California has expanded the ADAP Formulary
Earlier this year, while many other states are restricting access to key HIV drugs, California implemented a significant expansion of the medications covered by ADAP. The California Expanded ADAP Formulary is a major policy expansion implemented by the California Department of Public Health (CDPH) Office of AIDS. This update fundamentally changes how medications are covered for eligible individuals in the state.
Core Purpose of the Expanded Formulary
The chief objective of the expansion is to align the AIDS Drug Assistance Program (ADAP) formulary with Medi-Cal’s broad outpatient medication coverage.
By creating a unified drug list, California aims to:
Eliminate Treatment Disruptions: Stop gaps in care that occur when a patient transitions between ADAP coverage and standard Medi-Cal.
Broaden Drug Access: Provide access to a wider variety of standard FDA-approved prescription drugs and select over-the-counter (OTC) medications beyond strictly HIV-related therapeutics.
Streamline Administration: Make it easier for medical providers to write a single ongoing script without checking conflicting state drug lists.
Key Details & Program Requirements
Eligibility Limits: To access the expanded formulary, individuals must still meet California ADAP requirements. This includes an official HIV-positive diagnosis, California residency, being 18 or older, and holding an income at or below 600% of the Federal Poverty Level (FPL).
Exclusions Remain: While significantly broader, the formulary does not cover every medication. For example, certain high-cost weight management drugs (like Zepbound) are excluded across both Medi-Cal and ADAP. Additionally, pharmaceutical manufacturers must actively participate in federal rebate programs to remain eligible on the list.
How to Verify Coverage: Providers and patients can look up specific National Drug Codes (NDCs) using the searchable CDPH Prime Therapeutics Formulary Portal, which handles the state's clinical documents and coverage rules.
More recently, ADAP has begun covering some over the counter medications as well and is open to consider adding more of the higher priced treatments we take based on community input. Your doctor may have to write a prescription showing that you need to use the OTC medication, but most doctors will be happy to help get these covered. Check with your provider or the California Department of Public Health for more information
