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ADAP and Medicaid Back-Billing

November 2016


Fact sheet to explain policies and procedures for ADAPs to follow to ensure that Ryan White funds are used as the payer of last resort, including for Medicaid. Document discusses: 

  • Eligibility as mechanism to assess other payer sources
  • Scenarios under which ADAPs can coordinate with Medicaid
  • The role of Pharmacy Benefit Managers and central pharmacies in handling back-billing and
  • Avoidance of receipt of duplicate discounts/rebates. 
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