How to Enroll in ADAP to Pay for Your HIV Prescription Drugs

Program assists both low- and middle-income earners
Photo credit: BotacaQF

While access to healthcare has increased for people living with HIV since the enactment of the Affordable Care Act (ACA) in 2014, the cost of HIV drugs remains a major challenge. Even for some able to obtain private insurance, the price has become increasingly prohibitive, with some insurers moving antiretroviral drugs from more affordable "generic" and "non-generic" drug tiers to higher priced "specialty" drug tiers that command co-payments of 30% or more.

This practice of adverse tiering has affected both low- and middle-income earners, with many forced to pay for their drugs out of pocket. For a standard three-drug regimen, this could add up to well in excess of $1,000 per month, a price that most would consider unaffordable.

The AIDS Drug Assistance Program (ADAP) is a federal program first established in 1987 to provide lifesaving HIV drugs to low-income Americans. Since that time the scope of the program has expanded considerably, with some states able to subsidize doctor visits, lab tests, insurance deductibles, and even preventive therapy for those at risk of infection.

Eligibility is typically income-based, ranging from households whose annual income is less than 200 percent  of the Federal Poverty Level (FPL) to those whose income is less than 500 percent. Income calculations are based not on you or your family's total earnings for the year but on your modified annual gross income (essentially the Adjusted Gross Income found on line 37 of your 1040 tax return plus a few add-backs).

This means that, in the 11 states where the income threshold has been set at 500 percent, a married couple with a Modified Annual Gross income of $80,000 would still be eligible for ADAP assistance.

ADAP Eligibility by State

That's not to say that all ADAP programs are created equal. While ADAP is funded by the federal government, each state administer its own program, sets its own inclusion criteria, and outlines which services it will and will not provide.

In some states, that translates to direct prescription drug assistance; In others, services may include regular doctor visits, case management, or (as in New York State) a provision for home-based care.

Although the rules vary from state to state, eligibility is typically based on three factors:

  • Documentation of residence within that state. For non-U.S. citizens, documentation of permanent residence is required. Meanwhile, in other states, like New Mexico and Massachusetts, undocumented immigrants are also qualified for ADAP services.
  • Proof of income. This is typically based on you or your family's modified annual gross income (MAGI) but can also include a dollar value limitation on our personal assets (as in states like Delaware, Georgia, and New York).
  • Confirmation of your HIV status by a qualified physician. In some states, like Arkansas, CD4 count and viral load tests may be used to qualify eligibility.

As ADAP is considered a "last resort" payer, you may still be required to get health insurance even if ADAP services are rendered. In such case, you would need to provide proof of insurance in order to establish need, whether it be for drug coverage, co-pay assistance, or (in some states) deductible or premium payment assistance.

For those unable to obtain ADAP approval, co-pay and payment assistance programs (PAP) are offered by most HIV drug companies to provide free or low-cost medications to those who cannot afford them.

StateProgram AdministratorIncome QualificationsAdditional Information and Considerations
AlabamaAlabama ADAPLess than 250% of FPLIn most cases, clients enrolled in private or public health insurance is not eligible. Exceptions may apply on a case-by-case basis. 
AlaskaInterior AIDS Association and  Alaskan AIDS Assistance AssociationLess than 400% of the FPL for AlaskaMust be an active client of either the Alaskan AIDS Assistance Association (Four A's) or the Interior AIDS Association (IAA).
ArizonaArizona ADAPLess than 400% of FPL 
ArkansasArkansas ADAPLess than 200% of FPLPreviously untreated patient must have CD4 countless than 500 OR viral load over 55,000 (PCR test) OR viral load over 30,000 (bDNA test). Current or
previously treated patients qualify if proof of HIV drug treatment is provided.
CaliforniaCalifornia ADAPLess than 500% of FPL 
ColoradoColorado ADAPLess than 400% of FPLPersons with FPL between 400% and 500% are still eligible for prescription drug assistance. Persons with private insurance, COBRA, or employer-based insurance need to apply through Colorado ADAP’s Health Insurance Assistance Program (HIAP).
ConnecticutConnecticut ADAP (CADAP)Less than 400% of FPL 
DelawareDelaware ADAPEarn less than $50,000 per year and have less than $10,000 in assets. 
District of ColumbiaDistrict of Columbia ADAPLess than 500% of FPL and liquid assets of less than $25,000 
FloridaFlorida ADAPLess than 400% of FPL 
GeorgiaGeorgia ADAPLess than 300% of FPL and cash assets of less than $4,500 ($5,500 if married) 
HawaiiHawaii ADAPLess than 400% of FPL for Hawaii 
IllinoisIllinois ADAPLess than 300% of FPL for new applicants and less than 500% of FPL for active applicants enrolled before July 1, 2011Persons with income under 300% of FPL are encouraged to enroll in the Illinois Pre-Existing Conditions Plan (IPEX), a state-operated health insurance plan.
IndianaIndiana ADAPLess than 300% of the FPL 
IowaIowa ADAPLess than 200% of the FPL, with a $500 work deduction
KansasKansas ADAPLess than 300% of FPL 
KentuckyKentucky ADAP (KADAP)Less than 500% of FPL 
LouisianaLouisiana Health Access Program (LA HAP)Less than 300% of FPLIn determining household income, the members of your household is anyone who lives with you who is either related by blood, by legal marriage, or by legal adoption.
MaineMaine ADAPLess than 500% of the FPL 
MarylandMaryland ADAP (MADAP)Less than 500% of FPL 
MassachusettsMassachusetts HIV Drug Assistance Program (HDAP)Less than 500% of FPLThere is no age restriction for persons applying to HDAP. You do not have to be a U.S. citizen to enroll in ADAP.
MichiganMichigan Drug Assistance Program (MIDAP)Less than 450% of FPLIn some cases, you must have applied for public assistance (Medicaid or the Adult Benefits Waiver program) and be able show that you have either been (a) denied, (b) placed on a pending status, or (c) placed on a spend-down status within the past 90 days.
MinnesotaMinnesota ADAPLess than 400% of FPL 
MissouriMissouri HIV/AIDS Case Management ProgramGross income at or below 300% of the FPL 
MississippiMississippi ADAPLess than 300% of FPL 
MontanaMontana ADAPLess than 431% of FPL 
NebraskaNebraska ADAP (NE ADAP)Less than 200% of FPL 
NevadaNevada ADAPLess than 400% of FPL and liquid assets of less than $10,000Liquid assets do not include an owner-occupied home and one car (or two cars if married).
New HampshireNH CARE ProgramLess than 400% of FPLYou may still qualify for ADAP based on medical expenses. Contact the CARE call center to inquire about special circumstance qualifications.
New JerseyAIDS Drug Distribution Program (ADDP)Less than 500% of FPL 
New MexicoNew Mexico ADAPLess than 400% of FPLYou do not need to be a documented U.S. citizen or immigrant to qualify for ADAP services.
New YorkNew York State ADAPLess than 435% of FPL and less than $25,000 in liquid assets per householdU.S. citizenship is not required. HIV pre-exposure prophylaxis (PrEP) is also available for HIV-negative persons at risk of infection. Home care services are also available through an approved provider, up to a lifetime benefit of $30,000.
North CarolinaNorth Carolina ADAPLess than 300% of FPLPersons on Medicare with incomes less than 150% of FPL are required to apply for the Low-Income Subsidy (LIS) with the Social Security Administration.
North DakotaNorth Dakota ADAPLess than 400% of FPL 
O hioOhio HIV Drug Assistance Program (OHDAP)Less than 300% of FPLApplicants are required to provide household income (including that from spouse and dependents) when making application.
OklahomaOklahoma HIV Drug Assistance ProgramLess than 200% of FPL for those with no insurance Assistance with insurance premiums, co-pays and deductibles available to those who income is less than 400% of FPL.
OregonCAREAssistLess than 500% of FPL 
PennsylvaniaSpecial Pharmaceutical Benefits Program (SPBP)500% of FPL 
Puerto RicoPuerto Rico ADAPLess than 200% of FPL for Puerto Rico 
Rhode IslandRhode Island  ADAPLess than 400% of FPL 
South CarolinaSouth Carolina ADAPFrom less than 300% of FPL to less than 550% of FPL, depending on programDirect Dispensing Program (DDP) provides drugs through a mail-order provider and is available to persons with incomes under 300% of FPL. Medicaid B Assistance Program (MAP) also provides drugs through a mail-order provider and is available to persons with incomes under 550% of FPL. Assistance with insurance premiums, copays, and deductibles are provided through the Insurance Assistance Program (IAP) and are available to persons with incomes under 550% of FPL.
South DakotaSouth Dakota ADAPLess than 300% of FPL 
TennesseeTennessee ADAPLess than 400% of FPL and household assets less than $8,000 
TexasTexas HIV Medication Program (THMP)Less than 200% of FPL 
VermontVermont Medication Assistance Program (VMAP)Less than 500% of FPL 
VirginiaVirginia ADAPLess than 400% of FPL 
WashingtonEarly Intervention Program (EIP)Less than 400% of FPL 
West VirginiaWest Virginia ADAPLess than 400% of FPL 
WisconsinWisconsin HIV/AIDS Drug Assistance ProgramLess than 300% of FPL 
WyomingWyoming HIV Treatment ProgramVaries by county of residence (see current income eligibility guidelines) 
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  • Available only to persons who are ineligible for health insurance coverage. However, insurance assistance is available to persons with income of less than 400% of FPL.