[The Access Project]


To Local HIV
Care Consortiums
To PA ADAP
Contact Page
To ALL Other ADAPs
Main Page
To Access Project
Home Page

Pennsylvania ADAP Formulary
Which drugs are covered?

All drugs are listed by catagory and alphabetically, starting with their generic names followed by the brand names in parenthesis. Click on a high-lighted item in green to see a detailed description of the drug. To search for a specific drug, hold down both the control key (command key on the Mac) and the F key, then type in the drug name.
For a list of specific medical criterias, see the bottom of this page.

Antiretroviral
Nucleoside/tide Reverse
Transcriptase Inhibitor (NRTI)

abacavir (Ziagen)
abacavir/lamivudine/zidovudine (Trizivir)
didanosine (ddI, Videx)
emtricitabine (Emtriva)
lamivudine (Epivir, 3TC)
lamivudine/zidovudine (Combivir)
stavudine (d4T, Zerit)
tenofovir (Viread)
zalcitabine (ddC, HIVID)
zidovudine (AZT, Retrovir)
Protease Inhibitor (PI)
amprenavir (Agenerase)
atazanavir (Reyataz)
fosamprenavir (Lexiva)
indinavir (Crixivan)
lopinavir/ritonavir (Kaletra)
nelfinavir (Viracept)
ritonavir (Norvir)
saquinavir (Fortavase)
saquinavir (Invirase)
Non-nucleoside Reverse Transcriptase Inhibitor (NnRTI)
delavirdine (Rescriptor)
efavirenz (Sustiva)
nevirapine (Viramune)


Entry Inhibitor
enfuvirtide (Fuzeon)

HIV Drug Resistance Tests: None.

Opportunistic Infection (OI) Treatment & Prophylaxis
Public Health Service
Recommanded OI drugs

acyclovir
azithromycin
cidofovir (Vistide)
clarithromycin
famciclovir
fluconazole
foscarnet (Foscavir)
ganciclovir
isoniazid
itraconazole
leucovorin
pyrimethamine (Daraprim, Fansidar)
sulfadiazine
TMP/SMX (Bactrim, Septra)
Other OI drugs
amikacin
amphotericin B
atovaquone (Mepron)
bleomycin
capreomycin
ciprofloxacin
clindamycin
clofazimine
clotrimazole
cycloserine
dapsone
dexamethasone doxorubicin
ethambutol
ethionamide
etoposide
flucytosine
kanamycin
ketoconazole
nystatin
ofloxacin
paramomycin
pentamidine
prednisone
primaquine
pyrazinamide
rifabutin (Mycobutin)
rifampin
sulfadoxine & pyrimethaminel
terconazole
trimetrexate glucoronate (Neutrexin)
triple sulfa
valacyclovir
valganciclovir (Valcyte)
vinblastine (Velban)
vincristine (Oncovin)

Hepatitis C Treatment
peg-interferon alfa-2a (Pegasys)
peg-interferon alfa-2b (Peg-Intron)
ribavirin (Rebetol, Copegus, generic)

Wasting
dronabinol (Marinol)
megestrol acetate (Megace)


Medical Criteria
  • Active SPBP cardholders with identification numbers beginning with the prefix SP2 or SP231 are eligible for Clozaril - Risperdal - Seroquel or Zyprexa as prescribed for a DSM IV diagnosis of schizophrenia. Clients on Clozaril therapy may have Clozaril Support Services through: Provider Types 01, 29, or 33. The SPBP does not reimburse any other provider type for this service.
  • SPBP drug coverage is discontinued if the client becomes eligible for drug covrage through the medical assistance access card and or a medical assistance managed care organization. clients may not have drugs provided through both medical assistance and the SPBP.
  • If a client has third party insurance that covers drugs, it must be billed prior to billing SPBP. Call SPBP Provider Services for billing questions at: 1-800-835-4080

Recent Updates HomeHepatitis B and C About The Network The Access ProjectSimple Fact Sheets

Last modified: 12/15/2006
copyright © 2007 The Network
Contact The Network