VA MAP 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.
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Information and announcements from the Virginia Ryan White Part B Program
VA MAP's authorized partner, Benalytics, who helps eligible clients enroll for insurance coverage
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Important: Open Enrollment is Now!
Open enrollment for Virginia Medicare and the Affordable Care Act is happening now!
Read more about the process for VA MAP clients on our fact sheet.
Recent Announcements
Medicaid Transition: Effective September 1, 2025, VA MAP is now requiring that eligible uninsured patients in Direct MAP, and eligible insured patients in Affordable Care Act plans (HIMAP), apply for Medicaid. Financial eligibility for Medicaid is 138% of the federal poverty level.
The VA MAP program held several informational sessions on the Medicaid Transition last month, September. Please find an FAQ document summarizing questions from the sessions. The FAQ document also includes a link to the presentation given during the sessions.
Payer of Last Resort Requirement Reminder
By statue, RW grantees are expected to vigorously pursue Medicaid enrollment for individuals who are likely eligible for coverage. Recently mailed client letters indicate the need for clients to take immediate action to ensure the program is aligned with the payer of last resort requirement.
Second Letters Sent
Payer of Last Resort: Provider Resource
RW grantees can find a letter outlining information and actions to help clients with the transitions during this time. For additional information or questions, please contact the VA MAP Hotline.
The Virginia Medication Assistance Program (VA MAP) has changed how uninsured clients access medications under the program.
Uninsured clients will no longer pick up medications at local health departments (LHDs) or other medication pickup sites. As of February 1, 2025, clients will access medications from retail pharmacies, specifically Walgreens pharmacies across the state. Ramsell Corporation is assisting Walgreens in managing this new service provision.
New prescriptions written should be sent via electronic prescription to:
Walgreens (16570)
Telephone Number: 757-278-2577
2026 Medicare Open Enrollment
Medicare open enrollment began October 15 and continues until December 7. Enrollment assister, Benalytics, assists clients with enrollment into Medicare prescription drug coverage (Part C or D). Some carriers have made changes to their plan offerings for 2026. Benalytics can assist clients with finding prescription drug plans that meet their medication needs and provider needs (if enrolling into a Part C/Medicare Advantage).
Enrollment appointments can be made through the appointment tool on the co-branded website, myvamap.com or by calling the dedicated toll-free line, 855-483-4647.
Clients must provide their 2026 Medicare information to Benalytics by January 15, 2026.
2026 ACA Open Enrollment
Client enrollment for Affordable Care Act (ACA) plans began November 10, 2025, instead of November 1, 2025.
Only ACA enrollments completed through Benalytics will be accepted by the program.
VA MAP Service Options
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.
1. Direct Medication Assistance Program (Direct MAP): If a client does not have any other coverage for their HIV/AIDS medications, medications can be accessed via Walgreens pharmacies across the state.
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- Enrolled clients must setup a profile with Walgreens. Contact the program for assistance, 855-362-0658.
- Enrolled clients receive a 30-day supply of medication at a time.
- Enrolled clients can choose to pick up medications from a Walgreens location or participate in mail delivery.
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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.
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.
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 within the Virginia Insurance Marketplace under the Affordable Care Act.
Eligibility Criteria
To be eligible for one of the programs supported by VA MAP applicants/clients must:
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- Have a documented HIV diagnosis.
- Not qualify or have Medicaid.
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Insurance Coverage: Each applicant will be screened by the VA MAP or a VDH third-Party Vendor (Benalytics) to see if they have or are eligible for health insurance. VA MAP may be able to help with client cost shares (medication deductibles and co-payments) under some insurances.
Medicaid: Clients must not qualify for or have Medicaid. If a client loses their Medicaid coverage, VA MAP can provide medication assistance. If a Ryan White client is identified as being Medicaid eligible, they cannot be approved to receive VA MAP services until a Medicaid denial letter is received.
Disenrollment Due to Medicaid Coverage
Under HRSA payer of last resort requirements, program participants must utilize payer sources other than Ryan White HIV/AIDS Program (RWHAP) funds to access medications and other core and support services if they are eligible. If a client currently enrolled in the Virginia Medication Assistance Program (VA MAP) is eligible for Medicaid, that client will be removed from VA MAP services. The purpose of this policy and procedure, the steps of which are posted below, is to transition clients enrolled in Virginia Medicaid out of VA MAP, ensuring reasonable steps are taken to educate clients about using their Medicaid coverage for medication access.
Virginia Medication Access Program (VA MAP) Formulary
Virginia Ryan White Part B expanded its formulary effective February 1, 2025.
The Advisory Committee to VA MAP (formerly, the ADAP Advisory Committee) reviews the VA MAP formulary. Updates can include medication or vaccine additions, removal of medications due to low/no utilization or outdated clinical indications, and updates for medications or vaccines that were already on the formulary.
VA MAP Policies
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.
All Ryan White and VA MAP clients who are Medicaid eligible, must apply for Medicaid. The change is to increase compliance with Health Resources and Services Administration (HRSA) requirements that the Ryan White Program be the pater of last resort. This requires VDH to meet legislative requirements to vigorously purse third-part coverage.
Purpose: To provide clear parameters for eligibility and program enrollment.
Objective: To ensure Virginia Medication Assistance Program (VA MAP) eligible clients are referred to the appropriate service option.
To be eligible for one of the programs supported by VA MAP applicants/clients must:
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- Have a documented HIV diagnosis.
- Not qualify for or have Medicaid.
Purpose: To specify which medications and medication co-payments will be supported with VA MAP funds.
Objective: To ensure medication assistance through any of the VA MAP Service Options (Direct Medication Assistance Program; Health Insurance Marketplace Assistance Program; Insurance Continuation Assistance Program; and Medicare Prescription Assistance Program) complies with federal policies and regulations.
Policy: The Virginia Medication Assistance Program (VA MAP) operates under a single VDH VA MAP Formulary:
a) Direct Medication Assistance Program: Enrolled clients will receive medication assistance for medications on the VDH VA MAP Formulary.
b) Insurance Continuation Assistance Program: Enrolled clients will receive co-payment assistance for medications only on the VDH VA MAP Formulary.
c) Health Insurance Marketplace Assistance Program and Medicare Prescription Drug Assistance Program: Clients enrolled in a VDH-approved private insurance plan (through the Affordable Care Act (ACA), Virginia Marketplace Insurance (VIM)), and those enrolled in Medicare Prescription Drug Plan (Part D/C plan) will receive copayment assistance for all medications on the plan’s formulary. Coverage of medications through VA MAP that are not covered by the insurance plan’s formulary will be assessed on a case-by-case basis.
Purpose: To provide medication co-payments for VA MAP eligible clients with private insurance (health insurance from a source other than the Affordable Care Act [ACA]).
Objective: To expand medication access to insured VA MAP clients requiring assistance with medication co-payments, while maximizing rebates on medication co-payments used to sustain VA MAP.
Policy: VA MAP eligible clients who have private insurance may receive assistance with medication co-payments for medications only on the Virginia VA MAP and RW Part B formularies.
Direct Assistance clients who obtained employer-based insurance will no longer access medications through Direct Assistance beginning 60 days after successful transition. The client, pharmacy, medication distribution site (where the client obtained their medications) and the client’s medical provider will be notified of any enrollment transitions.
Purpose: To provide premium assistance and medication co-payments for VA MAP eligible clients with Medicare.
Objective: To expand medication access and ensure medication assistance for clients with Medicare complies with federal policies and regulations.
All VA MAP applicants who have Medicare coverage must enroll in the Medicare Prescription Assistance Program. Clients may not remain enrolled in private insurance assistance plans (ACA) through VA MAP if they are eligible for Medicare.
Clients may enroll into Direct Assistance only while applying for a Medicare plan.
VA MAP clients with household incomes less than 150% of the FPL must apply for Low Income Subsidy (LIS).
Clients who qualify for full LIS are not eligible for Medicare Prescription Drug Assistance through VA MAP. Those with partial LIS coverage or no LIS, however, do qualify.
When approved for Medicare Prescription Assistance Program, the client, their provider and LHD or alternate medication access site will be sent a letter (or fax), and the client will no longer access medications through Direct Assistance.
Purpose: To provide premium assistance and medication co-payments for VA MAP eligible clients for VDH approved ACA insurance plans.
Objective: To expand medication access and ensure medication assistance for clients with ACA insurance plans complies with federal policies and regulation.
Policy:
a) Plan Selection
Clients seeking assistance with costs for policies obtained through the Federal Insurance Marketplace under the ACA may only receive assistance with VA MAP-approved plans.
b) Individual vs. Family Plan Coverage
VDH will only enroll and make payments toward individual coverage plans. An exception may be made if all covered persons in a family are VA MAP clients.
c) Premium Tax Credits
If an VA MAP client is eligible for a premium tax credit when applying for Federal Marketplace Insurance, the client must request the tax credit be applied to the premium payment at the time of application (instead of receiving it in the form of a tax return or refund at the end of the calendar year).
d) Transition from Direct Assistance to ACA plan assistance
Clients enrolled in insurance plans will no longer access medications through Direct Assistance beginning 60 days after successful insurance plan enrollment. The client, pharmacy, medication distribution site (where the client obtained their medications) and the client’s medical provider will be notified of any enrollment transitions.
e) Medication Exception Requirement
When a drug is not covered by an ACA insurance company’s published formulary, the provider must complete a Medication Exception request through the insurance company providing all required information. The ACA provides for expedited review (within 24 hours) in exigent circumstances, which is when an enrollee is suffering from a health condition that may seriously jeopardize the enrollee’s life, health, or the ability to regain maximum function, or when an enrollee is undergoing a current course of treatment using a non-formulary drug. As part of the request for an expedited review based on exigent circumstances, the prescribing physician or other prescriber should support the request by including an oral or written statement that:
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- An exigency exists and the basis for the exigency (that is, the harm that could reasonably come to the enrollee if the requested drug were not provided within the timeframes specified by the issuer’s standard drug exceptions process), and
- A justification supporting the need for the non-formulary drug to treat the enrollee’s condition, including a statement that all covered formulary drugs on any tier will be or have been ineffective, would not be as effective as the non-formulary drug, or would have adverse effects.
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If the Medication Exception request is denied, the provider must file an appeal within 24 hours and follow up with the insurance company. VDH requests in all cases where a drug exception has been denied that the Bureau of Insurance Ombudsman be contacted:
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- By Toll free phone at: (877) 310-6560, select option 1.
- By fax at: (804) 371-9944
- By letter at: Office of the Managed Care Ombudsman, Bureau of Insurance, P.O. Box 1157, Richmond, Virginia 23218
- By email: ombudsman@scc.virginia.gov
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f) Medicare Enrollment
Clients who are currently enrolled in an approved VDH insurance plan through ACA and become eligible to enroll in a Medicare Part A or Medicare Part B plan may remain enrolled in their current ACA insurance plan. Per Centers for Medicare and Medicaid Services (CMS) guidance (Publication No. CMS-10050), clients who do not enroll in Medicare during their Initial Enrollment Period (either for Medicare Part B or Premium Part A) will only be able to enroll in Medicare during the Medicare General Enrollment Period and may be subject to the late enrollment penalties. The Medicare Part B penalty applies for as long as the individual has Medicare Part B.
VA MAP will cover premium costs for either the approved VDH insurance plan or the Medicare Part D plan if client chooses to enroll.
Purpose: To ensure VA MAP remains the payer of last resort for incarcerated clients.
Objectives: To remove incarcerated clients from Direct Assistance; to expedite VA MAP enrollment for incarcerated clients upon release; and to remove incarcerated clients from ACA plan assistance based on disposition of charges.
Policy:
a) Upon receiving notification that a VA MAP client has been incarcerated, the client will no longer be eligible for VA MAP services.
b) Before or upon release from incarceration, a qualifying applicant is referred to VDH Care Coordination (1-804-864-7919). Upon release from a local/regional jail that is participating with the Expedited Enrollment Program (EEP), a client should receive a 7-day supply of medications from the jail. Upon release from the Department of Corrections (DOC), a client should receive a 30-day supply of medication from the DOC. Applications to VA MAP may be completed prior to release to help expedite enrollment. A submitted VA MAP application is processed for non-incarcerated applicants within 48 hours. During the ACA open enrollment period, all eligible applicants are referred for ACA insurance enrollment. The applicant may also be eligible for health insurance through the ACA Marketplace Special Enrollment period if ACA open enrollment has ended. Eligible applicants may also qualify for medication assistance through Direct VA MAP, private insurance including employer based or Medicare through VA MAP or through VA Medicaid.
c) If a client is enrolled in VA MAP and is incarcerated, the client is no longer eligible to continue to receive services. A client may reapply before or upon release from incarceration.
Purpose: To ensure cost effectiveness for premium costs being covered for approved clients.
Objective: To ensure clients are utilizing Ramsell pharmacies to access medications and to remain cost effective according to federal policy.
Policy: ACA plan-assisted clients, whose monthly premium is being paid by VDH, must access medications through in-network, non 340B Ramsell pharmacies.
Purpose: To ensure VA MAP remains the payer of last resort.
Objective: To comply with Health Resources and Services Administration (HRSA)/HIV/AIDS Bureau (HAB) requirement to vigorously pursue other sources of health coverage for enrolled clients.
The Virginia Medication Assistance Program (VA MAP) will vigorously pursue enrollment into health care coverage for individuals who may be eligible for Medicaid, Medicare, employer-sponsored health insurance coverage, Qualified Health Plans through the Marketplace and/or other private health insurance and will document efforts in client file. Documentation that VA MAP has vigorously pursued other health coverage will include copies of or notes in the client’s file about:
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- Screening for coverage eligibility for other health coverage.
- Proof that the client is not eligible to obtain other health coverage, including but not limited to proof of an exemption.
- Detailed efforts to educate the client about other health coverage options including Medicaid, Medicare, employer-sponsored health insurance coverage, Qualified Health Plans through the Marketplace and/or other private health insurance, etc.
- Informational letters, brochures, or other materials provided to the client to educate about other health coverage options.
- Client’s acknowledgement of education and their decision about enrollment.
- Detailed efforts to enroll/apply or referral for assistance with enrollment/applications for other health coverage options including Medicaid, Medicare, employer-sponsored health insurance coverage, Qualified Health Plans through the Marketplace and/or other private health insurance, etc. Clients will be screened during the annual and semi-annual eligibility recertification process for eligibility for other types of health coverage (or any other alternative payment source). All clients must be informed about all possible health coverage available and the consequences (including possible penalties and financial impact) for not applying/pursuing health coverage.
Purpose: To simplify proof of income documentation for VA MAP applicants.
Objective: To ensure financial eligibility documentation can assist clients with both VA MAP and Affordable Care Act (ACA) enrollment.
If a client files taxes, the client is required to submit their most recent tax return to VA MAP as proof of income.
Purpose: To clarify that the use of Ryan White funds may be used to pay any tax credit liability that a VA MAP client may owe to the Internal Revenue Service (IRS) based on the reconciliation of the premium tax credit.
Objective: To assist VA MAP clients with this liability as VA MAP pays the monthly premiums for their insurance plans.
Policy: VA MAP may pay the tax credit liability if the criteria listed below are met:
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- Client was eligible for VA MAP the entire tax filing year.
- The client will complete the Request to Pay Tax Credit Liability Form and submit along with a copy of the client’s 1095-A form, 1040 form, and 8962 form.
- A refund is not owed to the individual by the IRS. In this case the tax credit liability would be deducted from the total refund.
No payment will be made to the client directly.
VA MAP will not pay any IRS late fees.
VA MAP will not pay any penalty the client may have incurred due to failure to enroll in a Qualified Health Plan (QHP) through the Health Insurance Marketplace.
VA MAP’s ability to pay tax credit liability is dependent upon the availability of funding.
Purpose: The purpose of this document is to provide a grievance policy and procedure that will ensure there is due process and fair treatment for clients receiving services under VA MAP.
Policy: Clients receiving services under VA MAP may file a grievance, or complaint, if services provided are different than what he or she believes should be offered under VA MAP. VDH will respond to client within 5 business days of the grievance.