Pharmacies
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.
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What Are the California ADAP Eligibility Requirements?
A patient may be eligible for California ADAP services if:
Which Documents Are Needed?
What Drugs Are Covered?
There are over 180 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?
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.
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. 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.
Rosiglitazone (Avandia™)
When completing rosiglitazone (Avandia™) access forms, fill out section 2 of
the application completely if your patient is an existing ADAP client who is
newly initiating rosiglitazone or is an ADAP client who previously received
rosiglitazone through another payer (i.e. Medi-Cal, Medicare Part D or Private
Payer). Fill out section 3 of the application completely if your patient is
currently taking rosiglitazone or continuing treatment. Download a copy of the
access form and submit the form prior to dispensing rosiglitazone. Please be
sure to include all requested clinical information including a signed informed
consent form and a list of therapies that have been tried and failed. 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. Treatment 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:
Where Can Patient's Prescriptions be Filled?
Patients can fill their ADAP prescriptions through any one of the more than 3,500 participating pharmacy in the Ramsell Public Health Rx's pharmacy network.
To locate the pharmacy closest to you, enter your City, Zip code or County in the Pharmacy Locator below:
Pharmacy LocatorOr call Ramsell Public Health Rx at 1-888-311-7632. 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?Our Heart is in Public Health | ||
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