California
- They are at least 18 years of age
- They have an HIV diagnosis (ADAP will only process prescriptions written by a licensed California physician/prescriber)
- They have limited or no prescription drug benefit from another source
- They have 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)
What Documents Are Needed?
- Proof of California Residence (i.e. rental agreement or utility bill in your client’s 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 client’s most recent Federal or State Income Tax returns, most recent pay stub, 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 client’s physician/prescriber. Lab values (CD4 and viral load counts) not less than 6 months old
Where Can Your Patient's Prescriptions be Filled?
The client 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 client’s zip code or city in the form to the right.
What Are Your Patients' Rights?
You have the right to apply, to appeal decisions and to receive confidential, nondiscriminatory, courteous and respectful service.
If you believe your client 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.
California Prior Authorization Forms
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.
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Maraviroc is approved for patients where there is evidence of ARV resistance, intolerance and/or lack of patient acceptability to reasonable alternative antiretroviral medications and already had a Tropism assay performed and the results confirm infection with CCR5 tropic HIV virus. Please fill out either section 2 OR section 3, whichever is applicable to your patient.
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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.
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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.
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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.
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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.
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