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Virginia AIDS Drug Assistance Program (ADAP)


March 5, 2014:

On March 5, 2014, a letter was sent to Anthem Prescription Management on behalf of the Virginia ADAP Advisory Committee, requesting consideration for adding Stribild and Complera to the formularies of plans offered in Virginia through the federal marketplace. Click here to view letter.

January 21, 2014:

For frequent updates regarding Virginia ADAP plans for enrollment into ACA Insurance Plans, please visit the ADAP Updates page.

The Virginia Department of Health (VDH) AIDS Drug Assistance Program (ADAP) has selected certain plans offered through the federal marketplace (insurance exchange) under the Affordable Care Act (ACA) that can be supported through Virginia ADAP.  ADAP will pay the premiums and medication costs (deductibles and copayments) only for these selected plans.

Program Requirements

    To receive continued support through ADAP, eligible clients are required to:
    1. Enroll in a Silver or Bronze plan based on income.
      a. If a client lives alone (family size=1) and has an income between $11,491 and $28,725, the client must choose a Silver plan because the client may qualify for extra financial help.  Otherwise, the client must apply for a Bronze plan.  If the client’s family size is greater than 1 person, click here to see which plans the client can enroll in.
    2. Enroll in Individual plans only. ADAP will not pay for Family plans (unless all family members currently receive medication from VDH ADAP).
    3. Apply any tax credits to premiums.
    4. Use in-network pharmacies.

ADAP-Selected Plans
Call the VDH Medication Assistance Hotline at 1-855-362-0658 if you have any questions regarding plan selection.

 
Company: Plans: Comments:
Care First BlueChoice Plus-Bronze $5500 Verified coverage at the following Provider sites: INOVA, Casey Clinic. Please check to see if your doctor is on the plan.
BlueChoice Silver $2000
Coventry Bronze Deductible Only POS Plan Verified coverage at the following Provider sites:  Carilion, Virginia Commonwealth University (VCU), University of Virginia (UVA), Centra, INOVA. Please check to see if your doctor is on the plan.
Silver $10 Copay POS
Kaiser KP VA Silver 1500/30/Dental
(No Bronze plan option)
Coverage limited to Kaiser facilities and physicians.  You would have to choose an “In-Network” provider. Please check to see if your doctor is on the plan.
Innovation Health IH Advantage 6350/Bronze INOVA, Casey Clinic, UVA. Please check to see if your doctor is on the plan.
IH Classic 5000/Silver
Aetna Aetna Advantage 6350/Bronze Verified coverage at the following Provider sites:  Carilion, Centra, VCU.  Some drugs on this plan are not covered. Please check to see if your doctor is on the plan. You can only choose Aetna plans if no other Insurance plans are provided in your area.  Before this plan is chosen, call VDH at:  1-855-362-0658.
Aetna Classic 5000/Silver
Optima Vantage 3500 60% Bronze Verified Coverage at the following medical sites:  Centra, Eastern Virginia Medical School (EVMS), UVA, and VCU.  Please check to see if your doctor is on the plan.
Vantage FourSight 3500 80% Silver

Sign up for a plan and let ADAP know
To sign up, a client can find an enrollment site in her/his area or schedule an appointment with a site by calling the ADAP hotline at 1-855-362-0658.  The client can also apply online.  The client must have (or create) an email address.  Go to www.HealthCare.gov.  ADAP must be notified when the client enrolls so that ADAP can coordinate payment of the premiums and medication costs.

For a list of Insurance Enrollment Sites that can help ADAP clients enroll in insurance, click here.

For more detailed information about how to enroll and other program requirements, please click here.

Resources
Insurance flyer for ADAP clients English Spanish

Insurance Fact Sheet for ADAP clients English Spanish

Clinical Support and Policy Development

In 1996, an ADAP Advisory Committee was created. The committee is comprised of HIV/AIDS medical providers, a pharmacist, and consumers. The committee advises VDH on changes to the formulary, changes in eligibility criteria, adherence issues, and educational concerns. The committee reviews data on ADAP utilization and assess budgetary implications of trends and program changes.

For more information about the committee, please see the ADAP Advisory Committee Scope.


Questions or comments?

Medication Eligibility Hotline 1-855-362-0658


Last Updated: 03-21-2014

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