Getting Patients the Help
They Need

A patient may be eligible for California ADAP services if:

• Patient is a resident of the State of California
• Patient is at least 18 years of age
• Patient has an HIV diagnosis
• ADAP will only process prescriptions written by a licensed California physician/prescriber
• Patient has limited or no prescription drug benefit from another source
• Patient has a Federal Adjusted Gross Income of not more than $50,000. (To determine their Federal Adjusted Gross Income, instruct your client to refer to their income tax forms or visit www.irs.gov)

• Proof of California Residence (i.e. rental agreement or utility bill in your name, identifying place of residence)
• Picture identification (California Driver's License, California Identification card, Passport, School I.D., etc.)
• Proof of Income (copies of either your most recent Federal or State Income Tax returns)
• If the patient is not required to file a tax return, then the patient must supply 3 consecutive months worth of current income documents
• Public Assistance or Social Security Award Letters
• Proof of Medi-Cal application (if applicable) and/or documentation of any current health insurance coverage (if applicable)
• Letter of HIV diagnosis from a physician/prescriber
• Lab values (CD4 and viral load counts) must be dated within 6 months

There are over 180 FDA approved drugs in the California ADAP program. To view the current list of drugs, or ADAP formulary, please choose one of the options below.

• Covered Drugs Alphabetically
• Covered Drugs by Drug Class

Patients can fill their ADAP prescriptions through any one of the more than 3,500 participating pharmacy in the Ramsell's pharmacy network.

To locate the pharmacy closest to you, enter your City, Zip code or County in the Pharmacy Locator form on the left side pannel.

A patient has the right to apply, to appeal decisions and to receive confidential, nondiscriminatory, courteous and respectful service.

If you believe a patient has been denied their rights, or treated unfairly or discourteously at any point in the ADAP enrollment process, or while receiving pharmacy services, contact the State Office of AIDS at (916) 449-5900.

Fuzeon (Enfuvirtide)

When completing Fuzeon access forms, please be sure to include all requested clinical information including CD4 lab measurements as well as two viral load measurements. IF your patient has never used Fuzeon, please submit TWO detectable viral load measurements within the last six-months in order to provide medical justification for starting Fuzeon. IF your patient has received Fuzeon previously through another insurance payer (e.g. Medi-Cal, Medicare Part D, private insurance), you must provide TWO detectable viral load measurements within a six-month period prior to the date the patient started Fuzeon treatment.
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Maraviroc (Selzentry™)

Maraviroc is approved for patients with CCR5 mono-tropic HIV confirmed by tropism assay results. Please fill out either section 2 OR section 3, whichever is applicable to your patient.
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Peg-Intron

Peg-Intron is available for free through Schering-Plough's Commitment to Care Free Peg-Intron program. Please fill out the Peg-Intron ADAP Access form and fax back to Ramsell at 800-848-4241.
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Rosiglitazone (Avandia™)

When completing rosiglitazone (Avandia™) access forms, fill out section 2 of the application completely if your patient is an existing ADAP client who is newly initiating rosiglitazone or is an ADAP client who previously received rosiglitazone through another payer (i.e. Medi-Cal, Medicare Part D or Private Payer). Fill out section 3 of the application completely if your patient is currently taking rosiglitazone or continuing treatment. Download a copy of the access form and submit the form prior to dispensing rosiglitazone. Please be sure to include all requested clinical information including a signed informed consent form and a list of therapies that have been tried and failed.
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Serostim

Please be sure to fill out Form A, section 1 of the application completely if your patient is a new-start applicant or is receiving Serostim thru another payer source. If you are requesting a refill of Serostim beyond the initial 3-month ADAP approval please fill out Form B.
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Treatment Exception Request Form

Please do not use this form to request medications that are not on the ADAP formulary. The TER forms will only be reviewed for the following purposes:

• To request formulary medications that exceed normal, FDA approved dosing guidelines
• To request formulary medications that have a medical justification outside of the scope of the restrictions and guidelines established by the California Office of AIDS Medical Advisory Committee.

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List of California State relevant HIV/AIDS resources.

California Department of Public Health
• www.cdph.ca.gov/programs/aids
Provides information from the California State Office of AIDS. Key features include: recent AIDS research reports; education and prevention program information; and Office of AIDS directory.

Project Inform
• www.projinf.org
HIV / AIDS Advocacy organization providing useful information for people living with HIV / AIDS.

San Francisco AIDS Foundation
• www.sfaf.org
Provides a wide variety of useful information on the subject of AIDS including general information about AIDS, prevention information, government policy and mechanisms for taking action against AIDS.

California Health and Welfare Data Center
• www.hwdc.cahwnet.gov

Aidsmed.com
• www.aidsmeds.com
Easy-to-read lessons covering questions about HIV and AIDS, along with summaries of all the approved and experimental treatments. Recent news stories, community forums, and tools such as drug interactions checker and a way to graph your lab tests.

AidsInfo.com
• www.aidsinfo.nih.gov
A Service of the U.S. Dept. of Health and Human Services - the AIDSinfo website is organized around five main subject categories about HIV/AIDS: guidelines, drugs, vaccines, clinical trials, and education resource centers.

Living with HIV
• http://ourworld.compuserve.com
Frequently asked questions. Written and funded by Roger Spitzer, MD.

Avert.org
• www.avert.org
Frequently asked questions on HIV and AIDS treatment. Information about anti-HIV drugs, combination therapy, groups, names of antiretroviral drugs, the main type of treatment for HIV or AIDS.

The Body: An HIV/AIDS Information Resource
• www.thebody.com
This website attempts to lower barriers between patients and clinicians by demystifying HIV/AIDS and its treatment. Content includes current news stories, an "Ask the Expert" forum, and a list of frequently asked questions.

The Momentum Project Inc.
• www.themomentumproject.org
The Momentum AIDS Project Nutrition News section is filled with information about the basics of HIV/AIDS nutrition, as well as covering exercise, food safety and budgeting issues.

HIV Clinical Resource NY State Dept. of Health AIDS Institute
• www.hivguidelines.org
A collaborative effort between the New York State Department of Health AIDS Institute, Office of the Medical Director and the Johns Hopkins University School of Medicine, Division of Infectious Diseases. This web site has been developed as a central, on-line resource that equips individuals who provide services to people with HIV infection with current, state-of-the-art tools to ensure delivery of the highest quality HIV clinical care.

HIV-druginteractions.org
• www.hiv-druginteractions.org
Access a wealth of information on HIV drug interactions. The dynamically driven process allows you to build your own customised drug interaction chart, giving detailed information on predicted interactions of specified multiple drug combinations.

HIV Medication Guide
• www.hivmedicationguide.com
Drug interactions, patient information pamphlets, and the drug administration schedule developed by pharmacists Antony Gagnon and Rachel Therrien. Information available on this site in English, Spanish and French.

Women, Children and HIV
• www.womenchildrenhiv.org
A library of practically applicable materials on HIV infection in women and children HIV/AIDS statistics for U.S. women. The goal of this site is to contribute to an improvement in the scale and quality of international HIV/AIDS prevention, care, and treatment programs for women and children by increasing access to authoritative HIV/AIDS information.

Women Alive
• www.women-alive.org
Resources by and for women with HIV/AIDS. A national treatment-focused organization by and for women living with HIV/AIDS.