Four Ways to Access Meds
Most people in the United States get their medications through insurance -- either public insurance like Medicaid or Medicare, or private insurance. A comprehensive insurance plan that pays for doctor's visits, hospital and home care, prescriptions and other services is the best way to get quality HIV care. But what do you do if you don't have and can't get complete coverage?
If you can't afford or obtain private insurance, you may have other options. In addition to Medicaid and Medicare, states and even some localities may have services to help you obtain insurance or access care. Some programs, however, don't cover prescription drugs. For example, Medicare (the national insurance program for the elderly and some disabled persons) doesn't cover prescriptions. A description of some of the main drug assistance programs follows.
If you have questions about these programs or need information about how to qualify and participate, call Project Inform's Hotline at 1-800-822-7422. The Hotline will help you explore your options and link you to local resources. For more information on Medicaid and AIDS Drug Assistance Programs, visit www.aidsinfonyc.org/network/access.
AIDS Drug Assistance Program (ADAP) is a federal and state program that provides HIV-related medications to uninsured and underinsured people who can't otherwise afford them. All 50 states, the District of Columbia, Puerto Rico, Guam and the Virgin Islands have ADAPs. Benefits and eligibility vary from state to state. Due to inadequate funding, some ADAPs may experience shortages that limit services in the upcoming year. You can sign up at offices in various locations.
Patient Assistance Programs (PAPs) are run by drug companies. They provide prescription drugs to people without means of getting the drug. The eligibility criteria are not public but do include income limits. PAPs can be more difficult to use because each company has a separate program with its own application process. You have to re-apply fairly often. Usually, your doctor or medical advocate has to fill out paperwork. Some companies also charge a small co-payment each time you get your drugs. You can sign up by contacting the company that makes the drug you need.
Experimental drugs: Sometimes you may need or want an experimental drug not yet approved by the Food and Drug Administration. Because less is known about experimental drugs, it's important to consult closely with your doctor before making decisions. There are two ways you can get these drugs. Expanded access programs are run by drug companies. They allow people who meet certain medical criteria to get experimental drugs. You sign up through your doctor's office. Compassionate use typically does not have pre-set criteria. Working with your doctor, you can apply to get the drug, and the company then decides on a case-by-case basis.
Clinical studies may be run by drug companies or academic institutions. They are research studies and not meant to provide ongoing treatment or care. However, there may be good reasons to consider enrolling. Work closely with your doctor and make sure you read and understand the study's informed consent form. Informed consent is a document that details the study, known risks of the experimental drug and your rights as a research subject. It can be technical and confusing. Be sure your questions are answered before you sign and enter the study.
This article was provided by Project Inform. It is a part of the publication WISE Words. Visit Project Inform's website to find out more about their activities, publications and services.