All individuals on the waitlist with a CD4 count at or below 500 and those newly presenting to Virginia ADAP with a CD4 at or below 500 may enroll directly into ADAP. In December 2011, VDH began enrolling individuals from the waitlist with CD4 counts between 351 and 500 by the date they were put on the waitlist.
As of April 2, 2012 ADAP enrollment criteria includes the following:
BACKGROUND:
Serving clients through the Medicare Part D Patient Assistant Program (MPAP) results in substantial cost-savings to the AIDS Drug Assistant Program (ADAP). Because there is a limit on out of pocket costs for clients (which MPAP pays on their behalf), approximately 3 clients are able to be served for every 1 client served through traditional ADAP. This allows ADAP to serve more clients who have no other coverage for medications.
Medicare eligibility status for ADAP-eligible clients is assessed at initial eligibility determination and every six months. ADAP-eligible clients who are also eligible for Medicare are instructed to enroll in a Medicare Part D plan. ADAP clients with household incomes less than 150% of the Federal Poverty level (FPL) must apply for the low-income subsidy (LIS) or “extra-help” component of the Part D benefit to assist with out-of-pocket costs. Medications can be accessed through the MPAP under ADAP until LIS eligibility determination is received. Clients who qualify for the full LIS are not eligible for MPAP/ADAP assistance.
POLICY:
DOCUMENTATION:
Clients and their HIV providers will be notified by letter if disenrolled from ADAP due to declining MPAP services or declining to apply for Medicare Part D. A copy of the letter will be maintained in the closed client file.
EXCEPTIONS: NONE
Applicants who do not meet one of these criteria will be put on a wait list.
Effective immediately, all ADAP prescriptions will be dispensed for a supply not to exceed 30 days. The LHS-181 will still be completed by the local ADAP coordinator or designated staff but cannot exceed a 30-day supply. Please keep in mind that antiretroviral prescriptions will have a refill maximum of six months and prescriptions for greater than 30 days will not be dispensed.
This change is necessary due to the current ADAP funding shortfall which has necessitated the need to transition some clients to pharmaceutical manufacturers'' patient assistance programs. Limiting the supply to 30 days provides tighter inventory control, reduced medication wastage if regimens change, and ensures clients are receiving equitable access to medications. Historically, about 20% of ADAP prescriptions were for a 90-day supply, but we have seen a recent increase in 90-day prescriptions. If you have any questions about this change, please contact Pharmacy Services at 804 786-4326.
Changes to Eligibility Criteria & Formulary - Power Point Summary (Nov. 2010)
New and Returning ADAP Clients - Patient Services, Inc. to Determine Eligibility (Nov. 2010)
Dispensing Medications at the Time of Disenrollment (April 2010)
Notification: State Pharmaceutical Assistance Co-Pay Assistance Wait List (February 2010)
In the event a disaster necessitates that Virginia assists evacuees from other states, please follow and utilize the following documents: (1) Virginia’s ADAP Evacuee Policy and (2) the Virginia ADAP Emergency Relief Application.
Questions or comments?
Contact HIV/STD/Viral Hepatitis Hotline