WV AIDS DRUG ASSISTANCE PROGRAM FORMULARY
WV AIDS DRUG ASSISTANCE PROGRAM FORMULARY
The WV ADAP assists eligible WV residents, with HIV infection, obtain the drugs listed on the formulary below.
Applicants must apply at their county office of the Department of Health and Human Resources.
Formulary drugs available in generic must be dispensed in generic.
To be eligible for the ADAP, HIV infected WV residents with a family income less than 400% of the federal poverty level, who are not eligible for other forms of reimbursement such as Medicaid or full insurance coverage, (ADAP will cover co-pays for eligible residents with insurance) must complete the applications at the Department of Health and Human Resources.
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WV AIDS DRUG ASSISTANCE PROGRAM FORMULARY4 / 2013
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| Trade Name |
Generic Name |
| Abilify | Aripiprazole |
| Advair | Fluticasone |
| Ambien/Ambien CR | Zolpidem/ Zolpidem CR |
| Androgel | Testosterone |
| Aptivus | Tipranavir |
| Atripla | Efavireniz/Emtrictabine/Tenofovir |
| AZT, Retrovir | Zidovudine |
| Bactrim, or equivalent | Cotrimoxazole |
| Baraclude | Entecavir (Prior Authorization) |
| Biaxin | Clarithromycin |
| Buspar | Buspirone |
| Celexa | Citalopram |
| Cleocin | Clindamycin |
| Combivir | Lamivudine/Zidovudine |
| Compazine | Prochlorperazine |
| Complera | Rilpivirine/Tenofivir/Emtricitabine |
| Copegus | Ribavirin ( Prior Authorization ) |
| Crestor | Rosuvastatin |
| Crixivan | Indinavir |
| Cymbalta | Duloxetine |
| Cytovene | Ganciclovir |
| Dapsone | Dapsone |
| Daraprim | Pyrimethamine |
| DDC, Hivid | Zalcitabine |
| DDI, Videx | Didanosine |
| Deltasone | Prednisone |
| Desyrel | Trazodone |
| Diflucan | Fluconazole |
| Edurant | Rilpivirine |
| Effexor / Effexor XR | Venlafaxine / Venlafaxine XR |
| Elavil | Amitriptyline |
| Emtriva | Emtricitabine |
| Engerix | Hepatitis B Vaccine(Prior Authorization) |
| Epivir, 3TC | Lamivudine |
| Epzicom | Lamivudine/Abacavir |
| Famvir | Famciclovir (Prior Authorization) |
| Foscavir | Foscarnet (Prior Authorization) |
| Fuzeon | Evfuvintide (Prior Authorization) |
| Glucophage | Metformin |
| Havrix | Hepatitis A Vaccine(Prior Authorization) |
| Hepsera | Adefovir Dipivoxil |
| Imodium ( Rx only) | Loperamide (Rx only) |
| Infergen | Interferon Alphacon 1(Prior Authorization) |
| Intelence | Etravirine |
| Intron A | Inteferon Alpha 2 B(Prior Authorization) |
| Invirase | Saquinavir |
| Isentress | Raltegravir |
| Kaletra | Lopinavir |
| Klonopin | Clonazepam |
| Lexapro | Escitalopram |
| Lexiva | Fosamprenavir Calcium |
| Lipitor | Atorvastatin |
| Lyrica | Pregabalin (Prior Authorization) |
| Mepron | Atovaquone |
| Myambutol | Ethambutol |
| Mycelex | Clotrimazole |
| Mycobutin | Rifabutin |
| Mycostatin | Nystatin |
| Naprosyn (RX and OTC) | Naproxen (RX and OTC) |
| Nebupent, Pentam | Pentamidine |
| Neurontin | Gabapentin |
| Niaspan | Niacin |
| Norvir | Ritonavir |
| Paxil | Paroxetine |
| Peg Intron | Peginterferon Alfa 2 B(Prior Authorization) |
| Pegasys | Peinterferon Alfa 2 A(Prior Authorization) |
| Potassium | Potassium |
| Prezista | Darunavir |
| Prilosec | Omeprazole |
| Pro Air | Albuterol Sulfate |
| Prozac | Fluoxetine |
| Rebetol | Ribavirin (Prior Authorization) |
| Remeron | Mirtazapine |
| Rescriptor | Delavirdine |
| Restoril | Temazepam |
| Reyataz | Atazanavir |
| Selzentry | Maraviroc (Prior Authorization) |
| Seroquel | Quetiapine |
| Sporanox | Itraconazole |
| Stribild | Elvitegravir /Tenfovir / Emtrictabine / Cobicistat |
| Sulfadiazine | Sulfadiazine |
| Sustiva | Efavirenz |
| Toprol,Lopressor (IR and ER) | Metoprolol (IR and ER) |
| Tricor | Fenofibrate |
| Trizivir | Lamivudine/Zidovudine/Abacavir |
| Truvada | Tenofovir/Emtricitabine |
| Twinrix | Hepatitis A&B Vaccines(Prior Authorization) |
| Tyzeka | Telbivudine |
| Valcyte | Valganciclovir |
| Valium | Diazepam |
| Valtrex | Valacyclovir |
| Viracept | Nelfinavir |
| Viramune | Nevirapine |
| Viread | Tenofovir |
| Wellbutrin (IR and ER) | Bupropion (IR and ER) |
| Wellcovorin | Leucovorin |
| Xanax (IR and XR) | Aprazolam (IR and XR) |
| Zantac (Rx only) | Ranitidine (Rx only) |
| Zerit, D4T | Stavudine |
| Zestril | Lisinopril |
| Ziagen | Abacavir |
| Zithromax | Azithromycin |
| Zoloft | Sertraline |
| Zovirax (Oral and Topical Ointment) | Acyclovir (Oral and Topical Ointment)(Prior Authorization on Topical Ointment) |
For an application or more information, please call the WV Ryan White Part B Program Office at 304-232-6822 or send a request to Jay Adams, HIV Care Coordinator, P.O. Box 6360, Wheeling, WV 26003 / or by email: jayadams@atfuov.org