Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.
The Bay Area Reporter - October 3, 1998
Michael Donnelly, ACT UP/Golden Gate Writers Pool
Rick S., who lives in Berkeley, had a completely different experience with the re-certification process than Alden. The city ADAP coordinator informed him of the need to re-certify his ADAP eligibility long before his prescriptions ran out. He had plenty of time to contact his enrollment site and complete his re-certification process.
California State ADAP was centralized last year, and the problems of re-certification of eligibility are now cropping up. Before November 1997, each county (or other entity like the city of Berkeley) administered its own ADAP program. There were about 60 different entities and 60 different formats. In an effort to simplify and standardize California ADAP, the state awarded a contract to Professional Management Development Corporation (PMDC). The counties were given several months to send in their information to PMDC; the deadline was November 1, 1997. While every ADAP participant needs to re-certify each year, during the reorganization last year many participants' re-certification dates were extended to cover the one-year period. So now there are many re-certification dates coming due.
The problem with re-certification started in September and got worse in October. Pharmacies in the Castro area indicated that they had two to three times the amount of ADAP prescription denials in October compared to the month before. This problem may continue through the end of the year.
Section XX-110-00 Eligibility Recertification of the Eligibility Guidelines updated on November 21, 1997 state that PMDC was to inform the client and the local ADAP coordinator. PMDC Senior Vice President Eric Flowers indicated that while the company could not contact individual clients, the list was being sent to the local ADAP coordinator. Dana Pierce-Hedge, California's chief of ADAP, verified that the list went out to local ADAP coordinators and that they were responsible to notify local sites.
In San Francisco, the ADAP coordinator and Department of Public Health employee Herman Levias was unaware of the ADAP re-certification problem - and, when asked whether he would start contacting San Francisco residents or enrollment sites about the need to re-certify for ADAP, said, "It's not my job." So it seems that San Francisco residents are on their own during these next few months in regards to re-certification issues.
Some tips
If you are a participant in the ADAP program and you receive a rejection of a refill, don't panic.
Inform the pharmacist that you will sign a "notice to re-enroll". The pharmacist then applies for an emergency approval. This allows you to receive your ADAP drugs and lets the pharmacist be reimbursed for the prescriptions. This may take 24 hours.
Re-certify your enrollment in ADAP. This isn't done at the pharmacy, but at one of the ADAP enrollment sites. You can go to the same enrollment site where you originally enrolled for ADAP. You will need proof of residency (a P.O. box cannot be used) and proof of income and furnish some medical information. You have 30 days, but start as soon as you can.
San Francisco has 21 enrollment sites, but each county is different. Some counties or cities only have one site. For more information about enrollment sites near you, or for any questions of enrollment and re-certification procedures, call PMDC at the toll-free number 1 (888) 311-7632. The office hours are Monday through Friday 9 a.m. to 7 p.m., Saturday 9 a.m. to 5 p.m., and Sunday 11 a.m. to 4 p.m. You or your pharmacist can use this toll-free phone number during office hours.
Stay ahead of the process. If you haven't re-certified in awhile you may want to check ahead of time. You can call the same toll-free number 24 hours a day to verify you own eligibility. Just use your ADAP identification number, which is usually your Social Security number, and use the electronic verification system.
Call in your prescription refills ahead of time. This gives the pharmacists a chance to resolve any problems early. The ADAP system allows only a three-day window for you to pick up the medication before you run out, so plan ahead.
Persons who enrolled in the ADAP system within the last year will be less affected. They should have a new ADAP card from the centralized system, and the card should have the correct expiration date.
To qualify for ADAP, a person must be HIV-infected, a resident of California, 18 years or older, have a valid prescription from a California licensed physician, have an annual federal adjusted gross income below $50,000, and not be covered by or eligible for MediCal or other third-party payors. If you have questions about enrolling in the ADAP program, can call PMDC's toll-free number.
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