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Virginia AIDS Drug Assistance Program (ADAP)


March 21, 2014:

The ADAP Advisory Committee Chair, in coordination with the Virginia Department of Health (VDH) AIDS Drug Assistance Program (ADAP), submitted a request to Anthem on March 5, 2014 to consider adding Stribild and Complera to the formularies for plans offered under the Affordable Care Act (ACA). Please see March 5, 2014 post below.

On March 21, 2014, the Virginia Department of Health received a response from Anthem. Unfortunately, Anthem has declined to add those medications to its formulary. While Anthem’s response cites an exception process under which access to a non-formulary drug �might� be granted, Virginia ADAP does not believe this provides adequate assurance that clients would be able to access these medications if prescribed. Virginia ADAP would not be able to provide those medications at full cost for insured clients in addition to paying for premiums and all other medication costs for ACA plans and comply with federal policy. Federal policy requires that ADAPs ensure that antiretrovirals offered on the ADAP formulary are also offered through plans supported with ADAP dollars, as well as demonstrate cost effectiveness when using funds to pay for insurance costs. Therefore, Anthem’s decision to exclude Stribild and Complera on the formularies of its ACA plans results in the inability to support those plans with ADAP dollars at this time.

VDH will continue to pursue options to increase options available to ADAP clients under the ACA and will keep you updated on those efforts. Click here to view letter.

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: 04-21-2014