Getting HIV Drugs in the U.S.
November 28, 2015
The Ryan White HIV/AIDS Program includes the AIDS Drug Assistance Program (ADAP), which is funded by the federal government to help pay for HIV drugs for people who might not be able to afford them otherwise. Each state provides it own coverage, and your local ADAP office can let you know which drugs it pays for and what the income limits are for your state.
Some states have a waiting list for ADAP. In other states, the ADAP program is big enough to cover not only HIV drugs, but also labs, some medical care, and non-HIV medications, like those used to manage side effects and other chronic diseases.
The Ryan White program can also pay for doctor visits and support services for people living with HIV. In some instances, HIV-negative family members can receive support through a Ryan White program for women and/or children living with HIV. To find out more about the Ryan White program in your state, call your state's HIV/AIDS hotline.
Medicaid is a government-sponsored insurance program that covers healthcare and medications. If you are disabled, not working, or earning little money, you may qualify for Medicaid. Like ADAP, each state has its own program so you will need to talk to a local Medicaid worker in order to apply. The ACA will enable states to provide access to Medicaid for people living below 138 percent of the federal poverty level. In addition, Medicaid eligibility will now be determined based on income alone; disability status will no longer be required.
It is important to note that only some states have chosen to expand their Medicaid coverage and change their eligibility requirements through the ACA. Many of the states that have decided not to expand Medicaid are also the states where the highest numbers of people living with HIV live. To see a list of which states have chosen/not chosen to expand Medicaid coverage (as of November 2, 2015), go here.
If you are pregnant and living with HIV, it is important to check to see if you qualify for Medicaid. In order to provide HIV treatment and prenatal care, income limits are increased for pregnant women. Medicaid may pay for your prenatal care, including counseling and medicines to prevent you from passing HIV to your baby. You may be able to stay on Medicaid for some time after you deliver your baby -- how long depends on the rules in your state.
Medicare is a government-sponsored insurance program for people over 65 and those who are disabled or blind. Part D of Medicare pays for medications. The ACA will gradually close the gap in Medicare's prescription drug benefit (Part D) known as the "doughnut hole." The doughnut hole refers to the amount between total drug costs (what you and your plan spend in drugs) and a person's total out-of-pocket spending maximum for the year (this includes any co-pays, co-insurance, and deductibles). In addition, ADAP payments for prescription drugs are now considered contributions toward the True Out of Pocket Spending Limit (TrOOP) for Part D, which means that people can move through the doughnut hole more quickly.
For more information on ADAPs, Medicaid, and Medicare, see the Health Benefits section of The Well Project's Public Benefits and HIV in the US article.
This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
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