Virginia Medication Assistance Program (VA MAP)

The Virginia (VA) Medication Assistance Program (MAP) provides access to life-saving medications for the treatment of HIV and related illnesses for low-income clients through the provision of medications or through assistance with insurance premiums and medication co-payments. The program is primarily supported with federal Ryan White (RW) Treatment Extension Act Part B grant funding, which is distributed by a formula based on living HIV and AIDS cases to all states and territories in the United States. VA MAP provides insurance cost support or directly purchased medications through four service options: Direct Medication Assistance Program; the Medicare Prescription Assistance Program; the Insurance Continuation Assistance Program; and the Health Insurance Marketplace Assistance Program.

We have exciting news!  The Virginia Ryan White HIV/AIDS Program Part B (RWHAP B) implemented Unified Eligibility (UE) that will have clients conduct eligibility every 24 months for all RWHAP B services, including ADAP services coordinated through VA MAP.  This is a major policy and procedure shift for Virginia RWHAP B client eligibility.  Clients and providers no longer have to do four eligibility assessments per year!  And no more 6-month recertification required.

As of May 9, 2022 and going forward, VA MAP will no longer process eligibility assessment for medication access.  Agencies that subcontract with VDH for RWHAP B services are currently the only agencies who can perform these assessments for clients.  To access the policy and procedure, a list of agencies that can conduct these client assessments, and other documentation related to VA RWHAP B Unified Eligibility, please visit the Virginia HIV Care Services webpage.

For further information regarding Provide, the online system through which all eligibility documentation must be submitted, please see the DDP - Provide webpage.

VA MAP Service Options

1. Direct Medication Assistance Program (Direct MAP): 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.
        • Enrolled 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 VA MAP 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 VA MAP Formulary medications will be sent to the Local Health Department (LHD) or a predetermined, alternate medication access site.
        • The VA MAP Central Office staff communicates to LHD or alternate medication access site staff as needed about client eligibility and medication pick-up to ensure ongoing VA MAP services.

2. Medicare Prescription Assistance Program (MPAP): VA MAP clients who are enrolled in Medicare can receive help with monthly premiums and cost shares.  Cost shares are medication deductibles and medication co-payments.  VA MAP will assist with co-payments for medications on the Medicare formulary.  Clients can pick up medications at any pharmacy that accepts their Medicare plan and is within the Ramsell network. Medication copayment assistance will cover medications on the VA MAP Formulary and the Ryan White Part B Formulary.

3. Insurance Continuation Assistance Program (ICAP):  Individuals with certain private insurance with medication benefits are eligible for VA MAP assistance with their medication co-payments and deductibles if all other qualifications are met.   At any point in time a client loses insurance, the client can access medications through the Direct Medication Assistance Program if the client continues to meet VA MAP eligibility criteria. Medication copayment assistance will cover medications on the VA MAP Formulary and the Ryan White Part B Formulary.

4. Health Insurance Marketplace Assistance Program (HIMAP): VA MAP 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.

 

VA MAP UPDATES, PER THE COVID-19 PANDEMIC

VA MAP, in continuously keeping abreast of the ongoing COVID-19 situation, is ensuring that clients, throughout all VA MAP programs, are able to maintain continuity of needed services. Below is regularly updated information regarding any updates to VA MAP programs, as well as what is being done to maintain complete and continued assistance.

January 20, 2023

The Virginia Medication Assistance Program (VA MAP) will conduct its quarterly call on Friday, January 27, 2023 from 10 a.m. – 11:30 a.m.  Representative(s) from each contracted RWB subrecipient must attend this meeting.  The Zoom meeting information is listed below.

https://www.zoomgov.com/j/1605877830?pwd=V3k5SDQvUHEyYWVJNHlrN3VpeDZsZz09

  • Meeting ID: 160 587 7830
  • Passcode: 221533
  • One tap mobile
    • +16692545252,,1605877830# US (San Jose)
    • +16468287666,,1605877830# US (New York)

January 13, 2023

Please note the following important updates from our Insurance Benefits Manager, Benalytics:

The Benalytics Call Center may be experiencing some delays due to power outages caused by last night’s storms.  At this time, they are able to receive calls, but hold times may be slightly longer than usual.  If clients are unable to hold, they should leave a voicemail in order for their phone number to be placed in the queue for an immediate call back from the next available representative.

Please note, clients reaching out to Benalytics should ONLY utilize the official line for VDH Insurance Benefit Services (855) 483-4647. Clients SHOULD NOT call or follow prompts that lead to the Benalytics main office line (or leave messages containing any PHI or PII on that line) as it is NOT secured.  We appreciate your patience and will send out an update as soon as phones are fully restored.

January 09, 2023

Optima Coverage Changes

Optima changed their mail-order pharmacy benefits manager from Optum Rx to Express Scripts. Unfortunately, Express Scripts is not part of the Ramsell network which means clients with Optima coverage need to change the way they access some medications.  

All specialty and Tier 4 medications are still accessed through Proprium, Optima’s specialty pharmacy.  Most ARVs are classified under Tier 4.  Clients must pick-up any medications that are not specialty or Tier 4 through a retail pharmacy to receive payment assistance through Ramsell. 

If clients choose to use Express Scripts (mail-order), they will be charged and will have balances to pay for their medications.  Ramsell and VDH will not be able to assist with or pay for these balances.

Optima sent notifications to clients regarding the mail-order changes.  Please encourage clients to read their mail. 

Contact the Eligibility & Medication Assistance Call Center at 855-362-0658 if there are questions or concerns regarding this information.

September 27, 2022

The 2023 open enrollment season will begin soon.  This communication has been mailed to clients, and can be accessed here.

UPDATE - SHIPPING MEDICATIONS TO HOME

October 13, 2020

Shipping medications to home may be an option for VDH clinical services/programs for which medications that can be self-administered are prescribed and then filled by the Division of Pharmacy Services (DPS). Some self-administered medications may not be eligible for this ship to home option. Please refer to the policy documents listed below for further information.

UPDATES FOR PROVIDERS REGARDING VA MAP OPERATIONS AMID COVID-19

May 18, 2020

The Virginia Medication Assistance Program (VA MAP) requests that if you have not yet set up access to the Secure File Transfer Protocol (SFTP) folders (Cerberus), please contact Cristina Gorman (cristina.gorman@vdh.virginia.gov). The STFP folders are a secure method to send VA MAP eligibility applications, as well as any supporting documentation (Proof of Residency, Income, Insurance cards, etc.). VA MAP will be using this secure folder structure going forward until it is replaced by VDH’s new client level data system that will permit direct upload of applications and supportive documentation. While many sub-recipients have gained SFTP folder access, VA MAP is still receiving  faxes, rather than STFP uploads. VA MAP requests that everyone begin submitting all eligibility documents using their assigned STFP Folder. For sub-recipients that have a complex agency structure that does not easily accommodate or allow SFTP folders, we understand you will need to continue to fax documentation until the new client level data system is available or we are eventually able to  establish secure folders for your agency.

In addition to not receiving applications using the STFP folders, VA MAP is also receiving a high percentage of incomplete applications. We know everyone is extremely busy, but receiving completed applications is vital to VA MAP staff’s ability to enroll clients into the appropriate program within 14 days or less. And, filling our race and ethnicity data for clients on applications is needed for our ADAP report to HRSA.  Please be sure to complete each section of the VA MAP application, including all insurance questions and provide legible and complete proofs of income and residency. If you have questions about how to complete an application, please contact the VA MAP Hotline at 855-362-0658 (toll free). Also, if a client is eligible for Medicaid based on income, please collaborate with your Case Managers to help clients apply for coverage, ensuring compliance with the Ryan White payer of last resort requirement.

The VA MAP thanks everyone for all of your hard work, especially during such times as these.

COVID-19 RESPONSE FOR VA MAP

March 12, 2020

For more information about coronavirus in Virginia, please visit the Virginia Department of Health COVID-19 webpage.  ,Up-to-date information on the status of the virus outbreak is available from the Centers for Disease Control and Prevention (CDC).

For other medication access concerns or questions related to eligibility, contact the VA MAP hotline toll free at 1-855-362-0658.

If you are a medication access site and have any questions related to placing medication orders for clients on the Direct Medication Assistance Program (Direct MAP), please call Central Pharmacy at 804-786-4326.

If you are a Ryan White Part B provider and have questions about services other than medication access, please contact your HIV Services Coordinator.

**VA MAP Recent Policy and Procedure Updates (i.e., Cabenuva policy, LIS policy, etc...) can be found under VA MAP Policies in the "Recent Policy Updates" Tab. Click on the + sign to expand the box and see related documents.

Updated VA MAP  Forms in Response to COVID-19

For PDF Medical Certification Forms - after download, click the "Fill & Sign" option in order to fill out and save the complete form to your desktop.

Clinical Support and Policy Development

In 1996, a VA MAP (ADAP from 1996 to 2019) Advisory Committee was created. The committee is comprised of HIV/AIDS medical providers, a pharmacist, and consumers. The committee advises VDH on changes to the formulary, changes in eligibility criteria, adherence issues, and educational concerns. The committee reviews data on VA MAP utilization and assess budgetary implications of trends and program changes.

For more information about the committee, please see the VA MAP Advisory Committee Scope.

VA MAP Quarterly Calls - 2022

Below are the scheduled VA MAP Quarterly Calls for 2022. Provided are the links to attend these sessions via GoogleMeets, as well as the numbers to dial-in by phone, and the needed PIN numbers for access, for any attendees for whom GoogleMeets is not an option.

January 21, 2022

April 22, 2022 

July 22, 2022 - 10-11:30 A.M.

October 14, 2022 - 10-11:30 A.M.

Additional VA MAP Resources

Questions or comments?  Medication Eligibility Hotline 1-855-362-0658

November 1, 2022

2023 Open Enrollment

The following open enrollment letters were mailed to clients.  Clients who opted to not receive mail in their eligibility assessment will not receive this communication.

September 27, 2022

The 2023 Open Enrollment Period is Coming!

Enroll into Your Correct Coverage for Medication Access:

    • Medicaid Coverage - enroll any time throughout the year
    • Medicare drug coverage - October 15 - December 7
    • Marketplace coverage - November 1 - January 15

To enroll or re-enroll - Make an appointment with Benalytics (1-855-483-4647) to find out what coverage is best for you.

For questions - Call the Eligibility & Medication Call Center (1-855-362-0658)

Be sure to check your mail for more information in the coming weeks!

Virginia Medicaid

Virginia Medicaid offers several low-cost and no-cost health coverage programs for eligible children, pregnant women and adults, including individuals with disabilities. To find out more about each program, please visit the Cover Virginia website (CoverVA.org). The site includes an Eligibility Screening Tool to help you better understand if Virginia Medicaid can help meet you and your family's healthcare needs; there is a also chat feature, which allows you to chat with a real person about your Medicaid questions, as well as information on how to submit an application, and how to file an appeal.  Help is available in both English and Spanish.

The new website also features:

    • Simpler navigation
    • Improved display on mobile devices
    • Better search options

Visit Cover Virginia

May 11, 2021

Medicaid Enrollment Updates

As of April 1, 2021, the 40 Quarters Rule, which required Green Card holders (lawful permanent residents) to prove that they or members of their household had at least a 10 year work history in order to qualify for Virginia Medicaid, has been removed. Green Card holders (lawful permanent residents) with five years or more of residency in the United States may now be eligible for free or low-cost health coverage from Virginia Medicaid.  Previous applicants must reapply.  Additional information can be found using the link and letter listed below.

Beginning July 1, 2021, Virginia’s nationally recognized Smiles For Children (SFC) program will expand to provide comprehensive dental coverage for adults in full-benefit Medicaid covered groups. Dental coverage will continue for children and pregnant women. The new dental coverage for adults will focus on overall oral health, prevention, and restoration and will be similar to the coverage currently available to pregnant women. The program name will remain SFC with a new tag line, “Improving Dental Care for Children and Adults.”

 

In preparation for the hurricane season, June 1 through November 30, 2022 the Virginia Ryan White HIV/AIDS Part B (RWHAP B) program asks all of its partners and consumers to be prepared ahead of time. To assure adequate medication supplies, we ask all providers and consumers to assess medication refill needs before any storm affects Virginia. If consumers access medications at local health departments, mail order, or retail pharmacies, encourage and help them have peace of mind and get refills now. People Living with HIV (PLWH) may be displaced within Virginia if a region is impacted (particularly those in eastern and central regions), and others may be from out-of-state if they evacuate to Virginia. To help everyone be prepared, VDH has created new tabs on the Ryan White program sites  for "Hurricane/Emergency Preparedness." You will find information, policies, procedures, and forms to help PLWH who need emergency services during such events. If you need to provide emergency services to clients during or after a hurricane, the information you need is in a convenient location on this page, as well as the HIV Care Services web page. Stay safe and please reach out to the RWHAP B team if you have any question or need additional information.

It is important for each of us to be prepared to protect ourselves as well as our loved ones during this hurricane season. VDH has created Social Media Took Kits for Hurricane Preparedness.

Click on the following link for pre- and post-event information on severe weather preparedness and safety information.

Virginia's Department of Emergency Management has a prepared a list of needed terminology and information in the event of a hurricane in Virginia - VDEM - Hurricanes.

VA MAP and VA Ryan White HIV/AIDS Programs Part B Clients

Health Departments and Sub-recipients

Emergency Enrollment

 

 

Last Updated: January 31, 2023