A Common Patient Assistance Program Application Form for HIV Medicine: Improved and Available

Content From: Murray Penner, Executive Director, National Alliance of State & Territorial AIDS Directors (NASTAD)Published: November 27, 20134 min read


Common Patient Assistance Program Application Form A new streamlined application form is available to help low-income individuals who are living with HIV access antiretroviral (ARV) medicines through HIV patient assistance programs (PAPs).

Need for a Streamlined Application Form

PAPs are programs operated by pharmaceutical companies to provide free ARV medicines to low-income people living with HIV who do not qualify for insurance or assistance programs, such as Medicaid, Medicare, or AIDS Drug Assistance Programs (ADAPs). Each individual company has varying eligibility criteria. Most programs have a financial eligibility level of 500% of the Federal Poverty Level, or $57,450 for one person. Some programs have lower eligibility levels, but many also make exceptions to their eligibility criteria based on the needs of individuals applying for their program. Eligibility levels and other criteria of PAPs can be found on the Positively AwareExit Disclaimer website or the Fair Pricing CoalitionExit Disclaimer website.

As HIV regimens sometimes include three or more medicines, often from different companies, people who need to access PAPs may need to complete several different forms. This process can be cumbersome and time-consuming, as well as frustrating. People living with HIV and community advocates have long desired a simpler way for individuals to apply to PAPs—one that would require completing a single application form rather than having to complete numerous and differing forms.

Collaboration to Develop a Common Form

In 2012, the Department of Health and Human Services (DHHS), along with seven pharmaceutical companies, the National Alliance of State and Territorial AIDS Directors (NASTAD)Exit Disclaimer , and community stakeholders embarked upon a process to develop a common PAP application form. The vision was that the common form could be used by both people living with HIV and their providers (e.g., doctors or case managers) to apply to all HIV PAPs at once, thus reducing the application paperwork and time.

Following a consultation convened by NASTAD, seven of the eight companies that manufacture HIV ARV medicines agreed to develop and accept a common application form, called the Common Patient Assistance Program Application (CPAPAExit Disclaimer. Companies agreeing to accept the CPAPA include AbbVieExit Disclaimer, Boehringer IngelheimExit Disclaimer, Bristol-Myers SquibbExit Disclaimer, Gilead SciencesExit Disclaimer, Janssen TherapeuticsExit Disclaimer (Johnson & Johnson Patient Assistance Foundation), MerckExit Disclaimer and ViiV HealthcareExit Disclaimer. DHHS Secretary Sebelius announced during the 2012 International AIDS Conference that the CPAPA would soon be available. The new form was then launched in September 2012 and the form was recently updated to improve its utilization following additional input from stakeholders.


The CPAPA form combines common information collected on each individual PAP application form. The form reduces the need to complete several different application forms for PAPs. However, it still must be sent to each PAP separately to receive access to HIV medicine.

Once the form is completed (either online via a fillable form or on paper completed in writing), the same completed form (copied or printed the number of times required for the number of companies to which an individual is applying) must be submitted to each company that has the required medicines. The addresses where the completed form(s) should be sent are located on page 3 of the CPAPA form under each individual company section.

Several tools are available to assist people who wish to utilize this form to access HIV PAPs:

In order to ensure that the form remains useful and valuable, NASTAD has created an email address to receive suggestions for improving it. This is not designed to address challenges with accessing an individual company PAP or checking on eligibility determinations, but suggestions on the form design or ideas about how improve its usefulness can be sent here. Feedback received will be utilized to further refine and improve the form.

Further Efforts to Streamline Access to PAPs

Finally, there are other efforts underway to streamline how individuals receive their HIV medicines. Working closely with NASTAD and the Clinton Health Access Initiative (CHAI), HarborPathExit Disclaimer was recently created to further streamline access to HIV PAPs. HarborPath is an online portal that is currently in a pilot phase in several states. This online portal allows providers to collect the same information requested on the CPAPA form, but then allows a single process to obtain all the medicine on the HarborPath formulary (it currently includes medicines from BMS, Gilead Sciences, Merck, and ViiV Healthcare).

We would like to hear from you! Comments, feedback, or ideas about the CPAPA are invited below.