By Jeff Kosbie, Esq.
Big changes are coming to the AIDS Drugs Assistance Program (ADAP), Office of AIDS Health Insurance Premium Payment Program (OA-HIPP), and Medicare Part D Premium Payment Program.
On July 1, 2016, Ramsell will no longer administer ADAP. A.J. Boggs will take over program eligibility and enrollment. Magellan Rx will handle pharmacy benefits management. And Pool Administrators Inc. (PAI) will manage the OA-HIPP and Medicare Part D premium payment programs.
This post identifies important steps that you should take now and how you can stay informed as these changes roll out. As always, please call us at 415-777-0333 if you need more assistance.
New out-of-pocket expense coverage for OA-HIPP clients!
One of the most exciting changes is the addition of a new program to pay out-of-pocket medical expenses for OA-HIPP clients. We are still waiting for more details on this program. At present, we do not know if it will only cover HIV-related out-of-pocket costs or if it will cover all costs. This new program will be administered by PAI. If you are enrolled in OA-HIPP, you should receive a new ID card from PAI along with instructions on how to use it. We will also update you as we learn more.
What should I do now to avoid any disruption in my drug access?
- Keep an eye out for an informational letter from the State Office of AIDS and a welcome letter from Magellan Rx. The letter from Magellan Rx will include your new prescription benefit card. Please be sure to open this mail and keep your new prescription benefit card. The outside of the envelope will not say ADAP on it.
- Update your address with your enrollment worker. If you have changed your address within the last year, make sure your address is up to date with ADAP. If you are not sure if you updated your address, call your enrollment worker now. Any enrollment worker can update your ADAP profile, even if they did not initially enroll you.
We have included images of what the new Magellan prescription benefit card should look like along with the welcome letter that you should receive at the end of this blog post.
Will I need to switch pharmacies?
ADAP clients must use a pharmacy within the Magellan pharmacy network to access medication. Magellan Rx is contracted with over 6,000 pharmacies in California, and the majority of ADAP clients will not need to change pharmacies. If your pharmacy is not in the Magellan network, you should be contacted directly by the CA Office of AIDS (a division within the California Department of Public Health). Your ADAP enrollment worker should also receive a notification that you will need to change pharmacies. If Positive Resource Center handles your ADAP enrollment, we will be sure to update you immediately if we learn that your pharmacy is not included in the Magellan network. You may also call the California Department of Public Health (CDPH) at 844-421-7050 to confirm that your pharmacy is in the Magellan network.
Can I still use my Ramsell Prescription Benefit Card after July 1st?
Your Ramsell card will be deactivated effective July 1st. To avoid any problems at the pharmacy, we advise you to look out for your new Magellan Rx card and be sure to bring it with you. However, your program ID number will remain the same. The Office of AIDS assures us that you should still be able to access your drugs at the pharmacy without your new Magellan Rx card.
What if I have problems accessing my drugs on July 1st?
Starting July 1st, you can Magellan Rx’s live support team at 800-424-5906 to address any problems with program roll-out. We will also be posting any updates we learn about.
Will I still be able to get all of my drugs?
We have not been informed of any changes to the ADAP drug formulary. We will continue to update you if we learn of any changes.
How will the (re)enrollment process change?
All new clients will continue to have to see an ADAP enrollment worker to enroll. All existing clients will have to see an ADAP enrollment worker for their annual re-enrollment, on or before their birth date. When you visit an ADAP enrollment worker after July 1st, your enrollment worker will create an account on A.J. Boggs portal with you. After that, you can update your account and do annual re-enrollments on your own.
We have been able to preview the new enrollment system and are excited for some of the changes. These include:
- Improved communication abilities, including secure email within the web access portal.
- Improved error checking to identify missing items before an application is submitted.
- Ability to provide additional explanatory comments on application forms.
- Tags to indicate when an applicant has changed an answer from their last application. These tags will help ensure that entered changes (e.g., in address or viral load) are intended.
- Interactive pharmacy locator, searchable by address. Starting July 1st, this will be available without logging in at https://cdph.magellanrx.com.
What about the six-month self-verification form?
You will continue to receive this in the mail. Please look for correspondence from A.J. Boggs. If you are enrolled in both ADAP and OA-HIPP, this process will be more streamlined. You will now be able to use the same SVF form to re-certify for both programs.
How can I keep up-to-date on any changes?
We expect to continue to receive more information as we get closer to the transition. We will remind you as key dates arrive and update you if we learn anything new. Call Positive Resource Center at 415-777-0333 and follow us on Facebook and Twitter (#UpOnADAP).