Contact us for assistance with how to enroll in our programs, how to locate a pharmacy or document, or any other need you may have.Request Assistance
Or call us: 1-888-311-7632
The Ramsell Free Drug
Print Free Drug Card
Getting Patients the Help
We understand the needs of medical professionals, and we know that patients who rely on the public health require a greater level of sensitivity and attention.
Arizona AIDS Drug Assistance Program (ADAP Assist)
The Arizona Department of Health Services (ADHS) is responsible for the administration of the AIDS Drug Assistance Program (ADAP) and ADAP Assist for the state of Arizona. ADAP/ADAP Assist provides access to medications used to treat HIV and prevent the onset of related opportunistic infections to low-income individuals with HIV disease who have limited or no insurance coverage.
Frequently Asked Questions
The applicant must be medically confirmed as HIV positive:
- ADAP applicants Medical Provider will be required to provide documentation of medical diagnosis with recent lab values and medication regimen
A resident of Arizona;
Have affordable and adequate insurance coverage (including prescription coverage) through a primary insurer such as Medicare, Marketplace, or Employer-sponsored insurance:
- Once ADAP receives an application for an applicant who appears eligible for insurance 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 premium primary insurer and calculating if this amount is less than 9.5% of the applicant’s annual MAGI. If the total premium amount is less than 9.5% of the applicant’s annual MAGI, the insurance is affordable and the client must enroll as soon as possible or maintain their coverage. If the total premium amount is greater than 9.5% of the applicant’s annual MAGI, the insurance is deemed unaffordable and the client will be provided other options for insurance coverage including ADAP 340B and/or the marketplace.
- To ensure that Ryan White Part B is the payer of last resort for ADAP, all applicants applying for ADAP are screened for AHCCCS eligibility, which means all applicants must have AHCCCS denial letters.
ADAP Assist cannot pay copays for the following medication categories:
- Certain Over The Counter (OTCs) Medications
- Erectile Dysfunction (ED)
- Fertility Agents
- Non-oral Contraceptives
- Skin Coloring Agents
- Retinoids (Retin-A, Differin, Accutane, Others)
- Hydroquinone (Eldoquin, Others)
- Prescriptions used for cosmetic purposes
- Ancillary supplies
Please refer to Ramsell for assistance with the 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|
To locate the pharmacy closest to you, enter your City, Zip code or County in the Pharmacy Locator on the left panel. Or call Ramsell at 1-888-311-7632.