Getting Patients the Help
They Need

To qualify for the Arizona ADAP Assist program:

Upon request, ADAP applicants must provide:

• Documentation of a HIV diagnosis from a Medical Provider with recent viral load and/or CD4 lab values and the current prescribed medication regimen;
• Documentation showing the modified adjusted gross income (MAGI) does not exceed 400% of federal poverty level (FPL);
• Documentation showing the applicant is a resident of Arizona;
• Documentation showing the applicant has access to affordable and adequate insurance coverage (including prescription coverage) through a primary insurer/payer of last resort (POLR) such as Medicare, Marketplace, or Employer-sponsored insurance.

• Once ADAP receives an application for an applicant who appears eligible for primary insurance/POLR or is enrolled with coverage, ADAP will request premium, formulary and co-pay information. This information is used to determine if the insurance coverage is adequate and affordable. Adequate means the insurance will cover prescribed antiretroviral (ARV) drug therapy. Affordable is determined by adding the yearly premiums for the insurer/family health plan(s) offered and calculating if this amount is lesser than the affordability threshold set by the Federal Marketplace. If the total premium amount is lesser than the affordability threshold set by the Federal Marketplace, the health plan(s) offered is considered affordable and the client must enroll as soon as possible and/or maintain their coverage, if already enrolled. If the total premium amount is greater than the affordability threshold set by the Federal Marketplace, the insurance is deemed unaffordable and the client will be provided other options for insurance coverage including ADAP 340B and/or the Federal marketplace..

The applicant cannot be eligible for AHCCCS (Arizona’s version of Medicaid):

• To ensure that Ryan White Part B is the payer of last resort for ADAP, all applicants for ADAP with a MAGI less than 150% FPL are required to be screened for AHCCCS eligibility. After the AHCCCS screening occurs, all pages of the AHCCCS denial letter must be submitted for review. Clients are NOT permitted to deny, ignore, miss or refuse enrollment into their POLR. Failure to enroll into your POLR, when eligible, may result in disenrollment from ADAP/ADAP Assist and/or Ryan White.

You can get assistance with filling out your application through Central Eligibility (CE) if in Maricopa/Pinal counties only or your local Ryan White Case Management (CM) office if elsewhere in the State. The ADAP application process can be time consuming thus we highly recommend that applicants work with CE or a case manager. We believe that working with CE or a case manager to complete your application will help make sure a complete and accurate application is submitted and processed in a timely fashion. Clients may also now enroll/renew on their own by creating a secure profile at https://rwp.azdhs.gov/ryanwhite/account. Please note: CE and/or a CM representative may still contact to you to fully complete your application to make your eligibility active.

ADAP Assist provides copayment assistance for current ADAP Assist clients’ medications that are covered by their private insurance, employer based insurance, Medicare or Federally Facilitated Marketplace (FFM). If the drug is not covered by the member's primary insurance, please refer to the ADAP public website at www.azadap.org for directions on our off-formulary coverage procedure.

ADAP Assist cannot pay copays for the following medication categories:

1. Certain non-FDA approved Over The Counter (OTCs) Medications
2. Erectile Dysfunction (ED)
3. Fertility Agents
4. Non-oral Contraceptives
5. Skin Coloring Agents
6. Retinoids (Retin-A, Differin, Accutane, Others)
7. Hydroquinone (Eldoquin, Others)
8. Prescriptions used for cosmetic purposes
9. Prescriptions used for weight loss
10. Ancillary supplies

Please refer to Ramsell for assistance with the FDA-approved OTCs that are covered. Ramsell Pharmacy Service Representatives are available by calling 1-888-311-7632.

Click on the link below to download a Prior Authorization Form or User Guidelines.

•	Egrifta Application Form
•	Serostim Application Form
•	Sunlenca Application Form

Patients can fill their prescriptions through any participating pharmacy in BOTH their primary insurance pharmacy network AND the Ramsell's pharmacy network.

To locate the pharmacy closest to you, enter your City, Zip code or County in the Ramsell Pharmacy Locator or call Ramsell at 1-888-311-7632.

The ADAP office is located at:

Arizona Department of Health Services

150 N. 18th Ave - Suite 110

Phoenix, AZ 85007

602-364-3610 (Phone

800-838-9195 (Toll Free)

602-364-3263 (Fax)

Website: https://www.azdhs.gov/preparedness/bureau-of-infectious-disease-and-services/hiv-hepatitis-c-services/index.php#aids-drug-assistance-program-home