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Common Patient Assistance Program Application Tool Effective Today
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HHS, working collaboratively with seven pharmaceutical companies, the National Alliance of State and Territorial AIDS Directors, and community stakeholders, has taken the lead in developing a common patient assistance program application tool that can be used by patients and providers beginning on September 12, 2012. This form is a one-stop shop that collects the necessary information required of HIV patient assistance program applicants.

Prior to the development of the common form, patients and their advocates had to fill out different sets of paperwork to apply for assistance from each company - common for complicated, multi-drug regimens. This was a time-consuming and burdensome process. and the new streamlined application has the potential to provide faster, easier access to live-saving medications.

· Common Patient Assistance Program Application form (PDF - 943 KB)

NOTE: The Common Patient Assistance Program Application form (PDF -943 KB) is also available from the National Alliance of State & Territorial AIDS Directors. Applications submitted using this form before September 12, 2012 will not qualify for assistance.

Common application for HIV patient assistance program expedites application process for lifesaving drugs
HHS Press Release Sept 12 2012
202 690-6343 HHS Press Office

The Common Patient Assistance Program Application (CPAPA), announced by Health and Human Services (HHS) Secretary Kathleen Sebelius at the International AIDS Conference in July, went into effect today. This single common application allows uninsured individuals living with HIV to use one application to apply for multiple assistance programs that together provide an entire course of antiretroviral therapy.

The application is a result of a public private partnership between HHS' Health Resources and Service Administration (HRSA) and seven leading pharmaceutical companies and foundations, and their HIV patient assistance programs: Abbott Laboratories, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences Inc., Johnson & Johnson, Merck and ViiV Healthcare. In addition, the National Alliance of State and Territorial AIDS Directors assisted in the development and implementation of the application.

"The last thing someone living with HIV wants to think about is filling out another form," Secretary Sebelius said. "This application streamlines and simplifies the process, reduces barriers to medication access, and speeds access to lifesaving drugs."

Patient Assistance Programs provide free or discounted medication to qualifying patients who cannot afford it themselves. These programs serve an estimated 30,000 or more patients a year across the country, and this initiative will aim to expand access to these programs.

The application is in response to suggestions by advocates and providers in the field to greatly simplify the process of applying to different programs. Prior to the development of the common application, individuals living with HIV or his/her provider had to fill out multiple sets of paperwork because they were taking complicated, multi-drug regimens that many times involve multiple companies with varying application forms.

This initiative aligns with the goals of the President's National HIV/AIDS Strategy by increasing access to lifesaving drugs for eligible patients, and by helping more patients receive effective treatment for HIV.

The application can be found at
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