NH ADAP (AIDS Drug Assistance Program)
The AIDS Drug Assistance Program is Part B of the Ryan White CARE Program. This program provides FDA-approved medicine to people living with HIV, who are eligible for the program. Grants are funded to provide these services for clients. The state of New Hampshire provides this service through The Ryan White CARE Program which is in the NH Division of Public Health Services.
How NH ADAP Works
NH ADAP pays fully for a client’s medicines when a primary insurer denies payment for a prescribed medicine. NH ADAP also covers medicine co-payments after the primary insurer, such as Medicare or a private employer insurance, has paid their portion. Medicaid prescription co-payments are not covered.
The NH CARE Program will enroll an infant born to a person living with HIV (who gave birth to the infant) and pay for Antiretroviral Therapy (ART) prophylaxis (prevention) treatment.
What is Covered
Clients eligible and enrolled with the NH CARE Program may go to any Medicaid-enrolled pharmacy in the State of NH.
- Pharmacy reimbursement rates are at NH Medicaid rates.
- Nutritional supplements, vitamins, smoking cessation medications and oral contraceptives are covered items with a prescription from the healthcare provider.
- Non-preferred drugs may require prior authorization from the NH CARE Program. Clinical criteria and prior authorization forms can be downloaded from the NH ADAP website.
90-Day Refills and Prior Authorization
Pharmacies may dispense a 90-day supply without approval by the NH CARE Program, if the primary payer will pay for it. If the NH CARE Program is the primary payer (full payment), prior approval is required.
The CDC recommends households maintain at least a 30-day supply of any prescription drugs, for unexpected events, and NH ADAP permits members to obtain a 90-day supply for travel, illness, and other restrictions related to the COVID-19 pandemic.
Additional refills due to the COVID-19 pandemic or lost or stolen medications, require prior authorization from the NH CARE Program.
Please see the NH CARE COVID-19 Interim Policy guidance for additional information.
Mail Order Refills
Mail order pharmacies must have the ability to bill NH ADAP as the secondary payer. All clients should work directly with their insurance company, when possible, to resolve any issues about mail order fills/refills.
If an issue does persist, please contact the NH CARE Program at 603-271-4502 or the NH CARE Magellan Health Customer and Provider Service Line.
Long-Acting Injectable Antiretroviral Therapy (LAART)
In 2021, the New Hampshire (NH) HIV Medical Advisory Board convened and discussed planning to provide Cabenuva extended release injection (cabotegravir 200mg/rilpivirine 300mg).
The NH ADAP Preferred Drug Formulary List, is only for oral medicines, so Cabenuva will not appear on this list. However, Cabenuva is available and fully covered for eligible clients enrolled in the NH ADAP as of January 31, 2021.
At this time, Cabenuva, paid for by NH ADAP, must be administered in a healthcare provider's office.
NH ADAP Medical Advisory Board
The purpose of the NH ADAP Medical Advisory Group is to bring NH HIV care providers together to review NH ADAP use and recommend any potential formulary or eligibility changes to the Bureau of Infectious Disease Control. Members provide expertise to guide NH ADAP policy and preferred medicines.
If you are interested in joining the Medical Advisory Board, please go to the HIV Planning Group website at nhhiv.org for more information.