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 WV Department of Health and Human Resources. Formulary drugs available in generic must be dispensed in generic. Please call Jay Adams @ 304 232 6822 for assistance.
To be eligible for the ADAP, HIV infected WV residents with a family income less than 500% 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 WV Department of Health and Human Resources.
WV AIDS DRUG ASSISTANCE PROGRAM FORMULARY 12/2020
Trade Name Generic Name Abilify Aripiprazole Actos Piaglitazone ActosPlusMet Piaglitazone Advair Fluticasone Albuterol/HFA Albuterol/HFA Ambien/Ambien CR Zolpidem/ Zolpidem CR Anafranil Clomipramine Androgel Testosterone Aptivus Tipranavir Atripla Efavireniz/Emtricitabine/Tenofovir AZT, Retrovir Zidovudine Bactrim, or equivalent Sulfamethoxazole Baraclude Entecavir (Prior Authorization) Biaxin Clarithromycin Bictegravir, Emtricitabine & Tenofovir Biktarvy Alafenamide Buspar Buspirone Bydureon Exenatide Celexa Citalopram Cimduo Lamivudine/Tenofovir Cleocin Clindamycin Combivir Lamivudine/Zidovudine Compazine Prochlorperazine Complera Rilpivirine/Tenofivir/Emtricitabine Copegus Ribavirin ( Prior Authorization ) Coreg Carvedilol Crestor Rosuvastatin Crixivan Indinavir Cymbalta Duloxetine Cytovene Ganciclovir Daliresp Roflumilast Dapsone Dapsone Daraprim Pyrimethamine 1
DDC, Hivid Zalcitabine DDI, Videx Didanosine Doravine/Lamivudine/Tenofovir Disoproxil Delstrigo Fumarate Deltasone Prednisone Depakote Sodium Valproate Descovy Emtricitabine/Tenofovir Alfenamide Desyrel Trazodone Diflucan Fluconazole Diovan Valsartan Dovato Dolutegravir/Lamivudine Edurant Rilpivirine Effexor / Effexor XR Venlafaxine / Venlafaxine XR Elavil Amitriptyline Eliquis Apixaban Emtriva Emtricitabine Hepatitis B Vaccine Engerix (Prior Authorization) Entresta Sacubitril/Valsartan Epivir, 3TC Lamivudine Epzicom Lamivudine/Abacavir Evotaz Atazanavir/Cobicstat Famvir Famciclovir (Prior Authorization) Farxiga Dapagliflozin Flovent Fluticasone Foscavir Foscarnet (Prior Authorization) Fuzeon Evfuvirtide (Prior Authorization) Elvitegravir/ Tenofovir Genvoya Alfenamide/Emtricitabine/Cobicistat Geodon Ziprasidone Glucophage Metformin Glyxambi Empagliflozin/Linagliptin Hepatitis A Vaccine Havrix (Prior Authorization) Hepsera Adefovir Dipivoxil Humalog Insulin Lispro Imodium ( Rx only) Loperamide (Rx only) Interferon Alphacon 1 Infergen (Prior Authorization) Intelence Etravirine Inteferon Alpha 2 B Intron A (Prior Authorization) Invirase Saquinavir Isentress Raltegravir Isosorbide Isosorbide Mononitrate Janumet, Janumet XR Sitagliptin/Metformin 2
Januvia Sitagliptin Jardiance Empagliflozin Juluca Dolutegravir/Rilpivirine Kaletra Lopinavir Klonopin Clonazepam Kreppra XR Levetiracetam Lamictron Lamotrigine Lantus Insulin Glargine Lexapro Escitalopram Lexiva Fosamprenavir Calcium Linzess Linaclotide Lipitor Atorvastatin Lithium Lithobid Lyrica Pregabalin (Prior Authorization) Mavyret Glrcapravir/Pibrentasvir (Prior Authorization) Mepron Atovaquone Myambutol Ethambutol Mycelex Clotrimazole Mycobutin Rifabutin Mycostatin Nystatin Mytesi Crofelemer Naprosyn (RX and OTC) Naproxen (RX and OTC) Narcan Naloxone Nebupent, Pentam Pentamidine Neurontin Gabapentin Niaspan Niacin Norvasc Amlodipine Norvir Ritonavir Novolog Insulin Aspart Injection Emtricitabine/Rilpivirine/Tenofovir Odefsey Alafenamide Onglysa Saxagliptin Pantrapazole Protonix Paxil Paroxetine Peginterferon Alfa 2 B Peg Intron (Prior Authorization) Peinterferon Alfa 2 A Pegasys (Prior Authorization) Pifeltro Doravine Plavix Clopidogrel
Potassium Potassium
Pradaxa Dabigratran
Pravachol Pravastatin 3
Prezcobix Darunavir/Cobicstat Prezista Darunavir Prilosec Omeprazole Pro Air Albuterol Sulfate Propranolol Inderal Prozac Fluoxetine Rebetol Ribavirin (Prior Authorization) Remeron Mirtazapine Rescriptor Delavirdine Restoril Temazepam Reyataz Atazanavir Risperdal Rispiridone Rukobia Fostemsavir SARS-CoV-2 Covid 19 Vaccines Selzentry Maraviroc (Prior Authorization) Singulair Montelukast Seroquel Quetiapine Spiriva Titropium Bromide Sporanox Itraconazole Starlix Nateglinide Elvitegravir /Tenfovir / Emtricitabine / Stribild Cobicistat Sulfadiazine Sulfadiazine Sustiva Efavirenz Symbicort Budesonide/Formoterol Symfi Lo Efavirenz/Lamivudine/Tenofovir Darunavir/Cobicistat/Emtricitabine/Tenofovir Symtuza Alafenamide Ombitasvir/Paritaprevir/Ritonavir Technivie (Prior Authorization) Tegretol Carbamazepine Tivicay Dolutegravir Sodium Topamax Topiramate Toprol,Lopressor (IR and ER) Metoprolol (IR and ER) Toujeo Insulin Glargine Tresiba Insulin Degludec Tricor Fenofibrate Triumeq Dolutegravir/Abacavir/Lamivudine Trizivir Lamivudine/Zidovudine/Abacavir Trogarzo Ibalizumab Truvada Tenofovir/Emtricitabine Hepatitis A&B Vaccines Twinrix (Prior Authorization) Tybost Cobicistat
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Tyzeka Telbivudine Valcyte Valganciclovir Valium Diazepam Valtrex Valacyclovir Ventolin Albuterol Dasabuvir/Paritaprevir/Ritonavir Viekira XR (Prior Authorization) Viibyrd Vilazodone Viracept Nelfinavir Viramune Nevirapine Viread Tenofovir Vistaril Atarax Viteka Elvitegravir Wellbutrin (IR and ER) Bupropion (IR and ER) Wellcovorin Leucovorin Xanax (IR and XR) Aprazolam (IR and XR) Xarelto Rivaroxaban Xigduo XR Dapagliflozin/Metformin Zantac (Rx only) Ranitidine (Rx only) Zerit, D4T Stavudine Elbasvir/Grazoprevir Zepatier (Prior Authorization) Zestril Lisinopril Ziagen Abacavir Zithromax Azithromycin Zoloft Sertraline Acyclovir (Oral and Topical Ointment) Zovirax (Oral and Topical Ointment) (Prior Authorization on Topical Ointment) Zyprexa Olanzapine
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