Subject: ADAP
From: Ron Buckmire <prince>
To: [email-masked]
Date: Fri, 06 Sep 91 19:25:48 EDT

An earlier posting made reference to NYS's AIDS Drug Assistance Program
(ADAP).  Below is a summary of the program:

AIDS DRUG ASSISTANCE PROGRAM

The New York State Department of Health's AIDS Drug Assistance
Program (ADAP) has provided zidovudine (AZT, brand name Retrovir)
free of charge to financially and medically eligible residents of
New York State since October 1987.  ADAP has additional medications
for the treatment of HIV infection, PCP treatment and prophylaxis
and treatments of AIDS opportunistic infections and neoplasms.

ADAP - COVERED DRUGS

    I       HIV Infection (Antiretroviral Drugs)

            Drug:       zidovudine (Retrovir, "AZT")

    II      Pneumocystis Carinii Pneumonia (PCP) Prophylaxis and
            Treatment

            Drugs:      dapsone
                        leucovorin/folinic acid (for optional use with
                        TMP/SMZ)
                        pentamidine
                        sulfadoxine/pyrimethamine
                        trimethoprim (for use with Dapsone)
                        trimethoprim/sulfamethoxazole

    III     AIDS Neoplasms - HIV infection and Kaposi's sarcoma

            Drugs:      alpha interferon
                        bleomycin
                        doxorubicin
                        etoposide
                        vinblastine
                        vincristine

    IV      AIDS Opportunistic Infections

            Drugs:      acyclovir
                        amphotericin-B
                        clindamycin
                        clotrimazole
                        fluconazole
                        ganciclovir
                        ketoconazole
                        leucovorin
                        nystatin
                        pyrimethamine
                        sulfadiazine
                        triple sulfa # 2

ELIGIBILITY FOR ADAP

ADAP is currently providing assistance by using a federal grant
received by New York State.  The terms of this grant restrict who
may receive assistance through the program.  To receive any
benefits from ADAP, all prospective participants must first
complete the established application process.

1.          Residency

    The first requirement for ADAP eligibility is New York State
    residency.  Applicants must be able to prove residence by
    providing a copy of a drivers license, voter registration card,
    utility bill, or other acceptable documentation showing name and
    address.  Other proofs of residency may be accepted for
    applicants who may have unstable living arrangements. For
    example, an individual may provide a statement from a clinic
    indicating that he/she has been treated for a period of time, or
    a statement from a social worker.  Proof of U.S. citizenship is
    not required for ADAP eligibility.

2.)         Financial Need

    Applicants must also demonstrate financial need.  The Income
    Table below indicates the maximum gross household income
    allowable for participation in ADAP.  Proof of income, such as
    copies of pay stubs, business records, or benefits award letters,
    must be submitted with the application.

                             ADAP INCOME TABLE

    HOUSEHOLD           ADAP MONTHLY     ADAP ANNUAL
    SIZE                INCOME LEVEL     INCOME LEVEL

           1            $3,667               $44,000
           2             4,933                59,200
           3            +6,200                74,400

    The above figures refer to gross income of the household.  Gross
    income is income before deductions for income tax, employee's
    Social Security taxes, etc.  The applicant's household size
    includes the individual applying for assistance and/or any
    declared dependents.  The house-hold may also include individuals
    legally responsible for the applicant, such as the spouse or the
    applicant, or the parent of an applicant under 21.  A legally
    responsible relative may reside outside of the home.

    Individuals with substantial ($25,000 or more) liquid assets are
    not eligible to participate in the program.

    Since Medicaid covers the cost of AZT and other ADAP-approved
    drugs, anyone currently receiving Medicaid is not eligible to
    receive ADAP benefits.  Interim ADAP assistance may be provided
    for eight weeks or longer (if there is a delay in the
    determination of Medicaid eligibility) to persons eligible for,
    but not yet receiving Medicaid.  These interim benefits are meant
    to serve as temporary assistance only.  Once other assistance
    becomes available, the ADAP eligibility card must be returned
    immediately.  ADAP expenditures may be used to meet Medicaid
    Spenddown requirements.  Individuals must notify ADAP if they are
    in a spenddown situation.

    Veterans must first contact the Veterans Administration to
    determine if they can receive treatment through a VA hospital
    before their application for ADAP benefits can be processed.  If
    the applicant is not eligible to receive ADAP covered treatments
    in a Veterans facility, he/she should provide ADAP with a copy
    of a denial of benefits letter, or a letter explaining the
    circumstances of the denial.

    Although ADAP cannot provide assistance to anyone who has the
    total cost of medication reimbursed by third-party insurance,
    there may be individuals with prescription drug coverage who
    cannot meet deductibles, co-payments, who have policies with
    waiting periods, or who have been delayed in receiving payment
    from the insurance company.  Individuals who meet the other ADAP
    criteria, but have prescription drug coverage should still apply.
    ADAP has developed a mechanism for assisting these individuals.

3.)         Medical Eligibility

    The final criterion is medical eligibility which is drug
    specific.  Applicants are asked to have their physician complete
    a form providing specific information regarding their condition.
    It is assumed that physicians will determine the appropriateness
    of treatment and monitor progress for each of their patients.
    An individual who meets one of the following criteria will be
    considered eligible for one or more categories of drugs from the
    program:

    I       HIV Infection (Antiretroviral Drugs)

            Criteria:

            One of the following:

            -  CDC-defined AIDS
            -  Meets AIDS Institute Standard for Clinical/Symptomatic
               HIV Illness (includes CDC-defined AIDS and HIV-related
               disease)
            -  HIV infection and CD4+ < or =  500 cubic mm

    II      Pneumocystis Carinii Pneumonia (PCP) Prophylaxis and
            Treatment

            Criteria:

            HIV infection AND one of the following:

            -  CDC-defined AIDS
            -  current or prior CD4+ count < or = 300 cubic mm
            -  current or prior CD4+/lymphocyte % < or = 30%

    III     AIDS Neoplasms

            Criteria:

            HIV infection and Kaposi's sarcoma

    IV      AIDS Opportunistic Infections

            Criteria:

            One of the following:

            -  CDC-defined AIDS
            -  Meets AIDS Institute Standard for Clinical/Symptomatic
               HIV Illness (includes CDC-defined AIDS, HIV-related
               disease and CD4+ < or = 200 cubic mm)

    Applicants who meet the above criteria will be provided with
    an eligibility card indicating the categories of drugs for
    which they qualify.  They will take this card to a
    participating pharmacy along with a prescription from their
    physician once a month to receive the drug.

    Requests for applications or questions regarding ADAP can be
    directed to the program's toll- free hotline; 1-800-542-2437, or
    by writing to:

                        ADAP
                        P.O. BOX 2052
                        EMPIRE STATION
                        ALBANY, NEW YORK  12220

    All information provided to ADAP will be kept strictly
    confidential.