While access to healthcare has increased for people living with HIV since the enactment of theAffordable Care Act (ACA)in 2014, the cost of HIV drugs remains a major challenge. Even for some able to obtain private insurance, the price has become increasingly prohibitive, with some insurers moving antiretroviral drugs from more affordable “generic” and “non-generic” drug tiers to higher priced “specialty” drug tiers that command co-payments of 30% or more.
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This practice of adverse tiering has affected both low- and middle-income earners, with many forced to pay for their drugs out of pocket. For a standard three-drug regimen, this could add up to wellin excess of $1,000 per month, a price that most would consider unaffordable.
TheAIDS Drug Assistance Program (ADAP)is a federal program first established in 1987 to provide lifesaving HIV drugs to low-income Americans. Since that time the scope of the program has expanded considerably, with some states able to subsidize doctor visits, lab tests, insurance deductibles, and evenpreventive therapyfor those at risk of infection.
Eligibility is typically income-based, ranging from households whose annual income is less than 200% of the Federal Poverty Level (FPL) to those whose income is less than 500%. Income calculations are based not on you or your family’s total earnings for the year but on your modified annual gross income (essentially the Adjusted Gross Income found on line 37 of your 1040 tax return plus a few add-backs).
This means that, in the states where the income threshold has been set at 500%, a married couple with a Modified Annual Gross income of $80,000 would still be eligible for ADAP assistance.
Although the rules vary from state to state, eligibility is typically based on three factors:
As ADAP is considered a “last resort” payer, you may still be required to get health insurance even if ADAP services are rendered. In such case, you would need to provide proof of insurance in order to establish need, whether it be for drug coverage, co-pay assistance, or (in some states) deductible or premium payment assistance.
See the links below to find out the eligibility criteria and how to apply in your area.
StateProgram AdministratorAlabamaAlabama ADAPAlaskaInterior AIDS AssociationandAlaskan AIDS Assistance AssociationArizonaArizona ADAPArkansasArkansas ADAPCaliforniaCalifornia ADAPColoradoColorado ADAPConnecticutConnecticut ADAP (CADAP)DelawareDelaware ADAPDistrict of ColumbiaDistrict of Columbia ADAPFloridaFlorida ADAPGeorgiaGeorgia ADAPHawaiiHawaii ADAPIllinoisIllinois ADAPIndianaIndiana ADAPIowaIowa ADAPKansasKansas ADAPKentuckyKentucky ADAP (KADAP)LouisianaLouisiana Health Access Program (LA HAP)MaineMaine ADAPMarylandMaryland ADAP (MADAP)MassachusettsMassachusetts HIV Drug Assistance Program (HDAP)MichiganMichigan Drug Assistance Program (MIDAP)MinnesotaMinnesota ADAPMissouriMissouri HIV/AIDS Case Management ProgramMississippiMississippi ADAPMontanaMontana ADAPNebraskaNebraska ADAP (NE ADAP)NevadaNevada ADAPNew HampshireNH CARE ProgramNew JerseyAIDS Drug Distribution Program (ADDP)New MexicoNew Mexico ADAPNew YorkNew York State ADAPNorth CarolinaNorth Carolina ADAPNorth DakotaNorth Dakota ADAPOhioOhio HIV Drug Assistance Program (OHDAP)OklahomaOklahoma HIV Drug Assistance ProgramOregonCAREAssistPennsylvaniaSpecial Pharmaceutical Benefits Program (SPBP)Puerto RicoPuerto Rico ADAPRhode IslandRhode Island ADAPSouth CarolinaSouth Carolina ADAPSouth DakotaSouth Dakota ADAPTennesseeTennessee ADAPTexasTexas HIV Medication Program (THMP)VermontVermont Medication Assistance Program (VMAP)VirginiaVirginia ADAPWashingtonEarly Intervention Program (EIP)West VirginiaWest Virginia ADAPWisconsinWisconsin HIV/AIDS Drug Assistance ProgramWyomingWyoming HIV Treatment Program
SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Available only to persons who are ineligible for health insurance coverage. However, insurance assistance is available to persons with income of less than 400% of FPL.
Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Available only to persons who are ineligible for health insurance coverage. However, insurance assistance is available to persons with income of less than 400% of FPL.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Available only to persons who are ineligible for health insurance coverage. However, insurance assistance is available to persons with income of less than 400% of FPL.
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