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Florida ADAP March 5 Forum Summary

March 5, 2026

ViiV Healthcare’s Patient Assistance Program

Enrollment information and more is available for providers and people with HIV  online or by calling ViiV Connect directly at:   844-588-3288. 

Emergency 30-day Supply Available Via a Presumptive Fill Process 

• There is an option for a 30-day emergency supply of a medication by providers requesting a presumptive fill. Patients can have three presumptive fills in a lifetime. 
• There is a 24/7 presumptive fill portal (including weekends). Provider verified by ID.me. Once approved – can fill the prescription at a pharmacy. Still building the pharmacy network for the program. Pharmacies can join by signing an agreement with PDMI.
• More information is available on www.viiv.connect.com by searching for “presumptive” or go to  https://www.viivconnect.com/hcp/orals/ and scroll down to ”request immediate access to an oral medication for your patient” which will take you to the presumptive fill portal.

Patient Assistance Program Process

• To avoid processing delays, ensure that all of the questions on the form are completed. This includes a signature from the health care professional and patient.  HCP needs to print the form for the patient to sign and then fax it in with the prescription. ViiVConnect does not accept electronic prescriptions except from New York.
• Enrollment typically takes 24 to 48 hours to process if there’s no missing information in the form. Drug ships within 4 to 6 days. Cabenuva is shipped overnight.
• A denial letter from ADAP is not required and ViiV staff have been advised of this.
• ViiV plans on keeping eligibility at the 500% FPL level but are continuously evaluating the program.
• Important for the patient to indicate their preferred method of communication so that they receive communications and updates on the application’s status.
• ViiV’s patient assistance program provides medications by mail order only.
• If request is for Cabenuva – need to designate location for the injectable. Option to indicate if requires an oral lead. Oral lead in ships directly to the patient. ViiV does not cover cost of administering the injectable.
• Enrollment extends for a year, but ViiV conducts periodic eligibility checks
• Health care professionals receive a confirmation via fax of enrollment status. Patient also receives notification if indicated a preferred method of communication.

Other Q&A:

• Does ViiV have a copay program?  Yes – copay assistance is available  for ViiV medications.  More information is available from the ViiV Connect oral medication page and injectables page. 
• Will ViiV support clients who have family planning Medicaid?  As of today – people with family planning Medicaid are not an approved population, but ViiV is working on the issue as well as for people with emergency Medicaid coverage. 

ACA Marketplace Special Enrollment Period for ADAP Clients  

See:  The AIDS Institute’s Fact Sheet:  Options for Florida ADAP Enrollees When ADAP Premium Assistance Stops

• The Florida ADAP program stopped paying the premiums for ACA coverage for ADAP clients on March 1 but did not cancel their coverage. 
• Around 80% of ADAP clients are eligible for advanced premium tax credits so the state was only paying for part of their monthly premium. 
• The advanced premium tax credits will continue for those who were eligible so most clients will not be responsible for the full premium amount. 
• ACA requires insurers to provide a grace period.
• For people receiving advanced premium tax credits – there is a 90-day grace period before insurance is cancelled.  During the first month (March) of non-payment by ADAP  – client access to providers and ability to fill medications should continue. In the second and third months (April and May) – the insurer will no longer pays claims and will put them in pending status. Clients will have until the end of May to pay back the premiums. If clients do not pay back premiums or change plans by the end of May then their insurance will be cancelled with a termination date of April 1. After March, prescriptions will be denied. 
• For clients without advanced premium tax credits – the grace period is determined by state law but is typically 31 days.  

Special Enrollment Period

• The Centers for Medicare and Medicaid Services created a special enrollment period for Florida ADAP clients. ADAP clients can change their plan and apply for advanced premium tax credits until April 30.
• Clients can evaluate plan options from healthcare.gov. Important for clients to not just evaluate based on premium costs – but to also check the drug formulary and out of pocket costs for medications in addition to ensuring their providers are in network.
• Clients should be cautious of catastrophic coverage plans and high-deductible plans. 
• Clients may want to stick with one of the ADAP approved plans in the event ADAP premium assistance is restored. 
• Clients who rushed to change their ACA plan right after the cuts were announced also can use the special enrollment period to re-evaluate their options and change their plan.
• ACA enrollment staff should be aware of the special enrollment period. If they are not aware — ask to talk to a supervisor.  
• Clients will need proof of insurance termination for the special enrollment period. Clients can use their ADAP termination letter.  
• The special enrollment period – is only available to people who are eligible for ACA coverage.
• When clients enroll in a new plan – the coverage will start on the first of the month after enrollment is complete. Clients can ask for coverage to start retroactively back to March 1. 
• Advise for clients to take advantage of the special enrollment and take some time to shop online for an affordable plan that meets their needs. Clients should be on alert for junk plans that may have lower premiums but will be more costly in the end because they will not adequately cover medications or health care services. 
• Clients with income under 200% FPL should consider a silver plan because they come with extra benefits for people with income under 200% FPL.
• Cost sharing assistance is still available from ADAP for people with commercial insurance and Medicare up to 400% FPL. It was reported during the meeting that ADAP may be covering cost sharing for Biktarvy for clients with Medicare or commercial insurance coverage (including for those enrolled in ACA plans). Also reported that prior authorization for Descovy may be delayed until April. 
  

Advocacy Update       

• Still advocating in the legislature for a reversal of the cuts and there is support from both chambers. 
• Upcoming court dates:
• On March 11 – there will be a circuit court hearing regarding the injunction filed by AHF. 

On March 17 – there will be an administrative law court hearing challenging the emergency rule that will likely be accessible via zoom.