PAP and Welvista Programs for HIV

Patient Assistance Programs (PAPs) offer free HIV drugs to people with low-incomes who do not qualify for any other insurance or assistance programs, such as Medicaid or AIDS Drug Assistance Programs (ADAPs). Different company programs have different eligibility criteria based on the Federal Poverty Level (FPL) designation. The 2010 FPL income for one individual is $10,830.  It is adjusted based on family or household size. 200% FPL is $21,660 and 300% $32,490 for individuals. A complete table is available here. Unless otherwise stated, companies ask for verification of income, usually in the form of a federal income tax return. Companies also generally consider household income, meaning that a married couple that files joint taxes would be judged on their combined income. People who file individual income tax returns would only have their individual income considered. Always apply for an exception if told you are not eligible.

A special program which is overseen by the Heinz Family Philanthropies, and managed by Welvista, a non-profit mail-order pharmacy based in South Carolina, has been initiated to make it easier for people on ADAP waiting lists to access their HIV medications from one location rather than having to access multiple industry PAPs to obtain their medications for different manufacturers. Thus far, Welvista is working with six HIV drug companies to provide HIV drugs for free to individuals on ADAP waiting lists.

The FPC has listed information on the major HIV drug company PAPs below. Please note:

  • Some companies are using Welvista for ADAP waiting list patients.
  • Some companies are covering waiting list patients through their own PAPs.
  • Some companies are also covering ADAP disenrolled clients through their own PAP programs and some are not.
  • If an ADAP patient has been disenrolled because the state has lowered FPL eligibility, the drug company FPL may also be too low to cover them. Check the individual company PAP criteria; and always apply for an exception if you are told you are not eligible.

Companies participating in the Welvista program are indicated below.

ABBOTT

Drugs covered: Kaletra, Norvir
Contact Information: 800-222-6885
Program Details: The PAP is for people who do not qualify for other assistance or health insurance programs and is limited by income. Most programs have limits based on the total household income compared to established federal poverty levels (FPL). Abbott’s program covers people with incomes up to 500 percent of the FPL. Abbott does not request income verification and they only consider the income of the individual. Generally, programs will accept appeals for special circumstances if a person does not initially qualify and is turned down. People initially denied coverage through the PAP should apply a second time and ask for a relevant exception. Abbott currently participates in the Welvista program.

BOEHRINGER INGELHEIM (BI)

Drugs covered: Aptivus, Viramune IR (Lead-in doses), Viramune XR
Contact Information: 800-556-8317 or www.rxhope.com or www.pparx.org
Program Details: The PAP is for people who do not qualify for other assistance or health insurance programs and is limited by income. Most programs have limits based on the total household income compared to established federal poverty levels. BI’s program covers people with incomes up to 500 percent of the FPL. Generally, programs will accept appeals for special circumstances if a person does not initially qualify and is turned down. People initially denied coverage through the PAP should apply a second time and ask for a relevant exception. BI participates in the Welvista program.

BRISTOL-MYERS SQUIBB (BMS)

Drugs covered: Atripla, Reyataz, Sustiva, Videx and Zerit
Contact Information: 888-477-2669 or www.pparx.org or go to product websites (e.g. www.sustiva.com). The Atripla PAP is handled separately at 866-290-4767
Program Details: The PAP is for people who do not qualify for other assistance or health insurance programs and is limited by income. Most programs have limits based on the total household income compared to established federal poverty levels. BMS’s program covers people with incomes up to 300 to 500 percent of the FPL, depending on the FPL criteria for each state’s ADAP program. Generally, programs will accept appeals for special circumstances if a person does not initially qualify and is turned down. People initially denied coverage through the PAP should apply a second time and ask for a relevant exception. BMS currently participates in the Welvista program.

GENENTECH/ROCHE

Drugs covered: Fuzeon
Contact Information: 877-757-6243
Program Details: The PAP is for people who do not qualify for other assistance or health insurance programs and is limited by income. Most programs have limits based on the total household income compared to established federal poverty levels (FPL). Genentech’s program covers people with incomes up to 950 percent of the FPL. Generally, programs will accept appeals for special circumstances if a person does not initially qualify and is turned down. People initially denied coverage through the PAP should apply a second time and ask for a relevant exception. Genentech does not currently participate in the Welvista program.

GILEAD SCIENCES

Drugs covered: Atripla, Complera, Emtriva, Truvada, Viread
Contact Information: 800-226-2056 or go to product websites (e.g. www.truvada.com). The Atripla PAP is handled separately at 866-290-4767
Program Details: The PAP is for people who do not qualify for other assistance or health insurance programs and is limited by income. Most programs have limits based on the total household income compared to established federal poverty levels (FPL). Gilead’s program covers people with incomes up to 500 percent of FPL. Generally, programs will accept appeals for special circumstances if a person does not initially qualify and is turned down. People initially denied coverage through the PAP should apply a second time and ask for a relevant exception. Gilead currently participates in the Welvista program.

GLAXOSMITHKLINE See ViiV Healthcare

MERCK & CO

Drugs covered: Crixivan, Isentress
Contact Information: 800-850-3430 or www.isentress.com
Program Details: The PAP is for people who do not qualify for other assistance or health insurance programs and is limited by income. Most programs have limits based on the total household income compared to established federal poverty levels (FPL). Merck’s program covers people with incomes up to 500 percent of the FPL. Generally, programs will accept appeals for special circumstances if a person does not initially qualify and is turned down. People initially denied coverage through the PAP should apply a second time and ask for a relevant exception. Merck currently participates in the Welvista program.

PFIZER See ViiV Healthcare

TIBOTEC

Drugs covered: Edurant, Intelence, Prezista
Contact Information: 800-652-6227 or product-specific website (e.g. www.prezista.com)
Program Details: The PAP is for people who do not qualify for other assistance or health insurance programs and is limited by income. Most programs have limits based on the total household income compared to established federal poverty levels (FPL). Tibotec’s program covers people with incomes up to 200 percent of the FPL. Generally, programs will accept appeals for special circumstances if a person does not initially qualify and is turned down. People initially denied coverage through the PAP should apply a second time and ask for a relevant exception. Tibotec currently participates in the Welvista program.

ViiV HEALTHCARE

Drugs covered: Combivir, Epivir, Epzicom, Lexiva, Retrovir, Selzentry, Trizivir, Viracept and Ziagen.
Contact Information: 877-784-4842 or www.ViiVhealthcareforyou.com
Program Details: The PAP is for people who do not qualify for other assistance or health insurance programs and is limited by income. Most programs have limits based on the total household income compared to established federal poverty levels (FPL). ViiV’s program covers people with incomes up to 500 percent of the FPL. Generally, programs will accept appeals for special circumstances if a person does not initially qualify and is turned down. People initially denied coverage through the PAP should apply a second time and ask for a relevant exception. ViiV currently participates in the Welvista program.

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