The purpose of this Management Memorandum is to notify ADAP and Pre-Exposure Prophylaxis Program (PrEP-AP) enrollment workers of updates to current enrollment procedures that are in place to minimize the exposure of ADAP and PrEP-AP clients to Novel Coronavirus, also known as COVID-19.
Documentation Requirements in Response to COVID-19
The current temporary policy states that clients who are capable of providing the documentation for initial enrollment or re-enrollment should be asked to do so. However, enrollment workers are not to place clients on a Temporary Access Period (TAP) for missing documentation. Enrollment workers are to keep track of clients that did not provide documentation for future follow up.
Effective January 1, 2022, the temporary policy will no longer be in effect and clients are now required to submit all required supporting documentation. Enrollment Workers are to place a 30-day TAP for clients that are unable to provide all supporting documentation during initial enrollment or re-enrollment. ADAP Advisors will also resume placing a 45-day secondary review TAP for insufficient supporting documentation.
Additionally, enrollment workers are required to vigorously pursue collecting all missing supporting documentation from clients who did not have the capacity to do so due to impacts of COVID-19. Missing documentation should be requested a minimum of one time accompanied with the following case note "[Date missing documentation was requested] - Requested all missing documentation from prior enrollments due to COVID-19 shelter-in-place" on the client's profile to track the request date(s). Enrollment workers are to upload all missing documentation, in addition to current supporting documentation, to substantiate past and present eligibility during the client's next re-enrollment.
Phone Enrollment Process for New or Lapsed ADAP/PrEP-AP Clients
New or lapsed clients enrolling in ADAP or PrEP-AP are able to enroll over the phone with their enrollment worker. Clients who are unable to provide the required documentation are to be placed on a TAP. A TAP will allow the client up to 30 days to provide all required documentation. In order to reduce the risk of a possible privacy incident, enrollment workers should collect documents via encrypted email that the client can respond to with all supporting documentation. See Phone ADAP/PrEP-AP Emergency Enrollment Procedures (PDF) for more instructions. Please note: A new client without proof of HIV status cannot be enrolled on a TAP.
Continuation of E-mail Enrollment Process for New or Lapsed ADAP/PrEP-AP Clients
ADAP and PrEP-AP will continue to allow clients to enroll or re-enroll with their enrollment worker through encrypted email or fax. In order to reduce the risk of a possible privacy incident, enrollment workers should collect documents via encrypted email that the client can respond to with all supporting documentation. See Email/Fax ADAP/PrEP-AP Emergency Enrollment Procedures (PDF) for more instructions. ADAP and PrEP-AP will continue with the current email enrollment policy outlined.
Continuation of 90-Day Medication Dispenses
To ensure clients maintain an adequate supply of medication, ADAP and PrEP-AP will continue to allow its Pharmacy Benefits Manager, Magellan Rx Management to dispense 90-day medication fills. ADAP clients can receive up to a 90-day fill on medications as long as the client has eligibility throughout the duration of the 90-day time period. ADAP will continue with the current 90-day dispense policy outlined, indefinitely. PrEP-AP clients can receive 90 day medication fills, except for PrEP medications that are covered, in whole or part, by Gilead's Patient Assistance Program or Co-Pay Coupon Program.
Discontinuation of Medication Mail-Order Policy for Out of State or Country Requests and Early Refill Requests.
ADAP and PrEP-AP will discontinue allowing prescription(s) to be mailed out of state or out of the country. In addition, ADAP and PrEP-AP will discontinue allowing early refills. However, ADAP's vacation prescription and lost medication policies are still in effect.
Vacation Prescription Policy
An ADAP client may request a vacation supply of medication if they will be out-of-state or out of the country when their next fill date is due. A vacation supply must be requested in advance and dispensed to the client prior to their departure. Vacation supplies are only allowed once in a one-year period. Vacation supplies will not be filled if the client's eligibility is due to expire during the period in which the client will be away. If annual ADAP re-enrollment is due, it must be completed before the client begins travel. The pharmacy must contact the Magellan call center at (800) 424-5906 and request a vacation supply. Magellan call center staff will approve dispensing of the vacation supply only after verifying the client's eligibility will be valid throughout the time period for the amount of medication requested and the client has not received a vacation supply within 12 months of the date of the request.
Lost Medication Policy
ADAP clients who lose their medication may request a replacement fill. ADAP will grant a "lost medication" refill only once per year per medication.
Please contact your OA Advisor if you have any questions regarding the information provided in this memo.
ADAP Branch Chief
Office of AIDS
California Department of Public Health