To be eligible for the OHDAP formulary program, the applicant must:
- Submit a complete application and demonstrate a willingness to sign all forms and to provide necessary documentation.
- Be a resident of Ohio.
- Have a monthly gross income that meets our Financial Eligibility Guidelines (500% of the Federal Poverty Level, adjusted for family size). Applicants with an income at or below the federal poverty level are required to have an ODH-Approved Part B Medical Case Manager who can assist them in accessing all eligible services.
- Provide proof of monthly income (for the applicant, as well as the applicant's legal spouse and/or dependents). This includes copies of pay stubs for the most recent 30 consecutive days of employment, Social Security Income award letters, copies of unemployment compensation stubs, etc.
- For the self-employed: provide a copy of an IRS Income Tax Transcript for the most recent tax year. The form to obtain the transcript is Form 4506T and is available at the IRS Web site. Step-by-step instructions are also available by following the IRS transcript request instructions.
- First-time applicants: provide documentation of HIV positive status such as lab results (CD4+ cell count, HIV RNA [viral load], positive HIV serology results, genotype results, etc.) or documentation by a medical provider.
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).