Fact sheet: the north carolina aids drug assistance/hiv medications program (adap)

ADAP FACT SHEET
The North Carolina AIDS Drug Assistance Program (ADAP)
Communicable Disease Branch, Division of Public Health, NC DHHS
What is the North Carolina AIDS Drug Assistance Program (ADAP)?
The North Carolina AIDS Drug Assistance Program (ADAP) uses a combination of state
and federal funds to provide low-income residents of North Carolina with assistance in
obtaining essential, life-sustaining medications to fight HIV/AIDS and the opportunistic
infections which often accompany the disease.
What are the eligibility criteria for ADAP?
To be eligible for ADAP, individuals must:
• have a gross family income that is equal to or less than 300 percent of the federal poverty level (FPL); see page 6 for the current Federal Poverty Guidelines. • not have any third-party prescription drug coverage (private insurance or Medicaid) that enables them to obtain their medications (other than Medicare*). • have at least one prescription for any medication on the ADAP formulary; see pages 7-8 for the current ADAP formulary. * Clients eligible for Medicare are required to enroll in a Medicare Prescription Drug Plan.
Clients eligible for Medicare with an income at/below 150 percent FPL are required to apply for
the Low Income Subsidy (LIS or Extra Help) through the Social Security Administration.

How does someone apply for ADAP?
Applications must be submitted by an interviewer (not the applicant). The interviewer
can be an applicants’ medical provider, case manager, social worker or anyone else
working in an official capacity on the applicant’s behalf. Individuals looking for an
interviewer should talk to their clinician, the person in their doctor’s office who handles
bills and/or insurance, their HIV case manager, someone at one of NC’s HIV Regional
Networks, a local health department, or at an AIDS service organization/agency. The
applicant, with the assistance of their interviewer, will complete two forms; one to
establish financial eligibility for the Program (Form 3014 – Financial Eligibility
Application) and one to document their clinical information (Form 3056 – Authorization
Request).
Forms 3014 and 3056 must be sent to POMCS (Purchase of Medical Care Services)
with proof of income, proof of residency, proof of lab values and a copy of one
prescription for a final determination of eligibility. POMCS may request additional
information before making a final determination. The individual and the interviewer will
receive a letter from POMCS stating whether the client was approved, denied or
pended. Once a client is approved, prescriptions should be sent to the pharmacy.
The two application forms with instructions, the ADAP Application Manual, the RW
(Ryan White) Part B/ADAP Eligibility Checklist/instructions and the POMCS
provider/instruction manual can be found on the ADAP website at

Please check the ADAP website for updated versions of Form 3014 and 3056; POMCS
will not accept older versions of these forms.

Are all applicants required to provide documentation of income, residency, labs,
and prescriptions?
Yes. In accordance with HRSA (Health Resources and Services Administration)
guidance, all new applicants are required to submit proof of income, proof of NC
residency, proof of the lab values entered on Form 3056 and proof that there is a
prescription for one medication on the ADAP formulary with their application to verify
and document eligibility for ADAP. Applicants with no income or low income will be
asked to explain how they meet their monthly living expenses and submit verification of
no income or verification of low income. Applicants with undocumented income will be
required to submit an Income/Signature Card. Applicants who cannot provide an official
document with their name and address (driver’s license, utility bill, lease, etc.) will be
required to submit a Declaration of Residency. Different documentation is required
during Winter Recertification and Summer Recertification, see the ADAP Application
Manual for more information about what is required during the renewal periods. The
ADAP Application Manual, RW Part B/ADAP Eligibility Checklist which can be found on
the ADAP website a

How often do clients on ADAP need to renew their eligibility for coverage?
All clients on ADAP must renew every six months. All clients are required to submit an
application for the Winter Recertification between January 1 and March 31 every year
and submit an application for the Summer Recertification between July 1 and
September 30 every year.

What is the difference between Winter Recertification and Summer
Recertification?
The Winter Recertification period starts on January 1 and ends on March 31 every year
and covers clients from April 1 to September 30. The Summer Recertification period
starts on July 1 and ends on September 30 every year and covers clients from October
1 to March 31. All clients must resubmit an application during both of these renewal
periods. Please see the ADAP Application Manual for more information about what
forms and documents are required during each renewal period.
What happens if a client misses the deadline for Winter Recertification or
Summer Recertification?
All clients are covered for six months at a time. If a client misses a renewal deadline
they will lose their coverage and access to medications through ADAP. ADAP coverage
will be terminated for all clients whose renewal is not approved by the first day of the
next six month authorization period on that day.
What are the two programs within ADAP?
The ADAP Pharmacy Program or APP and the State Pharmaceutical Assistance
Program or SPAP are the two programs within ADAP for paying for and dispensing
medications. APP uses a model that requires ADAP to purchase medications from a
wholesaler and distributes medications through a pharmacy network. SPAP uses a cost
sharing model where SPAP clients pay their Medicare Part D premiums and then ADAP
pays all their out of pocket costs for ADAP formulary medications though a Pharmacy
Benefits Manager. The fundamental difference between APP and SPAP are related to
how medications are paid for and which pharmacy dispenses the medications.

How do clients on APP get their medications?
Walgreens is the contracted dispensing pharmacy for APP. Walgreens will mail a thirty-
day supply of medication to clients each month. Walgreens will mail medications to any
verifiable address in North Carolina. APP prescriptions are filled at and mailed from the
Walgreens Store located at 500 Fincher Street in Monroe, NC. APP clients also have
the option of picking up their medications at one of twelve Walgreens locations. Clients
or providers should call Walgreens to make arrangements to pick up medications at one
of these locations (See page 5 for a list of Walgreens locations where clients can pick
up medications).

Can someone on Medicare apply for ADAP?
Yes. Clients with Medicare Part D coverage are served through SPAP. In order to be
considered for the program, clients eligible for Medicare Part D are required to enroll in,
and pay the premiums for, a Medicare Part D plan. Once the client is approved for
ADAP and their Medicare Part D coverage has been confirmed they will be moved onto
SPAP. Clients may be eligible for the Low Income Subsidy (LIS), also known as “extra
help” to help pay Medicare Part D Premiums and related out of pocket costs. All
applicants with Medicare Part D coverage and income at or below 150 percent of the
federal poverty level are required to apply for the LIS. For more information about LIS
or “extra help” visit
How does SPAP work?
SPAP is the program within ADAP for clients who have Medicare Part D coverage.
Clients on SPAP pay their Medicare Part D premiums and SPAP pays their out of
pocket costs for all medications on the ADAP formulary (copayments and all payments
in the ‘donut hole’). When a client on SPAP fills a prescription for a medication on the
ADAP formulary, the pharmacy will bill their Medicare Part D plan as the primary payer
and ADAP as the secondary payer. The client will not incur any expenses for these
dispenses. All ADAP clients who are eligible for Medicare Part D must enroll in a
Medicare Part D plan and pay the plan premiums.

Is there any cost to clients on APP or SPAP?
There is no cost to individuals on APP or SPAP for medications on the formulary. All
clients are responsible for the cost of medications that are not on the formulary. Clients
who are eligible for Medicare Part D are required to enroll in a Part D plan and are
responsible for plan premiums.
How do clients on SPAP get their medications?
Walgreens is the contracted pharmacy for SPAP. Walgreens will mail a thirty-day
supply of medication to clients each month. Walgreens will mail medications to any
verifiable address in North Carolina. SPAP prescriptions mailed by Walgreens are filled
at and mailed from the Walgreens Store located at 4701 South Boulevard in Charlotte,
NC. SPAP clients also have the option of picking up their medications at one of twelve
Walgreens locations. Clients or providers should call Walgreens to make arrangements
to pick up medications at one of these locations (See page 5 for a list of Walgreens
locations where clients can pick up medications).
How can clients get their medications if they are away from home?
Clients should notify the pharmacy in advance if they need their medications sent
somewhere other than their home. Walgreens can mail medications to any verifiable
address in North Carolina. Walgreens can also mail medications to a verifiable address
in another state if the ADAP office approves a delivery exception (the maximum allowed
is 90 days). Clients cannot receive medications if they are out of the country. Clients
can fill prescriptions early if the ADAP office approves a delivery exception (the
maximum allowed is 90 days).

Can someone in jail receive services from ADAP?
Individuals in local jails that cannot cover medications may be eligible for ADAP
services. Individuals in State or Federal prisons are not eligible for ADAP services.
New applicants and existing clients in local jails will be evaluated on a case by case
basis by the ADAP office based on a variety of factors. Before clients in jail can receive
ADAP services, the jail will need to prove that their facility is unable to pay for
medications and the staff is willing to coordinate medication delivery logistics.
APP and SPAP Walgreens Locations
Store #9458
Store #5761*
Store #11396
Store #11423
Store #7317
Store #7805
Store #12283
Store #6579
Store #7549
Store #1319
Store #11202
Store #11692**
All clients (APP and SPAP) can pick up medications at any of these stores but arrangements should be
made in advance by calling Walgreens at 1-800-573-3602 (Client Line) or 1-888-516-8003 (Healthcare
Professional Line).
* All SPAP prescriptions delivered by mail will come from Store #5761.
** All APP prescriptions delivered by mail will come from Store #11692.




How can someone get in touch with program staff or get more information?
• ADAP Website: http://epi.publichealth.nc.gov/cd/hiv/adap.html • ADAP Toll Free Line: 1-877-466-2232 (only works from within North Carolina) (919) 733-9576, or [email protected] • Trisha Hailperin, Assistant ADAP Coordinator: (919) 715-3688 or [email protected] • Debra Bost, ADAP Public Health Program Consultant: (919) 733-9556 or [email protected] • Eleana Sessoms, Public Health Consultant/SPAP Project Manager: (919) 715-1664 or [email protected] • Iris Girard, ADAP Processing Assistant: (919) 715-7301 or [email protected] • POMCS (applications are processed by the client’s last name alphabetically): o Sue Harrington, Supervisor: (919) 855-3652 o Mike Benson: (919) 855-3666 Letters: A, D, M, V, Y o Mary Hardin: (919) 855-3670 Letters: C, N, O, S, X o Sandra Smith: (919) 855-3669 Letters: E, F, J, K, L, T o Glenys Spencer: (919) 855-3665 Letters: G, H, W o Toni Wallace: (919) 855-3668 Letters: B, I, P, Q, R, U, Z o POMCS Address: 1907 Mail Service Center; Raleigh NC 27699-1907 All Applications (New clients, Annual Reauth., Summer Recert.) must be sent by mail. (Only items requested by POMCS should be faxed) o Client Line 1-800-573-3602 o Healthcare Professionals Line 1-888-516-8003 • Information about Medicare Part D and the Low Income Subsidy (LIS) o Medicare: www.medicare.gov or 1-800-633-4227 o Social Security: www.ssa.gov or 1-800-772-1213 o Seniors’ Health Insurance Information Program (SHIIP): www.ncdoi.com/SHIIP/Default.aspx or 1-800-443-9354 Family Size/Federal Poverty Guidelines ($) 2014
100% $11,670 $15,730 $19,780 $23,850 $27,910 $31,970 125% $14,588 $19,663 $24,725 $29,813 $34,888 $39,963 150% $17,505 $23,595 $29,670 $35,775 $41,865 $47,955 200% $23,340 $31,460 $39,560 $47,700 $55,820 $63,940 250% $29,175 $39,325 $49,450 $59,625 $69,775 $79,925 300% $35,010 $47,190 $59,340 $71,550 $83,730 $95,910 $108,090 $120,270 SOURCE: Federal Register, January 22, 2014 ADAP Formulary

Tier 1 - Antiretroviral Medications - Brand (Generic):
Atripla (Efavirenz, Emtricitabine, Tenofovir) Complera (Rilpivirine, Emtricitabine, Tenofovir) Selzentry (Maraviroc) Stribild (Elvitegravir, Cobicistat, Emtricitabine, Trizivir (Zidovudine, Lamivudine, Abacavir)
Tier 1A - Brand (Generic):
Bactrim, Septra, Cotrim, Sulfatrim (Sulfadiazine Sulfamethoxazole/trimethoprim) *If available, generic medications are dispensed. The above brand names are only examples of those products available, and are neither recommended nor required. Tier 1B - Brand (Generic):
Doryx, Vibramycin, Vibra-Tabs (Doxycycline *If available, generic medications are dispensed. The above brand names are only examples of those
products available, and are neither recommended nor required.
Tier 2 - Brand (Generic):
Androgel, Testim Androderm (Testosterone) Glucophage, Glumetza, Riomet (Metformin) *If available, generic medications are dispensed. The above brand names are only examples of those products available, and are neither recommended nor required.

Source: http://epi.ncpublichealth.com/cd/hiv/docs/ADAPFactSheet.pdf