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How to Become an Insider

How to Become an Insider

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So you think you might need to take the ADAP plunge? Hold your breath. Here are some tips for making a slam dunk application. To qualify, your income must fall below your state's cutoff point, which ranges between 125% of the federal poverty level in North Carolina and 500% in such states as New York and New Jersey. (The 2003 federal poverty level for an individual is $8,980 and below in annual income and is slightly higher in Hawaii and Alaska. For a complete list, gauging family size, go to www.atdn.org/access/poverty.html.) You can access a spreadsheet that has each state's cutoff level, the number of drugs on its formulary, and if it has a waiting list for entry, by going to www.kff.org/content/2003/20030430a, clicking on the 'report' link, and scrolling down to page 11 of the report. Some states may also have limits for your total assets, CD4-cell count, or other medical criteria. If you are eligible for any other form of health coverage, ADAP will not provide you drug coverage. However, if you cannot afford your policy's deductibles, premiums, or copayments (this includes COBRA plans), or if you are underinsured, many ADAPs will pick up the tab or fill in the blanks. In many states a program will even purchase you a new plan. To find the number for your state ADAP office, call your county or state health department, the National STD and AIDS Hotline at (800) 342-2437, or go to www.thebody.com/sfaf/drugassist.html. You might also want to seek assistance from a case manager at a local AIDS service organization. Ask the ADAP official or case manager exactly what kind of documents you will need and how current they have to be. You must provide proof that your are HIV-positive'ask for a letter from your doctor or testing site. ADAP may require recent lab reports, including viral load, CD4-cell count, as well as other medical information, such as your past immunizations. For the financial data, last year's tax return should suffice. If your income has dropped this year, other forms of proof include recent pay stubs (including unemployment) or a letter from Social Security. People with especially dubious sources of income, such as freelancers, may have to sign an affidavit about their income status. Some states require an interview along with the application; some do not. Once you submit, the approval usually comes through in a day or so, at which point you will be issued an ADAP prescription card that can be used only at the pharmacies through which your state program contracts. Some states use major chain pharmacies; others rely on county health departments or mail order. Keep in mind that unless ADAP is paying for your outside insurance, its coverage is usually only for prescriptions, not medical care (New York is a major exception, but even there, the medical coverage is not all-purpose), and the variety of prescriptions offered may be very limited. In some localities, Ryan White Act money exists to pay for doctor visits and lab work as well as for drugs not on an ADAP formulary and, in some cases, nutritional supplements. Also, participation in the program does not provide you protection under the Health Insurance Portability and Accountability Act, which protects Americans from 'preexisting condition' restrictions when beginning a new insurance plan, provided their insurance coverage has not lapsed longer than 62 days. If you are wait-listed, you may be able to obtain drugs through pharmaceutical companies' patient assistance programs. For more information on these, go to www.phrma.org, or call (202) 835-3400. There are also groups that collect unused drugs from patients and redistribute them to those in need'ask at your local AIDS service organization. And keep in mind not to make too much money as the year goes by: ADAPs require periodic reauthorization.

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Benjamin Ryan

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