Eligibility Criteria:
- Must be inside Arizona.
- Must be under 400% of the federal poverty level (FPL).
- Proof of HIV diagnosis (required with initial application).
- Payer-of-last-resort documentation: Proof that all other forms of insurance and coverage are used before ADAP funds.
- Denial letter from AHCCCS (Arizona's Medicaid program) if income is below 150% of the FPL.
Application Instructions:
New ADAP users must complete a Full Application and New Applicant Addendum. The application and support documents must be submitted to your Case Manager, sent to eligibility@siren.az.gov or our secure fax at 602-364-3263.
For general questions on how to complete the application, please feel free to review the Joint Application Processing Guide found here.
For additional enrollment assistance, we strongly encourage you to work with a case manager.
Hepatitis C (HCV) Drug Therapy:
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).
Long-Acting Agents Therapy - Cabenuva:
State covers Cabenuva as part of their approved drug formularies: No
Location
Address:
150 N. 18th Ave
Phoenix, AZ
85007