AIDS Pharmaceutical Assistance by 4v4x0P4


									Part A Service Definitions
For each funded service, a definition has been developed based on guidelines provided by
HRSA, the intent of the local Planning Council and standards of practice determined by the
grantee. Unless other agreements are made, proposals should reflect, and service contracts will
be written, to reimburse providers for the services as they are defined herein.

Please note: The Ryan White Part A Program is the “payer of last resort.” This means providers
must make reasonable efforts to identify and secure other funding sources outside of Ryan White
legislation funds, whenever possible. Part A funds are intended to be “the payer of last resort” for
the provision of care. Providers are responsible for verifying an individual’s eligibility by
investigating and eliminating all other potential billing sources for each service, including public
insurance programs, or private insurance. Part A funds may not be used to supplant partial
reimbursements from other sources to make up any un-reimbursed portion of the cost of such

AIDS Pharmaceutical Assistance (Local) – Core Service

Definition: Local pharmacy assistance program for the provision of prescription drugs to
prolong life or prevent the deterioration of health directly related to an individual’s HIV
condition. Medication Assistance provided based on guidelines set by the Ryan White Part A
Program. Individuals MUST be documented as ineligible for permanent and temporary sources
of coverage (e.g., ADAP, Medicaid, Medicare, patient assistance programs, or private payer).
Medications provided must be listed on the ADAP formulary.

Providers proposing pharmacy services under the RW Act are required to participate in Public
Health Service 340 B pricing and/or accept this pricing as reimbursement in full from Part A. A
letter stating provider participation in the PHS340B program is required to be submitted with the

Service Unit: A unit of service is the prescription written per medication per client. Medication
should be billed at 340 B pricing plus any dispensing fees charged by the pharmacy.

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