NEW - Ohio High Risk Insurance Pool

NEW -  Financial Eligibility Guidelines for OHDAP/HIPP (Ohio HIV Drug Assistance Program & Health Insurance Premium Program)

NEW - OHDAP Formulary

NEW - Pharmaceutical Company Patient Assistance and Savings Programs for HIV Medications

Co-pay Assistance Programs for Anti-Retroviral Medications

Patient Assistance Programs:

Partnership for Prescription Assistance
1.888.477.2669

Rx Hope
1.877.267.0517

Together Rx Access
1.800.444.4106

Rx Assist – Patient Assistance Program

Patient Assistance

Needy Meds

Charitable Pharmacy of Central Ohio
614.227.0301

The Ohio Department of Health (ODH) administers the Ohio HIV Drug Assistance Program (OHDAP), providing medications to fight HIV and to treat HIV-related conditions.  This program must be the payer of last resort.  For eligible participants, HIV-related medications are provided free of charge.  The medications are obtained through a specialty mail-order pharmacy to ensure confidentiality and to ensure all geographic areas of Ohio have equal access to this service.  Verification of monthly income, updated enrollment applications and a physician’s report are required at the beginning of each enrollment period.

• As of August 30, 2010, the only changes that have been implemented to the RW Part B Program have been 1) to change the financial eligibility for program participation from 500% of the federal poverty level to 300% of the federal poverty level (bringing Ohio in line with other states) and 2) to reduce the ancillary medications on the OHDAP formulary.

• The Ohio Department of Health (ODH) is collecting information about each OHDAP client’s previous health status so they can document the client's nadir or LOWEST EVER CD4+ T-Lymphocyte count as this number has predictive value for health status and guides many treatment options. ODH has not removed anyone from the program at this time based on CD4+ count. ODH has, however, come up with a categorical system that will allow us to identify, at a glance, the clients in greatest need of our services based on their health.

• The HIV Care Services Section at ODH is working with the HIV Surveillance Unit at ODH to identify current OHDAP clients who have had a reported AIDS diagnosis to reduce the burden on physicians to help us with this identification process.

• ODH has worked with infectious disease physicians to develop the category system. Should it become necessary to make further reductions, due to cost-constraints, physicians have asked that ODH consider such medical criteria rather than basing future decisions exclusively on financial eligibility criteria.

• The Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents (December 1, 2009) are published by the Department of Health and Human Services (DHHS) and are developed by the Office of AIDS Research Advisory Council (OARAC) at the federal level. These guidelines change periodically to reflect the state-of-the-art in HIV treatment based on available research. The HIV Care Services Section at ODH makes decisions based on the guidelines (e.g., the medications included on OHDAP formulary). There have been recent studies, shared at international conferences, which indicate potential advantages for initiating treatment earlier in the HIV disease progression than has been the norm in the past. This is the type of information that might be expected to drive changes to the DHHS guidelines in the future.

• Should the guidelines change in this manner, the Ryan White Part B Porgram would have to be responsive. The good news is that people are living longer and more productive lives with HIV today. Starting treatment earlier to help more people get the greatest possible benefit from today’s medications, however, comes with an associated (and not insignificant) price tag.

• Everything done at the Ohio Department of Health is governed, in part, by the Ohio Administrative Code (OAC). The Chapter of the Code regarding the Ryan White Part B program is 3701-44 and the specific sections that address our program are 01-08. The current Rule allows us to make changes based on financial eligibility and we are working to address changes to the Rule that would allow ODH to consider medical criteria.

• ODH has applied for and received two additional federal grants to help the Part B Porgram. One of these, the Part B Supplemental Grants resulted in an award of an additional $372,000. To put this in perspective, while this is a large sum, it would allow us to care for 25 OHDAP clients for a year. ODH will not receive this money until September 30, 2010. ODH has also received an ADAP-RFI grant (this was the $25M recently made available). Ohio received $1.2M from this effort. Although ODH has not received the grant guidance that thoroughly explains the limitations on use of this money, we understand that it can only be used toward care for the individuals who were on the waiting list as of July 8, 2010.

• ODH is working closely with Governor Strickland’s office to try to secure additional dollars that would allow our program to go forward with minimal additional cuts. However, as stewards of the public dollar, it is incumbent on us to have a plan to address any shortfall that may occur.

In ealry July 2010, the Ohio Department of Health (ODH) announced changes to the Ryan White program, which provides assistance to eligible Ohioans living with HIV/AIDS. The changes are being implemented because of a combination of decreasing resources and increasing enrollment, costs of health insurance premiums and medications. These changes will impact current and potential future clients, and are designed to maintain core services for those most in need, both financially and medically.

Nationally, many Ryan White programs have felt the same impact with a record number of people on waiting lists due to increasing enrollment, combined with increased costs of medications. Ohio will join a dozen other states that have initiated a waiting list for this program. ODH staff will be working as closely as possible with case managers and clients to help those affected in identifying other resources, including patient assistance programs.

Some strategies being used include implementing a waiting list, reducing the number of approved medications available to clients (drug formulary), aggressive pursuit of rebates, revising eligibility requirements and eliminating some services.

Ohio HIV Drug Assistance Program Cost Containment Guide

Ryan White Part B Frequently Asked Questions

For more information on eligibility criteria, implementation of a waiting list for new applicants, changes in drug formulary and other program reductions, click here

Financial Eligibility Guidelines

New Drug Formulary