Are you uninsured? If you do have health coverage, are your prescription co-pays or other co-insurance costs prohibitively expensive? Or does your health plan come with high medication deductibles that you can’t afford? Help may be available from the following:

Cost-sharing Assistant Programs (CAPs)

Patient Assistance Programs (PAPs)

AIDS Drug Assistance Program (ADAP)

Medicaid

Different assistance programs have different eligibility criteria based on the federal poverty level (FPL). Eligibility for this year is based on last year’s income. The figure is adjusted based on family or household size. A complete table is available here. Unless otherwise stated, companies ask for verification of income, usually in the form of a federal income tax return. Companies also generally consider household income, meaning that a married couple that files joint taxes will be judged on their combined income. People who file individual income tax returns will only have their individual income considered. In many cases, if you are told you are ineligible for assistance, you can appeal to have the decision reversed.

COST-SHARING ASSISTANCE PROGRAMS (CAPs)

These programs offer cost-sharing assistance (including deductibles, co-payments and co-insurance costs) to people with private health insurance to obtain HIV drugs at the pharmacy.


AbbVie (formerly Abbott)
Drugs covered: Kaletra, Norvir
Contact Information: 800-441-4987 / option 5, or go to the product websites (e.g. www.kaletra.com)
Program Details: The program covers the first $400 per month with a $4,800 per year maximum for Kaletra, and up to $100 per month with a $1,200 per maximum for Norvir. Must reapply each year.

Bristol-Myers Squibb
Drugs covered: Evotaz, Reyataz and Sustiva
Contact Information: 888-281-8981 for Evotaz, Reyataz or Sustiva, or go to  https://bmsdm.secure.force.com/bms3assist/copay
Program Details: The program covers up to $7,500 per year with no monthly limit.

Genentech
HIV Drugs covered: Fuzeon and Invirase
Contact Information: 866-422-2377, or go to www.genentech-access.com
Program Details: The program covers all out-of-pocket costs for Fuzeon prescriptions for individuals who: 1) have insurance, 2) have an annual household income of $150,000 or less, 3) spend 5% or more of their annual household income for Genetech prescriptions, and 4) have exhausted all other patient assistance options.

Gilead Sciences
Drugs covered: Atripla, Biktarvy, Complera, Descovy, Emtriva, Genvoya, Odefsey, Stribild, Truvada, Tybost, Viread
Contact Information: 877-505-6986, or go to product websites (e.g. www.truvada.com)
Program Details: The program covers the first $7,200 per year of co-payments for Biktarvy and Genvoya; the first $6,000 per year of co-payments for Atripla, Complera, and Stribild; the first $4,800 per year of co-payments for Descovy and Truvada; the first $300 per month/$3,600 per year of co-payments for Emtriva and Viread; and the first $50 per month/$600 per year of co-payments for Tybost. The program automatically renews annually for enrolled patients.

Janssen Therapeutics
Drugs covered: EdurantIntelence, Prezcobix, Prezista, Symtuza
Contact Information: 877-227-3728 or www.janssencarepath.com/.
Program Details: The program covers the first $7,500 per year of co-payments, deductibles and co-insurance for Edurant, Intelence, Prezcobix and Prezista. The program covers the first $10,500 per year for Symtuza. Must reapply for the program each year.

Merck & Co.
Drugs covered: Delstrigo, Isentress, Isentress HD, Pifeltro
Contact Information: 800-727-5400 or https://www.activatethecard.com/7726/#.
Program Details: The program covers out-of-pocket costs up to a maximum total program savings of $6,800. Coupon may be redeemed once every 21 days before the expiration date printed on the coupon, on each qualifying prescription up to 180 tablets each. Must reapply after the coupon expires.

ViiV Healthcare
Drugs covered: Juluca, Lexiva, Retrovir, Rescriptor, SelzentryTivicay, Trizivir, Triumeq, Viracept, and Ziagen
Contact Information: 844-588-3288 or visit www.viivconnect.com.
Program Details: Tivicay, Juluca and Triumeq have a $7,500 per year/per individual maximum. Lexiva, Rescriptor, Selzentry, Retrovir, Ziagen, Trizivir and Viracept have a $4,800 per year/per individual maximum.

PATIENT ASSISTANT PROGRAMS (PAPs)

Patient Assistance Programs (PAPs) offer free or low-cost HIV medications to people who do not qualify for any other insurance or assistance programs such as Medicaid, Medicare, or AIDS Drug Assistance Programs (ADAPs).

In 2012, the Department of Health and Human Services (DHHS), along with seven pharmaceutical companies, the National Alliance of State and Territorial AIDS Directors (NASTAD), and community stakeholders developed a common patient assistance program application that can be used by both providers and patients. Before, patients and advocates had to fill out different sets of paperwork for each company; the new application should help simplify this process, however the form still has to be sent to each company program you are applying to for assistance. Click here for the form.

HarborPath is a non-profit organization that helps uninsured individuals living with HIV/AIDS gain access to brand-name prescription medicines at no cost, by providing case managers with a single “one-stop shopping” online portal for PAP applications and medication fulfillment through a mail-order pharmacy.


AbbVie
Drugs covered: Kaletra, Norvir
Contact Information: 800-222-6885 or product specific websites (e.g. www.kaletra.com).
Program Details: The program covers individuals with incomes up to 500% of the federal poverty level. No income limits for Norvir.

Boehringer Ingelheim
Drugs covered: Aptivus, Viramune XR
Contact Information: 800-556-8317 or www.boehringer-ingelheim.us/our-responsibility/patient-assistance-program.
Program Details: The program covers individuals with incomes up to 500% of the federal poverty level.

Bristol-Myers Squibb
Drugs covered: Evotaz, Reyataz and Sustiva
Contact Information: 888-281-8981 or www.bms.com.
Program Details: The program covers individuals with incomes up to 500% of the federal poverty level.

Genentech
HIV Drugs covered: Fuzeon and Invirase
Contact Information: 866-422-2377 or www.genentech-access.com/patient.html
Program Details: The program covers annual household income less than $100,000 OR annual household income $100,000–$150,000 and out-of-pocket medication costs exceed 5% of income.

Gilead Sciences
Drugs covered: Atripla, Biktarvy, Complera, Descovy, Emtriva, Genvoya, Odefsey, Stribild, Truvada, Tybost, Viread
Contact Information: 800-226-2056 or www.gileadadvancingaccess.com/ or product-specific website.
Program Details: The program covers individuals with incomes up to 500% of the federal poverty level.

Janssen Therapeutics
Drugs covered: Edurant, Intelence, Prezcobix, Prezista, Symtuza
Contact Information: 800-652-6227 or www.jjpaf.org or product-specific website.
Program Details: The program covers individuals with incomes up to 300% of the federal poverty level.

Merck & Co.
Drugs covered: Crixivan, Delstrigo, Isentress, Isentress HD, Pifeltro
Contact Information: 800-727-5400 or www.merckhelps.com/
Program Details: The program covers individuals with incomes up to 400% of the federal poverty level.

ViiV Healthcare
Drugs covered: Combivir, Epivir, Epzicom, Juluca, Lexiva, Rescriptor, Retrovir, Selzentry, Tivicay, Triumeq, Trizivir, Viracept and Ziagen
Contact Information: 844-588-3288 or www.viivconnect.com.
Program Details: The program covers individuals with incomes up to 500% of the federal poverty level.

AIDS DRUG ASSISTANCE PROGRAMS (ADAP)

The Ryan White CARE Act is the largest federally funded program for people with HIV. It provides care and support services to people who don’t have insurance or don’t have enough coverage through their other plans. Ryan White also provides funding for ADAP. Here’s info on how to find out more about ADAP in your state:


STATE: Alabama
WEBSITEalabamapublichealth.gov/hiv/adap.html
PHONE866.574.9964
STATE: Alaska
WEBSITEalaskanaids.org/index.php/client-services/adap
PHONE907.263.2050
STATE: Arizona
WEBSITEazdhs.gov/phs/hiv/adap/
PHONE602.364.3610 or 800.334.1540
STATE: Arkansas
WEBSITEhealthy.arkansas.gov/programs-services/topics/ryan-white-program
PHONE501.661.2000
STATE: California
WEBSITEcdph.ca.gov/Programs/CID/DOA/Pages/OAadap.aspx
PHONE844.421.7050
STATE: Colorado
WEBSITEwww.colorado.gov/pacific/cdphe/colorado-aids-drug-assistance-program-adap
PHONE303.692.2716
STATE: Connecticut
WEBSITEportal.ct.gov/DSS/Health-And-Home-Care/CADAP/Connecticut-AIDS-Drug-Assistance-Program-CADAP
PHONE800.233.2503 or 860.424.5150
STATE: D.C. (Washington)
WEBSITEdchealth.dc.gov/DC-ADAP
PHONE202.671.4815
STATE: Delaware
WEBSITEdhss.delaware.gov/dph/dpc/hivtreatment.html
PHONE302.744.1050
STATE: Florida
WEBSITEfloridahealth.gov/diseases-and-conditions/aids/adap/
PHONE850.245.4422
STATE: Georgia
WEBSITEdph.georgia.gov/adap-program
PHONE404.463.0416
STATE: Hawaii
WEBSITEhealth.hawaii.gov/harmreduction/hiv-aids/hiv-programs/hiv-medical-management-services/
PHONE808.733.9360
STATE: Idaho
WEBSITEhealthandwelfare.idaho.gov/Health/FamilyPlanningSTDHIV/HIVCareandTreatment/tabid/391/Default.aspx
PHONE208.334.5612
STATE: Illinois
WEBSITEdph.illinois.gov/topics-services/diseases-and-conditions/hiv-aids/ryan-white-care-and-hopwa-services
PHONE800.825.3518
STATE: Indiana
WEBSITEin.gov/isdh/17740.htm
PHONE866.588.4948
STATE: Iowa
WEBSITE

idph.iowa.gov/hivstdhep/hiv/support

PHONE515.725.2011
STATE: Kansas
WEBSITE

kdheks.gov/sti_hiv/ryan_white_care.htm#ADAP

PHONE785.296.6174
STATE: Kentucky
WEBSITEchfs.ky.gov/agencies/dph/dehp/hab/Pages/services.aspx
PHONE866.510.0005
STATE: Louisiana
WEBSITEnew.dhh.louisiana.gov/index.cfm/page/1118
PHONE504.568.7474
STATE: Maine
WEBSITEmaine.gov/dhhs/mecdc/infectious-disease/hiv-std/contacts/adap.shtml
PHONE207.287.3747
STATE: Maryland
WEBSITE

phpa.dhmh.maryland.gov/OIDPCS/CHCS/pages/madap.aspx

PHONE410.767.6535 or 800.205.6308
STATE: Massachusetts
WEBSITEcrine.org/hdap/
PHONE800.228.2714 or 617.502.1700
STATE: Michigan
WEBSITEmichigan.gov/dap
PHONE888.826.6565
STATE: Minnesota
WEBSITE

mn.gov/dhs/people-we-serve/adults/health-care/hiv-aids/programs-services/medications.jsp

PHONE800.657.3761 or 651.431.2414
STATE: Mississippi
WEBSITE

msdh.ms.gov/msdhsite/_static/14,13047,150.html

PHONE888.343.7373 or 601.362.4879
STATE: Missouri
WEBSITEon.mo.gov/2hqrKyE
PHONE573.751.6439
STATE: Montana
WEBSITE

dphhs.mt.gov/publichealth/hivstd/treatmentprogram.aspx

PHONE406.444.4744
STATE: Nebraska
WEBSITEdhhs.ne.gov/publichealth/Pages/dpc_ryan_white.aspx
PHONE402.451.2101
STATE: Nevada
WEBSITE

dpbh.nv.gov/Programs/HIV-Ryan/Ryan_White_Part_B_-_Home/

PHONE775.684.4247
STATE: New Hampshire
WEBSITEdhhs.nh.gov/dphs/bchs/std/care.htm
PHONE603.271.4502 or 800.852.3345 (ext. 4502)
STATE: New Jersey
WEBSITE

state.nj.us/health/hivstdtb/hiv-aids/medications.shtml

PHONE877.613.4533
STATE: New Mexico
WEBSITE

nmhealth.org/about/phd/idb/hats/

PHONE505.476.3628
STATE: New York
WEBSITEhealth.ny.gov/diseases/aids/resources/adap/
PHONE800.542.2437
STATE: North Carolina
WEBSITEepi.publichealth.nc.gov/cd/hiv/hmap.html
PHONE919.733.3419
STATE: North Dakota
WEBSITEndhealth.gov/hiv/Resources/
PHONE701.328.2379
STATE: Ohio
WEBSITEodh.ohio.gov/odhprograms/hastpac/hivcare/aids1.aspx
PHONE800.777.4775 or 614.466.6374
STATE: Oklahoma
WEBSITEok.gov/health/Disease,_Prevention,_Preparedness/HIV_STD_Service/Ryan_White_Programs/index.html
PHONE405.271.4636
STATE: Oregon
WEBSITEwww.oregon.gov/oha/ph/DiseasesConditions/HIVSTDViralHepatitis/HIVCareTreatment/CAREAssist/Pages/index.aspx
PHONE971.673.0144
STATE: Pennsylvania
WEBSITE

health.state.pa.us/spbp

PHONE800.922.9384
STATE: Rhode Island
WEBSITE

eohhs.ri.gov/Consumer/Adults/RyanWhiteHIVAIDS.aspx

PHONE401.462.3294
STATE: South Carolina
WEBSITEscdhec.gov/Health/DiseasesandConditions/InfectiousDiseases/HIVandSTDs/AIDSDrugAssistancePlan/
PHONE800.856.9954
STATE: South Dakota
WEBSITEdoh.sd.gov/diseases/infectious/ryanwhite/
PHONE800.592.1861 or 605.773.3737
STATE: Tennessee
WEBSITE

tn.gov/health/health-program-areas/std0/std/ryanwhite.html

PHONE800.525.2437
STATE: Texas
WEBSITEwww.dshs.state.tx.us/hivstd/meds/default.shtm
PHONE800.255.1090
STATE: Utah
WEBSITE

health.utah.gov/epi/treatment/

PHONE801.538.6197
STATE: Vermont
WEBSITEhealthvermont.gov/immunizations-infectious-disease/hiv/care
PHONE802.951.4005
STATE: Virginia
WEBSITEvdh.virginia.gov/disease-prevention/eligibility/
PHONE855.362.0658
STATE: Washington
WEBSITEdoh.wa.gov/YouandYourFamily/IllnessandDisease/HIVAIDS/HIVCareClientServices/ADAPandEIP
PHONE877.376.9316 or 360.236.3426
STATE: West Virginia
WEBSITEdhhr.wv.gov/oeps/std-hiv-hep/HIV_AIDS/caresupport/Pages/ADAP.aspx
PHONE304.558.2195
STATE: Wisconsin
WEBSITEdhs.wisconsin.gov/aids-hiv/resources/overviews/AIDS_HIV_drug_reim.htm
PHONE800.991.5532 or 608.267.6875
STATE: Wyoming
WEBSITE
PHONE307.777.5856

MEDICAID

A little over half of all Americans with HIV get their meds and health care through these federal programs. Currently, you can qualify for Medicaid if you have a low income and are part of a “categorically eligible” group (children, parents with dependent children, pregnant women, and people with disabilities). In 2014, states have the option of allowing you to be eligible for Medicaid without being disabled (or part of any other eligible group) if your income is 133 percent below the federal poverty level. Here’s info on how to find out more about Medicaid options in your state:


STATE: Alabama
WEBSITEmedicaid.alabama.gov
PHONE800.362.1504
STATE: Alaska
WEBSITEdhss.alaska.gov/dhcs/Pages/medicaid_medicare/default.aspx
PHONE907.334.2520
STATE: Arizona
WEBSITEazahcccs.gov
PHONE602.417.4000
STATE: Arkansas
WEBSITEmedicaid.state.ar.us
PHONE800.457.4454
STATE: California
WEBSITEdhcs.ca.gov/services/medi-cal/Pages/default.aspx
PHONEVisit the website website for local county office numbers.
STATE: Colorado
WEBSITEhealthfirstcolorado.com
PHONE800.221.3943
STATE: Connecticut
WEBSITEct.gov/hh/site/default.asp
PHONE877.284.8759
STATE: D.C. (Washington)
WEBSITEdc-medicaid.com/dcwebportal/home
PHONE202.727.5355
STATE: Delaware
WEBSITEdhss.delaware.gov/dss/medicaid.html
PHONE800.372.2022
STATE: Florida
WEBSITEfdhc.state.fl.us/medicaid/
PHONE888.419.3456
STATE: Georgia
WEBSITEdch.georgia.gov/medicaid
PHONE404.651.9982
STATE: Hawaii
WEBSITEmybenefits.hawaii.gov/medicaid-faqs/
PHONE

877.628.5076

STATE: Idaho
WEBSITEhealthandwelfare.idaho.gov/Medical/Medicaid/tabid/123/Default.aspx
PHONE877.456.1233
STATE: Illinois
WEBSITEhfs.illinois.gov/medical/apply.html
PHONE866.468.7543
STATE: Indiana
WEBSITEin.gov/medicaid/
PHONE800.457.4584
STATE: Iowa
WEBSITEdhs.iowa.gov/ime/members/who-receives-medicaid
PHONE855.889.7985
STATE: Kansas
WEBSITEkancare.ks.gov
PHONE800.792.4884
STATE: Kentucky
WEBSITEchfs.ky.gov/dms
PHONE800.372.2973
STATE: Louisiana
WEBSITEdhh.louisiana.gov/index.cfm/subhome/1/n/331
PHONE888.342.6207
STATE: Maine
WEBSITEmaine.gov/dhhs/oms/
PHONE207.287.2674
STATE: Maryland
WEBSITEmmcp.dhmh.maryland.gov/Pages/home.aspx
PHONE855.642.8572
STATE: Massachusetts
WEBSITEmass.gov/eohhs/gov/departments/masshealth/
PHONE800.841.2900
STATE: Michigan
WEBSITEmichigan.gov/mdch
PHONE855.275.6424
STATE: Minnesota
WEBSITEmn.gov/dhs/
PHONE855.366.7873
STATE: Mississippi
WEBSITEmedicaid.ms.gov/
PHONE800.421.2408
STATE: Missouri
WEBSITEmydss.mo.gov/healthcare/mo-healthnet-for-seniors
PHONE855.373.4636
STATE: Montana
WEBSITEdphhs.mt.gov/MontanaHealthcarePrograms/MemberServices
PHONE888.706.1535.
STATE: Nebraska
WEBSITEdhhs.ne.gov/medicaid/Pages/medicaid_index.aspx
PHONE

855.632.7633

Lincoln:

402.473.7000

Omaha:

402.595.1178

STATE: Nevada
WEBSITEmedicaid.nv.gov/
PHONE877.638.3472
STATE: New Hampshire
WEBSITEdhhs.state.nh.us/ombp/medicaid/index.htm
PHONE603.271.4344
STATE: New Jersey
WEBSITEstate.nj.us/humanservices/dmahs/clients/medicaid/
PHONE800.356.1561
STATE: New Mexico
WEBSITEhsd.state.nm.us/mad/
PHONE888.997.2583
STATE: New York
WEBSITEhealth.ny.gov/health_care/medicaid/
PHONE800.541.2831
STATE: North Carolina
WEBSITEdma.ncdhhs.gov/medicaid
PHONE800.662.7030
STATE: North Dakota
WEBSITEnd.gov/dhs/services/medicalserv/medicaid/
PHONE701.328.7068
STATE: Ohio
WEBSITEmedicaid.ohio.gov/
PHONE800.324.8680
STATE: Oklahoma
WEBSITEokhca.org
PHONE800.987.7767
STATE: Oregon
WEBSITEoregon.gov/OHA/HSD/OHP/Pages/About-Us.aspx
PHONE800.699.9075
STATE: Pennsylvania
WEBSITEdhs.pa.gov/citizens/healthcaremedicalassistance/
PHONE866.550.4355
STATE: Rhode Island
WEBSITEdhs.ri.gov/Programs/index.php#medicaid
PHONE855.840.4774
STATE: South Carolina
WEBSITEscdhhs.gov/
PHONE888.549.0820
STATE: South Dakota
WEBSITEdss.sd.gov/medicaid/
PHONE605.773.4678
STATE: Tennessee
WEBSITEtn.gov/tenncare/members-applicants/eligibility.html
PHONE800.318.2596
STATE: Texas
WEBSITEhhs.texas.gov/services/health/medicaid-and-chip
PHONE800.252.8263
STATE: Utah
WEBSITEhealth.utah.gov/medicaid/
PHONE

Salt Lake area:

801.538.6155

Other areas:

800.662.9651

STATE: Vermont
WEBSITEovha.vermont.gov/
PHONE802.879.5900 
STATE: Virginia
WEBSITEdmas.virginia.gov/
PHONE

855.242.8282

STATE: Washington
WEBSITEhca.wa.gov/free-or-low-cost-health-care/apple-health-medicaid-coverage
PHONE877.501.2233
STATE: West Virginia
WEBSITEdhhr.wv.gov/bms/Members/Apply/Pages/default.aspx
PHONE304.558.1700
STATE: Wisconsin
WEBSITEdhs.wisconsin.gov/medicaid/index.htm
PHONE800.362.3002
STATE: Wyoming
WEBSITEhealth.wyo.gov/healthcarefin/medicaid/
PHONE855.294.2127

Looking for drug assistance programs for viral hepatitis? Please visit hepmag.com.

The CAP and PAP information on this page is based on a document originally produced by the Fair Pricing Coalition, an ad hoc group of activists who advocate with the pharmaceutical industry regarding the price and patient access to HIV and viral hepatitis drugs. For more information, please visit www.fairpricingcoalition.org.

Last Reviewed: October 22, 2018