Anti-HIV Drugs

Non-nucleosides (Non-Nukes or NNRTIs)

• Intelence - etravirine
• Rescriptor - delavirdine
• Sustiva - efavirenz
• Atripla - Multi-Class. efavirenz, tenofovir and emtricitabine
• Viramune - nevirapine

• Reyataz - atazanavir
• Prezista - darunavir
• Lexiva - fosamprenavir
• Crixivan - indinavir
• Kaletra - lopinavir/ritonavir
• Viracept - nelfinavir
• Norvir - ritonavir
• Invirase - saquinavir mesylate
• Aptivus* - tipranavir

New York ADAP and ADAP Plus - Both Genotypic and Phenotypic tests are covered. ADAP will pay for a maximum of three tests total (geno or pheno) in a patient year. This is the same limitation used by NYS Medicaid.

New York State calls Atripla a multi-class drug, since it has one component that is an NNRTI and two that are NRTIs. Certain anti-HIV combinations may be subject to "utilization review thresholds", which means they may question your doctor if you are taking a combination of 5 or 6 drugs or higher doses than typically used.

Request Form and Guidelines available by calling 1-800-542-2437. Some antiretroviral combinations may be subject to utilization review thresholds. New York ADAP also covers hydroxyurea, a cancer drug sometimes used in the treatment of HIV disease.

Entry Inhibitors

• Fuzeon* - enfuvirtide

Integrase Inhibitors

• Isentress - raltegravir

CCR5 co-receptor inhibitors

• Selzentry - maraviroc

Nucleoside/tides (NRTIs or nukes)

• Ziagen - abacavir
• Epzicom - lamivudine/abacavir
• Trizivir - abacavir/lamivudine/zidovudine
• Videx - didanosine
• Emtriva - emtricitabine
• Truvada - emtricitabine/tenofovir
• Epivir - lamivudine
• Combivir - lamivudine/zidovudine
• Zerit - stavudine
• Viread - tenofovir
• Retrovir - zidovudine

Opportunistic Infection (OI) Treatment or Prevention

• PCP Prophylaxis and Treatment : clindamycin, dapsone, leucovorin, pentamidine, primaquine, sulfadoxine/pyrimethamine, trimethoprim, trimethoprim/sulfamethoxazole
• Herpes Infections : acyclovir, penciclovir, valacyclovir
• Mycobacterial Infections (TB and MAC) : amikacin, azithromycin, capreomycin, ciprofloxacin, clarithromycin, cycloserine, ethambutol, ethionamide, gatifloxacin, isoniazid, kanamycin, moxifloxacin, ofloxacin, para-amino salicyclic acid, pyrazinamide, rifabutin, rifampin, rifampin in combination, rifapentine, streptomycin
• CMV disease :fomivirsen, foscarnet, ganciclovir, cidofovir, probenecid, valganciclovir
• Fungal infections :amphotericin B, caspofungin, clotrimazole, econazole nitrate, fluconazole, flucytosine, griseofulvin, itraconazole, ketoconazole, miconazole, nystatin, terbinafine, terconazole, voriconazole
• Toxoplasmosis :azithromycin, clindamycin, leucovorin, pyrimethamine, sulfadiazine, sulfamethoxazole, triple sulfa
• Cryptosporidiosis : paromomycin
• Microsporidiosis : albendazole

New York Resources

• State Programs and Contact Information
• Case Management and Support Services
• HIV Treatments
• Hepatitis Resources

Hepatitis B and Hepatitis C Treatments and Vaccines are covered

• Mandatory Generics : ADAP will cover only the generic form of A-rated drugs
• Cardiac medications listed individually are available in combination with other listed cardiac medications.
• IVIG is restricted to prevention of bacterial infections in children ONLY.
• Methadone is covered only for pain relief, ADAP does not cover methadone maintenance

Other HIV/AIDS Related Conditions

• Anemia : Epoetin alfa for AIDS related anemia, with: Hct < 30% and/or Hgb < 10g/dl;and serum erythropoietin levels < 500mU/ml.
• Neutropenia : Sargramostim or Filgrastim for severe neutropenia due to chemotherapy, or drug toxicity, or HIV disease with ANC < 500/mm3.
• Thrombocytopenia (HIV-associated) : Immune globulin Rho (Win Rho SDF) for HIV-associtaed thrombocytopenia with platelets < 20,000 mm3. Prior authorization is not required for children.
• Thrombocytopenia (chemotherapy induced) : Oprelvekin (Neumega) for chemotherapy induced thrombocytopenia with platelet count < 20,000/ul. and/or documented risk factors or clinical indications.
• Wasting Syndrome :cyproheptadine, dronabinol, testosterone, megestrol acetate, thalidomide, nandrolone
• Prevention of bacterial infections in children ONLY : intravenous immune globulin
• Condyloma acuminata :alpha N3, imiquimod, podofilox
• Reiter's syndrome :ansaid, sulfasalazine
• Prevention of dental cavities : fluoride
• Venous thrombosis : enoxaparin, warfarin