To be eligible for assistance, an individual must meet the following criteria and furnish the following information to the Montana HIV Treatment Program:
- Have a permanent Montana address.
- Have written documentation of income less than 431% of the federal poverty level (adjusted gross taxable income).
- Be ineligible for any other assistance programs that would cover such costs.
Insurance plans/premiums and Cash Option payments will be evaluated for cost‐effectiveness before premium payment assistance is authorized.
Applicant must submit a completed ADAP Application, a recent tax return document or other income verification, and a completed medical verification form and which has been signed by an HIV case manager certifying that the client is HIV positive and receiving care.
For specific questions, or an electronic application form, please call the Montana HIV Treatment Program at 406-444-4744 or e-mail firstname.lastname@example.org.
Mail or fax completed applications to:
P.O Box 202951
Cogswell Bldg C‐211
Helena, MT 59620‐2951
State covers some form of HCV drug therapies as part of their approved drug formularies: Yes
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).