California AIDS Drug Assistance Program (ADAP) Overview
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AIDS Drug Assistance Program
(ADAP)
ADAP Branch
Who Qualifies?
ADAP
HIV+ individuals
PrEP-AP
HIV- individuals
at risk of infection
•
CA residents
•
Aged 18+
•
Modified adjusted gross income
= or
<500% of the federal
poverty level (
~$
60
,700 or less
for a household of 1)
•
Not
fully
covered by another
3
rd
party payer (e.g. Medi-Cal)
What Does it Cover?
ADAP
•
Cost of prescription (Rx) drugs on the ADAP formulary
•
Health insurance premiums (if applicable)
Some medical out-of-pocket costs
PrEP-AP
•
Cost of Rx drugs on the PrEP-AP formulary
•
PrEP-related medical out-of-pocket costs
When using
a provider in the PrEP-AP network
HIV+
HIV -
Additional Programs – Details
ADAP
•
OA-HIPP
— O
ffice of AIDS Health Insurance Premium Payment program
•
EB-HIPP
— Employer-based Health Insurance Premium Payment program
•
MDPP
—
M
edicare Part D Premium Payment program
HIV +
OA-HIPP
Program Details
ADAP
Office of AIDS
Health Insurance Premium Payment
(OA-HIPP)
program
HIV +
OA-HIPP
Coverage
Private h
ealth insurance
premiums
Plan types:
•
Individual, Family
•
On and Off Exchange
•
COBRA, Cal-COBRA
•
Dental,
Vision-combination plans
Outpatient medical
o
ut-of-pocket costs
•
That count toward policy
’s
annual out
of pocket maximum
•
Example: lab or office visit co-pays
Current
coverage:
up
to $1938* a month
in
premiums per client
•
Payments sent to health plan
HIV +
*Subject to reassessment and adjustment annually
EB-HIPP
Program Details
ADAP
Employer-based Health Insurance Premium Payment
(EB-HIPP)
program
HIV +
EB-HIPP
Coverage
Employer-based h
ealth
insurance premiums
Pays for:
•
Employee’s portion of monthly
premium
•
Individual, Family plans
•
Dental, Vision-combination plans
Outpatient medical
o
ut-of-pocket costs
•
That count toward policy’s annual out
of pocket maximum
•
Example: lab or office visit co-pays
Current coverage:
Up to $1,938* a month
in
premiums per client
•
Payments sent to employer
•
Employer must agree to participate
HIV +
*Subject to reassessment and adjustment annually
MDPP
Program Details
ADAP
Medicare Part D Premium Payment
(MDPP)
p
ro
gram
HIV +
MDPP
Coverage
Medicare insurance
premiums
Pays
for:
•
Part D premiums
•
MediGap premiums
(if we are paying Part D
)
Outpatient medical
o
ut-of-pocket costs
•
That count toward policy’s annual out
of pocket maximum
•
Example: lab or office visit co-pays
Current coverage:
Up to $1,938* a month
in
premiums per client
•
Payments sent to health plan
HIV +
*Subject to reassessment and adjustment annually
What’s New?
•
HIV Test results
•
Proof of HIV status
Guideline Updates
•
HIV-1 Genotype Drug Resistance
testing
•
Hepatitis A vaccine
•
186 PrEP-AP enrollment sites
covering 136 clinics
PrEP-AP Updates
ADAP Client Portal
Eligibility Extensions
Response to COVID-19
Established
workflow for
phone and
secure email/fax
enrollments
HIV +
Resources
•
O
A
V
o
i
c
e
h
t
t
p
s
:
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/
w
w
w
.
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.
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v
/
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o
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s
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C
I
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/
D
O
A
/
P
a
g
e
s
/
O
A
v
o
i
c
e
.
a
s
p
x
•
A
D
A
P
a
n
d
P
r
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P
-
A
P
G
e
n
e
r
a
l
I
n
f
o
r
m
a
t
i
o
n
–
https://www.cdph.ca.gov/Programs/CID/DOA/Pages/OAadap.aspx
•
A
D
A
P
F
o
r
m
u
l
a
r
y
–
https://cdph.magellanrx.com/provider/external/commercial/cdph/doc/en-us/CDPH_Formulary.pdf
•
P
r
E
P
-
A
P
F
o
r
m
u
l
a
r
y
–
https://cdphprep-ap.magellanrx.com/member/external/commercial/caprep/doc/en-us/CDPH_PrEP-AP_Formulary.pdf
•
A
D
A
P
E
n
r
o
l
l
m
e
n
t
S
i
t
e
L
o
c
a
t
o
r
–
https://cdphdata.maps.arcgis.com/apps/webappviewer/index.html?id=e5a93c8e3f03424d8a414adf78c76e37
•
P
r
E
P
-
A
P
E
n
r
o
l
l
m
e
n
t
S
i
t
e
a
n
d
P
r
o
v
i
d
e
r
L
o
c
a
t
o
r
–
https://cdphdata.maps.arcgis.com/apps/webappviewer/index.html?id=6878d3a1c9724418aebfea96878cd5b2
•
L
i
s
t
o
f
O
A
A
D
A
P
A
d
v
i
s
o
r
s
b
y
C
o
u
n
t
y
–
https://www.cdph.ca.gov/Programs/CID/DOA/Pages/OA_adap_advisor_by_enroll_site.aspx
•
L
i
s
t
o
f
O
A
I
n
s
u
r
a
n
c
e
A
s
s
i
s
t
a
n
c
e
P
r
o
g
r
a
m
A
d
v
i
s
o
r
s
–
https://www.cdph.ca.gov/Programs/CID/DOA/Pages/OA_adap_hipp_staffassignments.aspx
•
L
a
y
i
n
g
a
F
o
u
n
d
a
t
i
o
n
f
o
r
G
e
t
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t
o
Z
e
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:
C
a
l
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f
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n
t
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g
r
a
t
e
d
H
I
V
S
u
r
v
e
i
l
l
a
n
c
e
,
P
r
e
v
e
n
t
i
o
n
,
a
n
d
C
a
r
e
P
l
a
n
–
https://www.cdph.ca.gov/Programs/CID/DOA/CDPH%20Document%20Library/IP_2016_Final.pdf
•
C
o
n
t
a
c
t
I
n
f
o
r
m
a
t
i
o
n
–
PAi
(insurance benefits manager) – (877) 495-0990 (Mon – Fri, 8 am – 5 pm)
Magellan Rx (prescription
benefits manager) – (800) 424-5906 (24/7)
ADAP
Call Center – (844) 421-7050 (Mon – Fri, 8am – 5 pm)
Learn about the California AIDS Drug Assistance Program (ADAP) and its Pre-Exposure Prophylaxis (PrEP) Assistance Program. Discover who qualifies, what the programs cover, and additional details on related programs such as OA-HIPP and EB-HIPP.
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Presentation Transcript
AIDS Drug Assistance Program (ADAP)
ADAP Branch Pre-Exposure Prophylaxis (PrEP) Assistance Program (PrEP-AP) AIDS Drug Assistance Program (ADAP) Treat & Manage HIV Prevent HIV California s Goal Getting to Zero
Who Qualifies? CA residents ADAP Aged 18+ HIV+ individuals Modified adjusted gross income = or <500% of the federal poverty level ( ~$60,700 or less for a household of 1) PrEP-AP HIV- individuals at risk of infection Not fully covered by another 3rd party payer (e.g. Medi-Cal)
What Does it Cover? HIV+ Cost of prescription (Rx) drugs on the ADAP formulary Health insurance premiums (if applicable) Some medical out-of-pocket costs ADAP HIV - Cost of Rx drugs on the PrEP-AP formulary PrEP-related medical out-of-pocket costs When using a provider in the PrEP-AP network PrEP-AP
Additional Programs Details HIV + OA-HIPP Office of AIDS Health Insurance Premium Payment program EB-HIPP Employer-based Health Insurance Premium Payment program MDPP Medicare Part D Premium Payment program ADAP
OA-HIPP Program Details HIV + ADAP Office of AIDS Health Insurance Premium Payment (OA-HIPP) program
OA-HIPP Coverage HIV + Private health insurance premiums Plan types: Individual, Family On and Off Exchange COBRA, Cal-COBRA Dental, Vision-combination plans Current coverage: up to $1938* a month in premiums per client Outpatient medical out-of-pocket costs Payments sent to health plan That count toward policy s annual out of pocket maximum Example: lab or office visit co-pays *Subject to reassessment and adjustment annually
EB-HIPP Program Details HIV + ADAP Employer-based Health Insurance Premium Payment (EB-HIPP) program
EB-HIPP Coverage HIV + Employer-based health insurance premiums Pays for: Employee s portion of monthly premium Individual, Family plans Dental, Vision-combination plans Current coverage: Up to $1,938* a month in premiums per client Outpatient medical out-of-pocket costs Payments sent to employer Employer must agree to participate That count toward policy s annual out of pocket maximum Example: lab or office visit co-pays *Subject to reassessment and adjustment annually
MDPP Program Details HIV + ADAP Medicare Part D Premium Payment (MDPP) program
MDPP Coverage HIV + Medicare insurance premiums Pays for: Part D premiums MediGap premiums (if we are paying Part D) Current coverage: Up to $1,938* a month in premiums per client Outpatient medical out-of-pocket costs Payments sent to health plan That count toward policy s annual out of pocket maximum Example: lab or office visit co-pays *Subject to reassessment and adjustment annually
Whats New? Guideline Updates PrEP-AP Updates HIV Test results Proof of HIV status HIV-1 Genotype Drug Resistance testing Hepatitis A vaccine 186 PrEP-AP enrollment sites covering 136 clinics
ADAP Client Portal View eligibility status Next re-enrollment or re- certification What can clients do? Process re-certification View/print pharmacy and medical card View insurance payments
Response to COVID-19 HIV + Eligibility Extensions Established workflow for phone and secure email/fax enrollments
Resources OA Voice https://www.cdph.ca.gov/Programs/CID/DOA/Pages/OAvoice.aspx ADAP and PrEP-AP General Information https://www.cdph.ca.gov/Programs/CID/DOA/Pages/OAadap.aspx ADAP Formulary https://cdph.magellanrx.com/provider/external/commercial/cdph/doc/en-us/CDPH_Formulary.pdf PrEP-AP Formulary https://cdphprep-ap.magellanrx.com/member/external/commercial/caprep/doc/en-us/CDPH_PrEP-AP_Formulary.pdf ADAP Enrollment Site Locator https://cdphdata.maps.arcgis.com/apps/webappviewer/index.html?id=e5a93c8e3f03424d8a414adf78c76e37 PrEP-AP Enrollment Site and Provider Locator https://cdphdata.maps.arcgis.com/apps/webappviewer/index.html?id=6878d3a1c9724418aebfea96878cd5b2 List of OA ADAP Advisors by County https://www.cdph.ca.gov/Programs/CID/DOA/Pages/OA_adap_advisor_by_enroll_site.aspx List of OA Insurance Assistance Program Advisors https://www.cdph.ca.gov/Programs/CID/DOA/Pages/OA_adap_hipp_staffassignments.aspx Laying a Foundation for Getting to Zero: California s Integrated HIV Surveillance, Prevention, and Care Plan https://www.cdph.ca.gov/Programs/CID/DOA/CDPH%20Document%20Library/IP_2016_Final.pdf Contact Information PAi (insurance benefits manager) (877) 495-0990 (Mon Fri, 8 am 5 pm) Magellan Rx (prescription benefits manager) (800) 424-5906 (24/7) ADAP Call Center (844) 421-7050 (Mon Fri, 8am 5 pm)
