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Alabama AIDS 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 Quarterly Report

The ADAP Quarterly Report is now available. This report reflects the number of clients actively enrolled in ADAP as of June 30, 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:

December 1, 2016

Active:

953

Medcap:

81

 

 

Forms

Last Revised

Alabama's Ryan White Part B Program Eligibility Standards

October 2016

Alabama RWHAP Part B Income Eligibility Guidelines

April 2016

BCBS Authorization for Disclosure of Protected Health Information

November 2016

BCBS Eligibility Coordination of Benefits

November 2015

Ryan White Part B Program Authorization for Release of Protected Health Information

October 2016

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

November 2016

MEDCAP Certification Statement

October 2016

MEDCAP Enrollment Guidance

October 2016

MEDCAP Bi-Annual Client Eligibility Review (CER) Guidance

October 2016

MEDCAP Self-Attestation Document

October 2016

ADAP-MEDCAP Formulary Information

October 2015

ADAP - MEDCAP Prescription Form

June 2016

ADAP Formulary

June 2016

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


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