CMSP and Eligibility for Other Programs

Capsule. When CMSP members are eligible for other benefit programs CMSP is the secondary payer to these other programs. This means that if another program covers a benefit that is also covered by CMSP, the other program will be expected to be the primary payer for the benefit.

California Aids Drug Assistance Program (ADAP)

CMSP members must apply for the California AIDS Drug Assistance Program (ADAP) to receive all HIV medications. A one-time, 30-day supply of the medication will be provided to assure continuity of care. Following the one-time supply, CMSP will consider payment for HIV medications only if the CMSP member provides a document showing eligibility for ADAP has been denied. Information about ADAP is available by calling (888) 311-7632 or (888) 575-ADAP. Information about ADAP is available on the Internet at the Public Health Service Bureau.

California Family Planning, Access, Care and Treatment Program (Family PACT)

CMSP members must apply for Family Planning, Access, Care and Treatment Program (Family PACT) to receive contraceptives. A one-time, 30-day supply of the medication will be provided to assure continuity of care. Following the one-time supply, CMSP will consider payment for contraceptives only if the CMSP member provides a document showing eligibility for Family PACT has been denied. Information about Family PACT is available by calling (800) 942-1054.

Breast and Cervical Cancer Treatment Program (BCCTP)

Beginning October 1, 2005 CMSP members must apply for benefits under the Breast and Cervical Cancer Treatment Program when breast or cervical cancer treatment is determined medically necessary. CMSP will continue to cover all appropriate diagnostic services associated with these conditions. Care managers with BC Life will assist CMSP members with breast and cervical cancer in getting connected with BCCTP. Benefit coverage under BCCTP provides full scope Medi-Cal.

Drug Company Patient Assistance Programs (PAPs) for Hepatitis-C Medications

CMSP members must apply for Drug Company Patient Assistance Programs (PAPs) to receive Hepatitis-C medications. CMSP will consider payment for Hepatitis-C medications only if the CMSP member provides a document showing eligibility for available PAPs has been denied by the manufacturers. Information about drug company PAPs is available on the Internet at www.helpingpatients.org/index.cfm. Medical providers may also be able to provide information.

If the programs listed above do not provide a document showing eligibility has been denied, CMSP clients may use the Record of Denied Program Eligibility Form provided by MedImpact or Anthem Blue Cross. This completed form must be submitted to CMSP via fax at (916) 848-3349. A formal document from the program showing eligibility has been denied will also be accepted.

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About CMSP Governing Board Committees Counties Eligibility Benefits Providers Data News	CMSP and Eligibility for Other Programs When CMSP members are eligible for other benefit programs CMSP is the secondary payer to these other programs. This means that if another program covers a benefit that is also covered by CMSP, the other program will be expected to be the primary payer for the benefit. California Aids Drug Assistance Program (ADAP) CMSP members must apply for the California AIDS Drug Assistance Program (ADAP) to receive all HIV medications. A one-time, 30-day supply of the medication will be provided to assure continuity of care. Following the one-time supply, CMSP will consider payment for HIV medications only if the CMSP member provides a document showing eligibility for ADAP has been denied. Information about ADAP is available by calling (888) 311-7632 or (888) 575-ADAP. Information about ADAP is available on the Internet at the Public Health Service Bureau. California Family Planning, Access, Care and Treatment Program (Family PACT) CMSP members must apply for Family Planning, Access, Care and Treatment Program (Family PACT) to receive contraceptives. A one-time, 30-day supply of the medication will be provided to assure continuity of care. Following the one-time supply, CMSP will consider payment for contraceptives only if the CMSP member provides a document showing eligibility for Family PACT has been denied. Information about Family PACT is available by calling (800) 942-1054. Breast and Cervical Cancer Treatment Program (BCCTP) Beginning October 1, 2005 CMSP members must apply for benefits under the Breast and Cervical Cancer Treatment Program when breast or cervical cancer treatment is determined medically necessary. CMSP will continue to cover all appropriate diagnostic services associated with these conditions. Care managers with BC Life will assist CMSP members with breast and cervical cancer in getting connected with BCCTP. Benefit coverage under BCCTP provides full scope Medi-Cal. Drug Company Patient Assistance Programs (PAPs) for Hepatitis-C Medications CMSP members must apply for Drug Company Patient Assistance Programs (PAPs) to receive Hepatitis-C medications. CMSP will consider payment for Hepatitis-C medications only if the CMSP member provides a document showing eligibility for available PAPs has been denied by the manufacturers. Information about drug company PAPs is available on the Internet at www.helpingpatients.org/index.cfm. Medical providers may also be able to provide information. If the programs listed above do not provide a document showing eligibility has been denied, CMSP clients may use the Record of Denied Program Eligibility Form provided by MedImpact or Anthem Blue Cross. This completed form must be submitted to CMSP via fax at (916) 848-3349. A formal document from the program showing eligibility has been denied will also be accepted.
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