Drug Assistance Program

The goal of the Alabama AIDS Drug Assistance Program (ADAP) is to reduce associated morbidity/mortality among HIV infected persons by delaying the progression of HIV disease through prevention and treatment of HIV complications.

ADAP Annual Report

The ADAP Annual Report is now available. This report reflects the number of clients actively enrolled in ADAP as of December 31, 2016. ADAP clients achieve optimal health outcomes at a higher rate than all persons living with HIV in Alabama, with the majority of ADAP clients already surpassing or approaching the National HIV/AIDS Strategy (NHAS) 2020 goals for 90 percent retention in HIV medical care and 80 percent viral suppression.

Alabama AIDS Drug Assistance Program (ADAP) Satisfaction Survey

The ADAP Satisfaction Survey is designed to help improve ADAP medication services. The survey should take approximately 5-10 minutes to complete, and answers and comments will remain anonymous. Take the survey.

ADAP Patient Activity Open Enrollment

Updated: August 17, 2017
Active: 780
Medcap: 87

Forms

Alabama's Ryan White Part B Program Eligibility Standards (March 2017)

Alabama RWHAP Part B Income Eligibility Guidelines (March 2017)

Alabama RWHAP Part B Annual Certification/Recertification Schedule (July 2017)

BCBS Authorization for Disclosure of Protected Health Information (January 2017)

BCBS Eligibility Coordination of Benefits (November 2015)

BCBS Dental Binding Arbitration (August 2017)

Ryan White Part B Program Authorization for Release of Protected Health Information (May 2017)

Ryan White Part B Certification Statement (October 2016)

Ryan White Part B Services Statement of No Income (November 2016)

Ryan White Part B Services Statement of Temporary Housing (October 2016)

Ryan White Part B Services Self-Attestation Document (October 2016)

Ryan White Part B Services/MEDCAP Standard Application Form (March 2017)

MEDCAP Certification Statement (October 2016)

MEDCAP Enrollment Guidance (May 2017)

MEDCAP Bi-Annual Client Eligibility Review (CER) Guidance (March 2017)

MEDCAP Self-Attestation Document (March 2017)

ADAP-MEDCAP Formulary Information (March 2017)

ADAP - MEDCAP Prescription Form (June 2017)

ADAP Formulary (June 2017)

ADAP Manifestación de certificación del cliente (January 2009)

Fuzeon Pre-Approval Checklist (October 2014)

Maraviroc (Selzentry™) Pre-Authorization Form (October 2014)

Procrit Pre-Approval Form (October 2014)

National Monitoring Standards Basics (May 2013)

Universal Monitoring Standards (May 2013)

National Monitoring Standards Ryan White Part B Grantees: Program Part B (May 2013)

Contact Us

Alabama AIDS Drug Assistance Program
HIV/AIDS Division
Alabama Department of Public Health
The RSA Tower
201 Monroe Street, Suite 1400
Montgomery, AL 36104
Phone: 1-866-574-9964
Fax: (334) 206-6221


Page last updated: September 19, 2017