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2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Complete (PPO) Chapter 2: Important phone numbers and resources 48 brand name drugs in the coverage gap. The 70% discount and any portion paid by the plan are both applied to the price of the drug before any SPAP or other coverage. What if you have coverage from an AIDS Drug Assistance Program (ADAP)? What is the AIDS Drug Assistance Program (ADAP)? The AIDS Drug Assistance Program (ADAP) helps ADAP-eligible individuals living with HIV/AIDS have access to life-saving HIV medications. Medicare Part D prescription drugs that are also on the ADAP formulary qualify for prescription cost-sharing assistance. Note: To be eligible for the ADAP operating in your State, individuals must meet certain criteria, including proof of State residence and HIV status, low income as defined by the State, and uninsured/under-insured status. If you change plans please notify your local ADAP enrollment worker so you can continue to receive assistance. For information on eligibility criteria, covered drugs, or how to enroll in the program, please call your state ADAP office listed below. AIDS Drug Assistance Program (ADAP) – Contact Information Alaska | Alaskan AIDS Assistance Association 1-800-478-2437 1057 W Fireweed LN, STE 102 Anchorage, AK 99503 9 a.m.-5 p.m. local time, http://www.alaskanaids.org/index.php/client-services/adap Monday-Friday Alabama | Alabama AIDS Drug Assistance Program 1-866-574-9964 Office of HIV Prevention and Care, 201 Monroe ST, STE 1400 8 a.m.-5 p.m. local time, Montgomery, AL 36104 Monday-Friday http://www.alabamapublichealth.gov/hiv/adap.html Arkansas | Arkansas Department of Health, Ryan White 1-501-661-2408 Program - Part B 8 a.m.-4:30 p.m. local 4815 W Markham ST, Slot 33 Little Rock, AR 72205 time, Monday-Friday https://www.healthy.arkansas.gov/programs-services/topics/ryan- white-faqs American Samoa | American Samoa Department of Health 1-684-633-1433 Faagaalu RD 1 Pago Pago, AS 96799 8 a.m.-5 p.m. local time, https://www.americansamoa.gov/departments Monday-Friday Arizona | Arizona Department of Health Services ADAP 1-800-334-1540 150 N 18th AVE, STE 110 Phoenix, AZ 85007 8 a.m.-5 p.m. local time, https://www.azdhs.gov/preparedness/epidemiology-disease- Monday-Friday control/disease-integration-services/index.php#aids-drug- assistance-program-home

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