PAPs, CPAPA, and HarborPath for HIV

Patient Assistance Programs (PAPs) offer free HIV drugs to people who do not qualify for assistance programs such as Medicaid, Medicare, or AIDS Drug Assistance Programs (ADAPs). Different company programs have different eligibility criteria based on the Federal Poverty Level (FPL) designation. The 2013 FPL income for one individual is $11,490.  It is adjusted based on family or household size. 200% FPL is $22,980 and 300% is $34,470 for individuals. All levels are somewhat higher in Alaska and Hawaii. 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. In some instances, Medicare Part D clients, as well as the underinsured who have co-insurance, deductibles, caps or co-pays they cannot afford, are covered 100% by the PAP; eligibility is based on both projected out of pocket drug/medical expenses and income. Both underinsured people and people without insurance initially denied coverage through the PAP should always ask for an exception or an appeal. AbbVie, Bristol-Myers Squibb, Gilead and Janssen will make exceptions to the income eligibility criteria.

Two other recent developments that will potentially ease access to PAPs are the Common PAP Application (CPAPA) and HarborPath. The Department of Health and Human Services (DHHS), along with seven pharmaceutical companies, the National Alliance of State and Territorial AIDS Directors (NASTAD), and community stakeholders developed a common patient assistance program application that can be used by both providers and patients. Before, patients and advocates had to fill out different sets of paperwork for each company; the new application should help simplify this process, however the form still has to be sent to each company program you are applying to for assistance. Click here for the form.

HarborPath is a non-profit organization that helps uninsured individuals living with HIV/AIDS gain access to brand-name prescription medicines at no cost, by providing case managers with a single “one-stop shopping” online portal for PAP applications and medication fulfillment through a mail-order pharmacy. Currently in its pilot phase in six states with most HIV pharmaceutical companies on board for ADAP waiting list clients, there are plans for expansion in 2013, including adding medicines for hepatitis C. (Merck participates with its HCV drug Victrelis.) Go to harborpath.org for more information.

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

  • Most companies are using HarborPath for ADAP waiting list patients.
  • Boehringer Ingelheim and Genentech are covering ADAP waiting list patients only through their own PAPs.
  • Other companies are covering ADAP waiting list patients through both HarborPath and 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.

In some instances, Medicare Part D clients, as well as the underinsured who have co-insurance, deductibles, caps or co-pays they cannot afford, are covered 100% by the PAP; eligibility is based on both projected out of pocket drug/medical expenses and income. Both underinsured and people with no insurance who are initially denied coverage through the PAP should always ask for an exception or an appeal.

For more comprehensive information on HIV patient assistance programs, click here for the HIV PAP and CAP Resource Guide.