Application Process | ADAP Service Options | Criteria | Recertification | ADAP Forms
1-855-362-0658 (phone) / 1-804-864-8050 (fax)
To enroll in ADAP clients must apply through the ADAP Central Office or through the Virginia Commonwealth University Health Systems (VCUHS) Financial Services (if clients receive services there). Incomplete applications will be returned to provider/sender and no further action will be taken.
- Clients may complete the application themselves and mail and/or fax to the ADAP Central Office (Fax 1-804-864-8050, Toll Free Fax 1-877-837-2853, Mailing address: Virginia Department of Health, HCS Unit, 1st Floor, James Madison Building, 109 Governor Street, Richmond, VA 23219).
- Clients may call the Medication Eligibility Hotline (1-855-362-0658), and staff will help with the application process. The application will be mailed to the client to sign and provide supporting documents.
The ADAP application is used to apply for all ADAP Service Options: Direct ADAP, the Medicare Part D Assistance Program (MPAP), the Health Insurance Marketplace Assistance Program (HIMAP) and the Insurance Continuation Assistance Program (ICAP). Once the client’s application is complete, the ADAP Central Office staff will determine the service option that best meets the client’s needs.
ADAP Service Options
1. Direct ADAP: If a client does not have any other coverage for their HIV/AIDS medications, medications can be picked up at any Local Health Department (LHD) or at VCUHS, INOVA, or Carilion Health if they receive services at those sites.
- Medication will be shipped from the VDH Central Pharmacy to LHD or alternate medication access site.
- Direct ADAP clients receive a 30-day supply of medication at a time.
- Clients may change their pick up site from one site to another by calling the ADAP Central Office. A letter noting the change will be sent to the client, medical provider, the old access site, the new access site, and pharmacy.
- Only ADAP Formulary medications will be sent to the LHD or an alternate medication access site.
- The ADAP Central Office staff communicates to LHD ADAP staff or alternate medication access site as needed about client enrollment, recertification, medication pick-up, labs, and data to ensure ongoing ADAP services.
- VCUHS Financial Services will continue to oversee the initial ADAP eligibility for their clients picking up ADAP medications from alternate medication access sites (Ambulatory Care Center (ACC), Hayes E. Willis Clinic or other sites). Recertification at 6 months is handled by the ADAP Central Office.
2. Medicare Part D Assistance Program (MPAP): MPAP clients are helped with monthly premiums and cost shares. Cost shares are medication deductibles and medication copayments. ADAP will assist with copayments for medications on the Medicare formulary. MPAP clients can pick up medications at any pharmacy that accepts their Medicare Part D plan and is within the Ramsell network.
3. Insurance Continuation Assistance Program (ICAP): Individuals with certain private insurance with medication benefits are eligible for ADAP assistance with their medication copayments and deductibles if all other qualifications are met. At any point in time a client loses insurance, the client can access medications through Direct ADAP if the client continues to meet ADAP eligibility criteria.
Medication copayment assistance will cover medications on the ADAP Formulary and the Ryan White Part B Formulary.
4. Health Insurance Marketplace Assistance Program (HIMAP): ADAP supports costs for insurance premiums and medication cost shares for clients who enroll in VDH approved plans under the federal Insurance Marketplace under the Affordable Care Act. Please refer to the Affordable Care Act page for approved plans.
Residency: ADAP applicants must live in Virginia and provide proof.
- Copy of utility bill with client name and current address
- Copy of lease or mortgage
- Copy of current health insurance /health coverage bill with client’s name and address
- Copy of official records/document issued by the state (such as a driver’s license or photo ID card)
Required Medical Documents: HIV Diagnosis Status complete with HIV Medication List [New applications ONLY]
Insurance Coverage: Each applicant will be screened by the ADAP Central Office to see if they have health insurance. ADAP may be able to help with client cost shares (medication deductibles and copayments) under insurance.
Income Criteria: Each ADAP applicant qualifies if their individual or family income is less than 500% of the Federal Poverty Level (FPL). If the individual or family income changes it is the duty of the client to advise the ADAP Central Office. Click here for information regarding Financial Eligibility Determination.
Medicaid: Clients must not qualify for or have Medicaid. If a client loses their Medicaid coverage, ADAP can provide medication assistance.
Services to Veterans: Federal policy gives Veterans (who meet all other ADAP eligibility criteria) the option of receiving covered medications through ADAP.
Expedited Enrollment for Pregnant Women and Minors: Pregnant women and minors are prioritized to ensure access to medications and to prevent treatment interruption. Medical providers may contact ADAP at: 1-855-362-0658 to coordinate.
Each client must provide updated information to VDH every six months. Clients will have 90 days to submit updated income, insurance, or updated proof of residency and to sign, or attest to the information on the recertification application. The application must be complete to maintain access to medications.
ADAP Application Form (February 2018)
ADAP Application Form – Spanish (February 2018)
Recertification Application (September 2017)
Recertification Application-Spanish (September 2017)
Self Attestation Form (September 2017)
“No Income” Letter (English-Spanish)
Questions or comments?
Medication Eligibility Hotline 1-855-362-0658