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Getting Patients the Help They Need
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.
Washington ADAP (Early Intervention Program)
The Washington State AIDS Drug Assistance Program (Early Intervention Program) pays for a variety of services to help meet the health care needs of low-to-moderate income people with HIV who live in Washington.
Frequently Asked Questions
What Are Washington ADAP Offer of Services?
- 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.
What Are Washington ADAP Requirements?
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.
What Documents Are Needed?
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.
What Drugs Are Covered?
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.
Where Can Patient's Prescriptions Be Filled?
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.
What Are Patients' Rights?
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.
Prior Authorization Forms
Authorization to receive Fuzeon is given in six-month periods and access to Fuzeon is limited based on the availability of openings.
Please be sure to include any necessary lab measurements that show the patient's viral load measurement, CD4 count and genotype resistance profile. Download PDFAptivus
Please make sure to fill out EITHER section 1 OR 2 of the application.
Patients must submit a request for pegylated interferon thru the WA Washington State Department of Health Prescription Drug Program by first submitting this form to Ramsell. Download PDFBaraclude
Patients must fail therapy with both lamivudine and tenofovir prior to therapy with Baraclude. There must be documented treatment failure evidenced by a (+) Hep B DNA and a (+) Hep BeAg (Hep B envelope antigen). Download PDFAnabolic Steroids
Please fill out Form A for the initial approval only and Form B for subsequent refill requests.
Please be sure to include documented dates and dosage of testosterone therapy when applying for the initial approval. Download PDFMaraviroc (Selzentry™)
Maraviroc is approved for patients with CCR5 mono-tropic HIV confirmed by tropism assay results. Please fill out the maraviroc prior authorization form.
Trofile™ test showing "CCR5 only" is required for maraviroc new starts. It is not required for those already on maraviroc through clinical trials, expanded access or other insurance.
The Selzentry (maraviroc) prior authorization access form must be faxed back to the program Pharmacy Benefit Manager, Ramsell at 800-848-4241. Download PDFHepatitis C Treatment Regimens
Please complete the Supplemental Form for Hepatitis C Treatment Regimens. Please include current CD4, HIV viral load and supporting lab documents for review of medical justification. Download PDFEgrifta™ (Tesamorelin)
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 PDFIbalizumab-uiyk (Trogarzo™)
Authorization to receive Trogarzo is given in six-month periods and approvals are dependent upon meeting the established criteria and providing documentation as noted in page 1 of this form.Download PDF