Anti-HIV Drugs
* after a drug means it requires prior approval
![[Intelence]](../../../gifs/2008/intelence.jpg)
![[Rescriptor]](../../../gifs/rescriptor.gif)
![[Sustiva]](../../../gifs/Sustiva.gif)
![[Sustiva and Truvada]](../../../gifs/Atripla.gif)
![[Viramune]](../../../gifs/viramune.gif)
Non-nucleosides (Non-Nukes or NNRTIs)
- Intelence - etravirine
- Rescriptor - delavirdine
- Sustiva - efavirenz
- Atripla - Multi-Class. efavirenz, tenofovir and emtricitabine
- Viramune - nevirapine
![[Reyataz]](../../../gifs/Reyataz300.gif)
![[Prezista]](../../../gifs/Prezista.gif)
![[Lexiva]](../../../gifs/Lexiva.gif)
![[Crixivan]](../../../gifs/crixivan.gif)
![[Kaletra]](../../../gifs/Kaletra_tablet.gif)
![[Viracept 625]](../../../gifs/Viracept625.gif)
![[Norvir]](../../../gifs/norvir.gif)
![[Invirase]](../../../gifs/Invirase500.gif)
![[Aptivus]](../../../gifs/Aptivus.gif)
Protease Inhibitors
- Reyataz - atazanavir
- Prezista - darunavir
- Lexiva - fosamprenavir
- Crixivan - indinavir
- Kaletra - lopinavir/ritonavir
- Viracept - nelfinavir
- Norvir - ritonavir
- Invirase - saquinavir mesylate
- Aptivus* - tipranavir
Covered Drugs and Tests
New York ADAP and ADAP Plus - Both Genotypic and Phenotypic tests are covered. ADAP will pay for a maximum of three tests total (geno or pheno) in a patient year. This is the same limitation used by NYS Medicaid.
New York State calls Atripla a multi-class drug, since it has one component that is an NNRTI and two that are NRTIs. Certain anti-HIV combinations may be subject to "utilization review thresholds", which means they may question your doctor if you are taking a combination of 5 or 6 drugs or higher doses than typically used.
Request Form and Guidelines available by calling 1-800-542-2437. Some antiretroviral combinations may be subject to utilization review thresholds. New York ADAP also covers hydroxyurea, a cancer drug sometimes used in the treatment of HIV disease.
![[Fuzeon]](../../../gifs/2008/Fuzeon.jpg)
Entry Inhibitors
- Fuzeon* - enfuvirtide
![[Isentress]](../../../gifs/2008/isentress.jpg)
Integrase Inhibitors
- Isentress - raltegravir
![[Isentress]](../../../gifs/2008/maraviroc.jpg)
CCR5 co-receptor inhibitors
- Selzentry - maraviroc
![[Ziagen]](../../../gifs/ziagen.gif)
![[Epzicom]](../../../gifs/Epzicom.gif)
![[Trizivir]](../../../gifs/Trizivir.gif)
![[Videx EC]](../../../gifs/videxec.gif)
![[Emtriva]](../../../gifs/Emtriva.gif)
![[Truvada]](../../../gifs/Truvada.gif)
![[Epivir]](../../../gifs/epivir.gif)
![[Combivir]](../../../gifs/combivir.gif)
![[Zerit]](../../../gifs/zerit.gif)
![[Viread]](../../../gifs/Viread.gif)
![[Retrovir]](../../../gifs/retrovir.gif)
Nucleoside/tides (NRTIs or nukes)
- Ziagen - abacavir
- Epzicom - lamivudine/abacavir
- Trizivir - abacavir/lamivudine/zidovudine
- Videx - didanosine
- Emtriva - emtricitabine
- Truvada - emtricitabine/tenofovir
- Epivir - lamivudine
- Combivir - lamivudine/zidovudine
- Zerit - stavudine
- Viread - tenofovir
- Retrovir - zidovudine
Opportunistic Infection (OI) Treatment or Prevention
- PCP Prophylaxis and Treatment : clindamycin, dapsone, leucovorin, pentamidine, primaquine, sulfadoxine/pyrimethamine, trimethoprim, trimethoprim/sulfamethoxazole
- Herpes Infections : acyclovir, penciclovir, valacyclovir
- Mycobacterial Infections (TB and MAC) : amikacin, azithromycin, capreomycin, ciprofloxacin, clarithromycin, cycloserine, ethambutol, ethionamide, gatifloxacin, isoniazid, kanamycin, moxifloxacin, ofloxacin, para-amino salicyclic acid, pyrazinamide, rifabutin, rifampin, rifampin in combination, rifapentine, streptomycin
- CMV disease :fomivirsen, foscarnet, ganciclovir, cidofovir, probenecid, valganciclovir
- Fungal infections :amphotericin B, caspofungin, clotrimazole, econazole nitrate, fluconazole, flucytosine, griseofulvin, itraconazole, ketoconazole, miconazole, nystatin, terbinafine, terconazole, voriconazole
- Toxoplasmosis :azithromycin, clindamycin, leucovorin, pyrimethamine, sulfadiazine, sulfamethoxazole, triple sulfa
- Cryptosporidiosis : paromomycin
- Microsporidiosis : albendazole
New York Resources
- State Programs and Contact Information
- Case Management and Support Services
- HIV Treatments
- Hepatitis Resources
Hepatitis B and Hepatitis C Treatments and Vaccines are covered
Medical Criterias
- Mandatory Generics : ADAP will cover only the generic form of A-rated drugs
- Cardiac medications listed individually are available in combination with other listed cardiac medications.
- IVIG is restricted to prevention of bacterial infections in children ONLY.
- Methadone is covered only for pain relief, ADAP does not cover methadone maintenance
Other HIV/AIDS Related Conditions
- Anemia : Epoetin alfa for AIDS related anemia, with: Hct < 30% and/or Hgb < 10g/dl;and serum erythropoietin levels < 500mU/ml.
- Neutropenia : Sargramostim or Filgrastim for severe neutropenia due to chemotherapy, or drug toxicity, or HIV disease with ANC < 500/mm3.
- Thrombocytopenia (HIV-associated) : Immune globulin Rho (Win Rho SDF) for HIV-associtaed thrombocytopenia with platelets < 20,000 mm3. Prior authorization is not required for children.
- Thrombocytopenia (chemotherapy induced) : Oprelvekin (Neumega) for chemotherapy induced thrombocytopenia with platelet count < 20,000/ul. and/or documented risk factors or clinical indications.
- Wasting Syndrome :cyproheptadine, dronabinol, testosterone, megestrol acetate, thalidomide, nandrolone
- Prevention of bacterial infections in children ONLY : intravenous immune globulin
- Condyloma acuminata :alpha N3, imiquimod, podofilox
- Reiter's syndrome :ansaid, sulfasalazine
- Prevention of dental cavities : fluoride
- Venous thrombosis : enoxaparin, warfarin