Maryland Aids Drug Assistance Program (madap)



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Maryland Aids Drug Assistance Program (MADAP)


  1. Contact Numbers:

Phone: 410-767-6535

Fax: 410-333-2608



  1. Drug Coverage

MADAP-1 – Covered Medications





Drug Name (Description)

HSN

GSN

Comments

Abacavir (Ziagen)










Abacavir/ Lamivudine/Zidovidine (Trizivir)










Acyclovir (Zovirax)










Albuterol Sulfate (Proventil)










Amitriptyline Hydrochloride (Elavil)










Amphotericin-B (Fungisone)










Amoxicillin










Amprenavir (Agenerase)










Atazanivir (Reyataz)










Atorvastatin (Lipitor)










Atovaquone (Mepron)










Augmentin










Azithromycin (Zithromax)










Bupropion (Wellbutrin, Zyban)










Cephalexin










Cidofovir (Vistide)










Ciprofloxacin (Cipro, Ciloxan)










Citalopran HBr (Celexa)










Clarithromycin (Biaxin)










Clindamycin (Cleocin)










Clotrimazole (Lotrimin, Mycelex)










Clotrimazole/ Betamethasone Cream (Lotrisone Cream)










Dapsone










Daunorubicin Citrate Liposomal (DaunoXome)










Delavirdine (Rescriptor)










Didanosine (Videx)










Diphenoxylate/Atropine (Lomotil)










Divalproex, Valproic Acid (Depakote, Depakene)










Doxycycline










Efavirenz (Sustiva)










Emtricitabine (Emtriva)










Emtricitabine Tenofovir (Truvada)










Enfuvirtide (Fuzeon)2










Epoetin Alpha (Epogen, Procrit) 2










Erythromycin










Escitalopram Oxalate (Lexapro)










Ethambutol (Myambutol)










Famciclovir (Famvir)










Fenofibrate (Tricor)










Filgrastim (Neupogen) 2










Fluconazole (Diflucan)










Fluoxetine (Prozac)










Fluphenazine (Prolixin)










Fomivirsen (Vitravene)










Fosamprenivir (Lexiva)










Foscarnet (Foscavir)










Gabapentin (Neurontin)










Ganciclovir (Cytovene)










Gemfibrozil (generic only)










Glipizide (Glucotrol XL)










Haldoperidol (Haldol)










Hydroxizine (Atarax)










Hydroxyurea (Hydrea)










Imiquimod (Aldara Cream)










Indinavir (Crixivan)










Interferon Alpha-2A (Roferon-A, Intron-A)










Isoniazid (Nydrazid, Rifamate)










Itraconazole (Sporanox)










Ketoconazole (Nizoral)










Lamivudine (Epivir)










Lamivudine Abacavir (Epzicom)










Leucovorin










Levetriracetam (Keppra)










Lithium










Loperamide (Imodium)










Lopinavir/Ritonavir (Kaletra)










Megestrol Acetate (Megace)










Metformin (Glucophage)










Metronidazole










Miconazole (Monistat)










Miratazapine (Remeron)










Nandrolone










Nelfinavir (Viracept)










Nevirapine (Viramune)










Nortriptyline (Pamelor, Aventyl)










Nystatin (Mycostatin)










Octreotide (Sandostatin)










Olanzapine (Zyprexa)










Oxandrolone (Oxandrin) 2










Oxymetholone (Anadrol-50)










Paromomycin (Humatin)










Paroxetine (Paxil)










Peginterferon Alfa 2a (Pegasys) 2,3










Peginterferon Alfa 2b (Peg-Intron) 2,3










Pentamidine (Pentam, NebuPent)










Perphenazine (Trilafon)










Polymxin b Sulfate/Trimethoprim Sulfate (Polytrim)










Pravastatin (Pravachol)










Primaquine










Prochlorperazine (Compazine)










Pyrazinamide










Pyrimethamine (Daraprim, Fansidar)










Ribavirin (Rebetol,Copegus) 2,3










Rifabutin (Mycobutin)










Rifampin (Rifadin, Rimactane)










Risperidone (Risperdal)










Ritonavir (Norvir)










Saquinavir (Invirase, Fortovase)










Sertraline (Zoloft)










Stavudine (Zerit,d4T)










Sulfadiazine










Tenofovir isoproxil










Fumarate (Viread)










Testosterone (injection & patches)










Thalidomide (Thalomid)










TMP-SMX (Bactrim, Septra)










Trazadone HCL (Desyrel/Desyrel Dividose)










Trimethoprim










Valacyclovir (Valtrex)










Valganciclovir (Valcyte)










Venlafaxine HCl (Effexor, Effexor XR)










Zalcitabine (HIVID)










Zidovudine (Retrovir, AZT)










Zidovudine 300/










Lamivudine 150 (Combivir)










NOTES:


1 Brand names are provided in parentheses for reference purposes. There may be other brand names than those listed here for a particular medication.
2 Coverage of medications noted in italics requires that patients meet specific medical criteria. Contact MADAP at (410) 767-6535 for more information.
3 Peginterferon alfa (including 2b and 2a) and ribavirin covered in combination, and only for treatment of HCV infection in HIV co-infected clients.


  1. Payer Specific Information



  1. Provider Information

Provider Manual

Provider Cheat Sheet




  1. Emergency Procedures: Not Applicable




  1. PA Request Form (see Y/CLIENT RELATIONS/MARYLAND/PA FORMS)




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