1. Patient Assistance Programs Overview Virginia Department of Health HIV Care Services Unit November 2010

2. Objectives 1. Describe how to help clients navigate and access these programs. 2. Understand what Patient Assistance Programs (PAPs) are, the various eligibility requirements, and how to use them. 3. Identify medication access options during current AIDS Drug Assistance Program (ADAP) funding crisis.

3. PAPs-What are they? PAPs provide free or low-cost drugs to individuals who cannot otherwise afford them. There are multiple options and companies. Each pharmaceutical company has specific criteria and eligibility requirements for each program.

4. Whats next? How do I get medications? First Step – Refer all clients to Patient Services Inc. (PSI) to apply for ADAP, verify eligibility, and place on waitlist if appropriate. Who can access PAPs? – A physician can register as a provider – An individual can enroll on their own; however they will still need information from their provider/physician 1-866-392-1309

5. Resource tool Resource tool provides information from all PAPs including non-antiretrovirals (non- ARVs) removed from the formulary: – Drug company/drug – Eligibility – Turnaround time – Medication delivery method – Refill method – Length of enrollment

6. Application Overview All applications will require: – Patient name, address, phone, date of birth – Provider name, address, phone, fax, drug enforcement agency number (DEA) – Prescription information – Financial information – Insurance information (Y/N, ADAP waitlist)

7. Overview of Low Cost Generics A list of available low cost generics for medications that have been removed from the ADAP formulary has been compiled. (see resource tool). Low cost generic medications are available at several retail pharmacies throughout the state and cost approximately $4 each for a 30-day supply.

8. If a patient is denied for ADAP, could they be eligible for other Ryan White (RW) services? Potentially, denied clients may be eligible for core and support services and are encouraged to apply for RW. However, RW Part B funds may not be used for the financial support of medications removed from the ADAP formulary. Please note: if a client is denied for ADAP, RW Part B funds cannot be used to purchase medications on the ADAP formulary.

9. Challenges Client may be on multiple medications from different drug companies. May be delivered at different times. Some drugs may be delivered to patient, some may be delivered to provider. A card/voucher may also be sent to the client. ADAP stakeholders have a variety of experience utilizing PAPs.

10. Tips for a smooth application process Review the application and make sure it is complete and that all documents are attached. Keep a copy of application package for your records. Follow instructions for each program since they are all different. Follow up with the company if you do not hear from them in 2-3 weeks.

11. Who do I contact? Each pharmaceutical company has individual requirements for PAPs; it is best to contact each company directly. Most companies have a designated website or toll-free number to receive information regarding PAPs.

12. Lessons Learned from other states using PAPs Educate stakeholders as early as possible on PAP process and medication access. Develop comprehensive tool with PAP resources for antiretrovirals (ARVs). Encourage case managers to communicate with the local health department ADAP staff and vice versa. Include links to PAPs on ADAP website.

13. PAP Resources NeedyMeds- http://www.needymeds.org/ NeedyMedshttp://www.needymeds.org/ (also for HCV drugs and vaccines) Partnership for Prescription Assistance- http://www.pparx.org/ Partnership for Prescription Assistance http://www.pparx.org/ RxAssist Patient Assistance Program Center- RxAssist Patient Assistance Program Center http://www.rxassist.org RxHope- https://www.rxhope.com/home.aspx RxHope

14. Virginia Health Care Foundation (VHCF) Provides medication assistance through free and community health clinics across Virginia. Utilizes a software program that finds PAPs for all of patients medications www.vhcf.org

15. Welvista Patient Assistance- http://www.welvista.org/adap_how.php Welvista Patient Assistance http://www.welvista.org/adap_how.php Covers six ARVs (Abbott, Merck & Tibotec)- Norvir, Kaletra, Isentress, Crixivan, Prezista and Intelence Only available for clients who are currently on a waiting list for a state ADAP. Other Patient Assistance Programs

16. Other Resources www.HIVCaseManager.com A free, innovative online resource directory designed to help front-line HIV service providers meet their client education needs. Links to more than 200 national, state and city HIV/AIDS organizations and resources.

17. Additional information needed? Please contact: ADAP Coordinator: Rachel Rees 804-864-7919 Rachel.Rees@vdh.virginia.gov ADAP Operations Specialists: Jennifer Flannagan 804-864-7360 Jennifer.Flannagan@vdh.virginia.gov Or Kate Cooke 804-864-8019 Kate.Cooke@vdh.virginia.gov Or HIV/STD/Viral Hepatitis Hotline 1-800-533-4148