In order to enroll into the Arkansas AIDS Drug Assistance Program (ADAP), individuals must fulfill all ADAP eligibility criteria. The client is responsible for providing proof of eligibility for ADAP to local ADAP coordinators or case managers at ADAP enrollment sites. All information provided for determining program eligibility will be kept completely confidential. Medications will not be dispensed in any case until medical, financial, and residency eligibility criteria are confirmed; a lack of health insurance pharmacy benefits is established; and no other payers have been identified.
Generally, individuals are eligible for ADAP if they meet all requirements below:
Application Requirements: In order for a client to be considered for ADAP, the following completed documents must be submitted to the ADAP office for approval:
- ADAP Application Form
- Signed Medication Request form from an Arkansas licensed physician
- Signed History of HIV Meidcations form, if necessary
- Lab Work
- Proof of Income, annual income is set at 200% of federal poverty level.
- Medicaid Screening form or Medicaid denial letter less than one year old.
- CD4 count < 500 (lab work less than 6 month old) OR
- Viral Load > or equal to 55,000 (PCR) (lab work less than 6 months old) OR
- Viral Load > or equal to 30,000 (bDNA) (lab work less than 6 months old) OR
- CD4 count > 500 and proof of history of prescribed HIV medication regimens from clinician or pharmacy OR
- Documented prior AIDS diagnosis
You can get an application and assistance with filling out your application through your case manager. If you don’t have a case manager, please call 501-661-2408 or 888-499-6544 to speak to someone about whether you qualify for ADAP.
State covers some form of HCV drug therapies as part of their approved drug formularies: No
To learn more about what HCV drug therapies are on the drug formulary, please visit tiicann.org/co-infection-watch.html (go to page #7).