Office of AIDS
The AIDS Drug Assistance Program (ADAP) helps ensure that people living with HIV and AIDS who are uninsured and under-insured have access to medication on the ADAP Formulary
ADAP Contractor Transition
ADAP (which includes the ADAP medication assistance program, Office of AIDS Health Insurance Premium Payment [OA-HIPP] Program, and the Medicare Part D premium payment program) has new contractors effective July 1, 2016:
Effective Wednesday, April 5th, enrollment workers should:
Magellan Rx Management
Magellan Rx Management (Magellan) provides Pharmacy Benefits Management services for ADAP. ADAP clients received a new prescription benefit card from Magellan and have access to a California pharmacy network with over 5,500 pharmacies. To locate a pharmacy please access this link: https://cdph.magellanrx.com/member/publicPharmacylocator.
The Magellan Call Center is available 24/7 at (800) 424-5906.
Pool Administrators Incorporated (PAI)
Pool Administrators Inc. provides Insurance and Medical Benefits Management services for ADAP. PAI will remit health insurance premium payments on behalf of clients enrolled in OA-HIPP and Medicare Part D premium payment programs.
For OA-HIPP clients, PAI will also pay outpatient medical out-of-pocket costs that count towards the client’s health insurance policy’s annual out of pocket maximum. Existing OA-HIPP clients received a new client ID card in the mail in June 2016. The medical out-of-pocket reimbursement benefit began on July 1, 2016. For questions regarding this benefit, please contact, the PAI Customer Service Representative team Monday through Friday from 8:00 am to 5:00 p.m. at (877) 495-0990 and/or via fax at (860) 986-6205.
You may see the medical out-of-pocket reimbursement process outlined here: https://www.cdph.ca.gov/programs/aids/Documents/MOoPCostClaimReqProcess.pdf
For medical providers who would like to establish a direct payment method for medical out of pocket costs, please contact the PAI Customer Service Representative team Monday through Friday from 8:00 am to 5:00 p.m. at (877) 495-0990.
Local Health Jurisdictions (LHJs) each designate an ADAP coordinator to act as the primary contact for OA and ADAP PBM/EBM contractors. The ADAP coordinator is responsible for reporting and disseminating ADAP-related information between OA and the ADAP PBMcontractors to enrollment site contacts and enrollment workers. The ADAP coordinator is also responsible for: maintaining staffing coverage at ADAP sites in order to meet client enrollment and eligibility recertification needs; assisting with enrollment site visits; and ensuring enrollment sites are in compliance with ADAP guidelines and policies. Each LHJ is assigned an OA ADAP Advisor to assist. See OA ADAP Staff Assignments by LHJs (PDF)for further information.
ADAP enrollment sites must be approved and certified through the OA. These sites (PDF) are limited to community-based non-profit organizations, clinics, medical providers, and case management service providers. For more information about ADAP enrollment sites in your area, please contact the local ADAP coordinator (PDF) in your county. Each enrollment site is assigned an OA ADAP Advisor to assist. See OA ADAP Staff Assignments by LHJs (PDF)for further information.
Only certified enrollment/eligibility workers (EWs) can enroll clients into ADAP. New EWs must attend in-person training, and recertify annually through a web-based training. If your EW certification has lapsed and you need additional time until the next training, please contact your local ADAP coordinator (PDF). For information regarding training schedules, or general enrollment questions, contact us at (844) 421-7050. .
Currently, there are over 6,000 pharmacies in the ADAP pharmacy network. If your pharmacy is interested in joining the ADAP pharmacy network, or for more information, please contact Magellen Rx at (800) 424-5906 You must be a Medi-Cal pharmacy to qualify. To locate a local pharmacy, please visit the Magellen Rx pharmacy locator tool here: https://cdph.magellanrx.com/member/publicPharmacylocator.
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