Getting Patients the Help They Need

• Prescription medications - program pays for certain HIV-related prescription medications. For clients with insurance, this program may pay what insurance doesn't for formulary covered medications.
• Clients receive a client identification number and a pharmacy card. They can present one of these to a contracting pharmacy to get their medications, in most cases for a nominal monthly fee.
• Washington State Early Intervention Program also provides assistance in medical services, as well as in acquiring insurance and Medicaid eligibility.

Basic requirements for all Washington State Department of Health Prescription Drug Program applicants:

• Are HIV positive
• Live in Washington State
• Have a gross monthly income of 300% or less of the Federal Poverty Level as a single person. For 2013, that amount is $2872.50 gross monthly income.
• Have financial resources of $10,000 or less (not counting one home, one automobile and certain retirement accounts).

Additional requirements for applicants with Medicare:

• Applicants with Medicare must be enrolled in a Prescription Drug Plan (PDP) or insurance that is "as good as" a PDP. If the applicant isn't enrolled in a PDP or "as good as" insurance, the applicant will receive temporary eligibility while enrolling.
• Applicants with a PDP and a gross monthly income at or below 150% or less of the Federal Poverty level for a single person, must apply for Extra Help (also known as Low Income Subsidy) with Social Security Administration. For 2013, that amount is $1,436.25 gross monthly income. Applicants will receive temporary eligibility during the Extra Help application period.

There are additional requirements for some applicants who may be eligible for Medicaid.

This is the list of documents that are required to be part of the Early Intervention Program (EIP):

• Proof of Identity (New Clients)
• Proof of residency
• Proof of income OR checking the "No Income Declaration" box on the application
• A copy of your Medicare card (if applicable)
• A copy of insurance credibility statement or copy of a PDP or MA-PD card
• A copy of your insurance card (if applicable)
• HIV & Health Status Information Form (HHSI) for new clients or clients returning after a 60 day gap in coverage. This form is also used to update your HIV & Health Status when there is a change.

Please click on the links below to download a PDF with a complete list of medications on Washington State AIDS Drug Assistance Program (EIP) formulary.

•   WA EIP Uninsured Formulary Alpha by Generic
•   WA EIP Uninsured Formulary by Drug Class
•   WA EIP Insured Formulary

Patients can fill their prescriptions through any one of the participating pharmacies in Washington.

To locate the pharmacy closest to your patient, enter their zip code or city in the form to the right, or call Ramsell at 1-888-311-7632.

Patients have the right to apply, to appeal decisions and to receive confidential, nondiscriminatory, courteous and respectful service.

If you believe a client has been denied their rights, or treated unfairly or discourteously at any point in the enrollment process, or while receiving pharmacy services, you may contact the local coordinator for your county or the Washington State Department of Health at 1-877-376-9316.

Initial authorization for Egrifta® will be limited to 24 weeks. For treatment beyond 24 weeks, prescribers will be requested to submit medical justification for continued use of therapy.

Please include current CD4, HIV viral load and supporting lab documents for review of medical justification. Treatment will not be authorized for cosmetic use or weight loss. Download PDF

•  Sunlenca® (lenacapavir)