The Wisconsin AIDS/HIV Drug Assistance Program (ADAP) provides people with HIV access to:
- HIV drugs.
- Other drugs that treat or prevent certain health conditions.
- Drugs to treat hepatitis C (HCV) for persons who have both HIV and HCV.
To be eligible, an individual must:
- Live in Wisconsin.
- Have HIV, confirmed by a physician.
- Have no or insufficient third-party payment.
- Have a family income not exceeding 300% of the federal poverty guideline.
Client access and benefits
ADAP applications are available statewide through community-based organizations and at the offices of physicians specializing in the treatment of HIV. Completed applications are mailed to ADAP at the Division of Public Health for screening. ADAP sends approval letters to eligible clients and the pharmacy selected by the client. The designated pharmacy dispenses a 30-day supply of approved medications to the client and submits billing for these prescriptions to ADAP.
The Wisconsin ADAP Formulary (PDF) lists the drugs covered by Wisconsin ADAP.
For additional information about the ADAP, contact the Wisconsin HIV Program at 608-261-6952, 608-267-6875 or 800-991-5532.
General information and application materials for the Wisconsin AIDS/HIV Drug Assistance Program
- Fact Sheet, P-42115 (PDF) (English and Spanish)
- Client Disclosure Authorization, F-01829 (Word)
- Application Form, F-44614A (PDF) (English and Spanish)
- Part B (Physician Portion) of Application Form, F-44614B (PDF) (English and Spanish)
- Instructions for Completing Application Form, F-44614I (PDF) (English and Spanish)
- Six-Month Verification Form (SMRF), F-00851 (PDF) (English and Spanish)
- Insurance Enrollment Report, F-01423 (PDF) (English and Spanish)
- Wisconsin AIDS Drug Assistance Program Policy Manual, P-01771 (PDF)
Information for pharmacies
To become an ADAP provider, submit the ADAP Provider Enrollment Application.
ADAP providers with claims or billing questions should call Provider Services at 800-947-9627.