North Carolina

• North Carolina ADAP Website
• North Carolina Medicaid
• North Carolina Medicaid Enhanced Pharmacy Program
• North Carolina Information for Medicaid Consumers
• North Carolina Medicare
• North Carolina Medicare Part D

AIDS Drug Assistance Program (ADAP)

• Steve Sherman
  Coordinator
  NC AIDS Drug Assistance/HIV Medications Program (ADAP)
  HIV/STD Prevention and Care Branch
  Phone: (919) 715-3111
  steve.sherman@ncmail.net


• Sally Kohls
  Nurse Consultant
  ADAP, HIV/STD Prevention and Care Branch
  Phone:(919) 733-9602
  sally.kohls@ncmail.net


• Purchase of Medical Care Services
  (applications processed by client's last name)
  
  (A-D, O) - Toni Wallace - (919) 855-3668
  (R-T, V, W) - Glenys Spencer - (919) 855-3665
  (F-L) - Mike Benson - (919) 855-3666
  (E, I, M, N, P, Q, U, X-Z) - Febby Manuel - (919) 855-3667
  
  General Info - Christy Bradsher - (919) 855-3652

Eligibility

The Program purchases the medications in bulk from a pharmaceutical wholesaler, and a central pharmacy dispenses and sends the prescriptions for each client to the client's designated address. In order for someone to be eligible for ADAP, the individual must:

• Be HIV+ (have HIV disease or AIDS)
• Reside in North Carolina
• Have a gross family income that is at or below 200% of the federal poverty level
• Not have any other third-party coverage* (e.g., private insurance, Medicaid or Medicare) that enables them to obtain their medications
• Have a (or several) prescription(s) for medications that are included in the ADAP formulary (list of drugs that the Program will pay for)
• * There may be some circumstances in which exceptions will be considered; please contact the ADAP Program

How to Apply for the program

• An individual who wants to apply for ADAP coverage should talk to their clinician or the person in the office who handles bills and/or insurance, their HIV case manager, or someone at one of NC's HIV Care Consortia, at any local/public health department, or at an AIDS service organization/agency.


• The applicant, with the assistance of these individuals, will complete two forms; one to establish that the individual qualifies financially for the Program and one to document their HIV+ status, their need for medications provided under this Program and a mailing/delivery address for the medications. These two forms are then sent to the Office of Purchase of Medical Care Services for a final determination of eligibility.


• The individual and their "case manager" will be advised if the applicant is eligible for and if they have been enrolled in the Program. Prescription information may either be captured on the central pharmacy's enrollment form and faxed to the central pharmacy or the actual prescriptions may be mailed to the central pharmacy.


• These three forms, along with the POMCS provider/instruction manual can be found and downloaded here

Is there any cost to the individual?

• There is no cost to the individual covered under this Program for the drugs that are on the Program's formulary. The individual is responsible for the cost of other drugs that they receive which are not covered by the Program.

About North Carolina

• State and National Resources - North Carolina specific contact information for different programs through which you can access a variety of services. This page also includes national resources, and links to other sources.


• North Carolina Resources and HIV Care Providers : North Carolina has Resources that can either provide or refer you to a case manager or a health care provider. This is funded by the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. The participating agencies are listed, as are some other resources.


• Accessing Treatments and other Resources : North Carolina covers treatments and services through several programs. Other potential sources of treatments for people with HIV or Hepatitis are also listed.


• Hepatitis Resources : North Carolina has Hepatitis vaccination programs, and covers some treatments for hepatitis B and Hepatitis C through their program.

Waiting List? - Sometimes a state has a waiting list people have to stay on until spaces become available. Check to see if there is a waiting list for the program by contacting them directly. According to NASTAD's most recent ADAP Watch . North Carolina does not have a waiting list. Otherwise, you may need to try a Patient Assistance Program or apply for Medicaid or Medicare or private insurance. Do not ever drop your private insurance without first seeing if your state will cover part or the whole premium, especially if you have children.


• Patient Assistance Programs : the pharmaceutical industry has set up programs that offer medications for free, or at a very low price. You may have to apply directly to a specific company, or use a national service set up by a group of companies called pparx.org. There are also other companies that charge a fee for applying to these programs. Your doctor or another member of your health care team like a case manager will usually help you out to apply, although some times you need to apply to more than one company.


• Medicaid - HIV medications are covered by government programs and most private insurance. Many people with HIV disease are covered by Medicaid. If your are on Medicaid there is a wide range of services and care that are covered. You will be switched over to Medicaid if you become eligible for that program while on ADAP. This may happen if, for example, you are using ADAP to help you with your Spenddown. If you have any questions contact The Access Project (network@atdn.org) and we'll help to explain how this affects your access to drugs and care for HIV and related conditions.


• Medicare and Medicare Part D - Some people with HIV are on Medicare. Many people must apply for a Medicare Part D program to cover the costs of their medications. If you are eligible for Medicare Part D, then you will probably be switched to that instead of ADAP. In some cases ADAP will then pay for your co-pays for drugs and possibly even your Medicare Part D monthly premium. Once you reach a certain point with regards to drug expenses, however, you must somehow cover a $2,700 expense, called the doughnut hole, before your drugs are covered again by Medicare Part D. Some people end up joining ADAP again because they just don't have the money. Each state is different right now, so keep in close contact with your case manager to make sure you know of all your access options. As with Medicaid, contact us if you have questions that have not been answered by the websites listed here, your health care providers or your Case Manager. We will also go over what your case manager has set up if you like, or provide you with case management support and resources.


• Confused or Have Questions? You can always contact The Access Project (theaccessproject@atdn.org) by e-mail or phone and ask questions about all this information. We are a non-profit, community based organization whose goal is to help you access the care and resources you need. There are also many excellent resources that provide extensive descriptions and information about these programs. Check out NASTAD's list of publications for comprehensive descriptions of Medicaid, Medicare, Medicare Part D, ADAP and other important topics. Other links are also listed throughout The Access Project and the AIDS Treatment Data Network website pages.