South Dakota AIDS Drug Assisstance Program Formulary

South Dakota ADAP Formulary
Which drugs are covered?

All drugs are listed by catagory and alphabetically, starting with their generic names followed by the brand names in parenthesis. Click on a high-lighted item in green to see a detailed description of the drug. To search for a specific drug, hold down both the control key (command key on the Mac) and the F key, then type in the drug name. For a list of specific medical criterias, see the bottom of this page.

Antiretroviral
Nucleoside/tide Reverse Transcriptase Inhibitor (NRTI) abacavir (Ziagen) abacavir/lamivudine/zidovudine (Trizivir) didanosine (ddI, Videx, Videx EC) emtricitabine (Emtriva) lamivudine (Epivir, 3TC) lamivudine/zidovudine (Combivir) stavudine (d4T, Zerit) tenofovir (Viread) zalcitabine (ddC, HIVID) zidovudine (AZT, Retrovir)	Protease Inhibitor (PI) None.	Non-nucleoside Reverse Transcriptase Inhibitor (NnRTI) delavirdine (Rescriptor) efavirenz (Sustiva) nevirapine (Viramune)

HIV Drug Resistance Tests: Both Genotypic and Phenotypic tests are covered by Title II CARE Program, with a maximum benefit at $1,500/year/client.

Opportunistic Infection (OI) Treatment & Prophylaxis
Public Health Service Recommanded OI drugs acyclovir (Zovirax) azithromycin (Zithromax) clarithromycin (Biaxin) famciclovir (Famvir) fluconazole (Diflucan) itraconazole (Sporanox) leucovorin pyrimethamine (Daraprim) TMP/SMX (Bactrim/Septra)	Other OI drugs atovaquone (Mepron) ciprofloxacin (Cipro) clofazimine (Lamprene) clotrimazole (Mycelex)	dapsone ethambutal (Myambutal) paramomycin (Humatin) pentamidine (NebuPent) rifabutin (Mycobutin) valacyclovir (Valtrex)

isoniazid, pyrazinamide, and rifampin are covered through the TB Program.

Wasting
megestrol acetate (Megace)

Other
acetaminophen/codine amitriptyline (Elavil) divalproex sodium (Depakote)	gabapentin (Neurontin) fentanyl (Duragesic) morphine MS Contin	phenytoin (Dilantin) prochlorperazine (Compazine) propoxyphene (Darvocet)

Medical Criteria
Limit of $7,000 / year in benefits to each client. If a client utilizes their maximum benefit in a program area, the client is kept on the program but is inactive for that program area until the beginning of the next fiscal year. An inactive client's health care providers would be notified in writing that no further benefits will be paid by the Ryan White Title II program for that individual in the current fiscal year. Case management will continue to be available to inactive clients. Before purchasing prescription drugs, the client is responsible for contacting the Ryan White CARE Program in order that a direct-billing arrangement with the client's pharmacy can be set up. If a client has not utilized benefits for 3 months, they will be considered no longer in need of services and will be excluded from the program. Clients excluded from the program will need to reapply for the program. All drugs will be reimbursed at the Medicaid rate to the pharmacy and are the oral form unless otherwise stated. Generics will be used when available.

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South Dakota ADAP FormularyWhich drugs are covered?

South Dakota ADAP Formulary
Which drugs are covered?