Utah AIDS Drug Assistance Program

Utah

Contact Information
Ryan White Title II Program Manager- Bureau of HIV/AIDS/TB Control
Utah Department of Health
Box 142105
Salt Lake City, UT 84114-2105
1-(801) 538-6397 (phone)
1-(801) 538-6397 (vanity_phone)
How to Apply:
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.
  • Click here to visit the program's web site.
    • Eligibility:
    ATTENTION: YOU MUST BE HIV POSITIVE TO BE ELIGIBLE FOR THIS PROGRAM. - must be HIV + - must be ineligible for Medicaid - must not be covered for medications requested through any other private or public program - income must be at or below 200% of the current Federal Poverty Level, if your income is more than that, you can still qualify and will pay a co-pay on a sliding fee scale
    Other Information:
    The Health Insurance Continuation Program will pay all or part of your health insurance payment and deductible/co-pay for either COBRA, or change to a single health plan. The HICP will also cover a client's premium payments for a short-term disability.
    Product(s) covered by program:
    • 3TC
    • Agenerase®
    • AZT
    • Bactrim
    • Biaxin® Filmtab
    • Biaxin® Granules
    • Biaxin® XL Filmtab
    • Biaxin® XL Pac
    • Combivir®
    • Copegus
    • Crixivan®
    • Cytovene
    • d4T
    • Daraprim®
    • ddC
    • ddI
    • Diflucan®
    • Diflucan® Suspension
    • Emtriva
    • Epivir®
    • Epivir-HBV®
    • EPOGEN®
    • Famvir®
    • Fortovase
    • Foscavir
    • Fuzeon
    • G-CSF
    • HIVID
    • Hydrea
    • Invirase
    • Kaletra®
    • Kaletra® Oral Solution
    • Lexiva®
    • Microsulfon
    • Neupogen
    • Norvir® Oral Solution
    • Norvir® Soft Gelatin Capsules
    • Peg Intron
    • Pegasys
    • Rebetol
    • Rescriptor®
    • Retrovir®
    • Reyataz
    • Septra
    • Sporanox®
    • Sporanox® Oral Solution
    • Sustiva
    • Trizivir®
    • Videx
    • Videx EC
    • Viracept®
    • Viramune
    • Viread
    • Wellcovorin
    • Zerit®
    • Ziagen®
    • Zithromax®
    • Zithromax® Z-Pak
    • Zovirax®