Covering the Costs of HIV Care: ADAP

By Rachel Welsh, MSW, APSW

 

ADAP stands for the AIDS Drug Assistance Program. ADAP is part of the federal Ryan White HIV/AIDS Program and each state manages its own ADAP program. The Wisconsin ADAP program is administered by the Department of Health Services HIV Program. ADAP is an important program as it can help eligible people living with HIV (PLWH) pay for certain medications and health insurance premiums and reduce the financial burden of HIV care. 

 

What does ADAP Cover?

  • Full cost of HIV medications and other related medications if you are uninsured
  • Co-pays for HIV medications and other related medications if you have insurance
    • This means that if your health insurance does not cover 100% of the costs of a prescription, ADAP can pay the portion not covered by your insurance
  • Your health insurance premium for a plan bought on the Health Insurance Market Place
  • Your health insurance premium for a plan through your employer
    • ADAP can reimburse the costs of health insurance deducted from your paycheck
  • Your health insurance premium for a Medicare Part D plan
  • Your health insurance premium for a basic Medicare supplement plan

In order for a medication to be covered by ADAP, it must be on a list called a “drug formulary”. The list changes from time to time as new medications are added or removed. You can view a copy of the WI ADAP Formulary (pdf).

 

You may be eligible for ADAP if you:

  • Live in Wisconsin
  • Have a family income up to 300% of the federal poverty guideline for the current year
    • In 2020: $38,280 per year for a 1-person household; $51,720 for a 2-person household, etc.
  • Are a PLWH, confirmed by a healthcare provider

One thing to keep in mind is that PLWH who have Medicaid or Badger Care are not eligible for ADAP. Medicaid and Badger Care already offer benefits similar to the ADAP Program.

 

How to Apply for ADAP

 

A UW Health HIV Clinic Social Worker can assist people with applying for ADAP. Once you apply for ADAP, there is a recertification process every six months to verify that you are still eligible for the program.

 

All application materials can be found at https://www.dhs.wisconsin.gov/hiv/adap.htm

 

If you have questions about ADAP or would like assistance applying, contact your UW Health HIV Clinic Social Worker. If you are not sure who that is, call the clinic at (608) 263-0946 and ask to speak the Social Worker on your care team.