This program pays for drugs determined by the U.S. Food and Drug Administration to prolong the life of people with AIDS, or HIV infection. To be eligible for the program in Connecticut, an individual must have a physician certification that the individual has HIV infection, HIV disease or AIDS, must not be a recipient of Medicaid, and must have net countable income within 400% of the Federal Poverty Level. In addition, the individual must apply for Medicaid within two weeks of approval for this program.

The department receives federal funding for the program under Ryan White Title II grants that are awarded to the Department of Public Health.

How to Apply

Please either download the application below (if available) or go to the program website for more information on how to apply. Once you fill out your application, send it to the address on the application. Remember not to send program applications to PPA.

Product(s) Covered by Program

  • 3

    • 3TC
  • A

    • ABILIFY® Oral Solution
    • Aclovate®
    • ACTOS®
    • Advair® Diskus
    • AeroBid®
    • Agenerase®
    • Ambien®
    • Anadrol
    • Androderm
    • Androgel® 1.62% and 1.0%
    • Aptivus®
    • Astelin
    • Atarax
    • Atripla®
    • Atromid-S
    • Augmentin®
    • Avandia® 4mg
    • Avlosulfon
    • Avosulfon®
    • AZT
  • B

    • Bactroban Ointment®
    • Baraclude®
    • BYETTA® (exenatide) Injection
  • C

    • Carnitor®
    • Cefuroxime cefuroxime sodium
    • Celebrex®
    • Celexa
    • Citrovorum
    • Cleocin®
    • Cogentin
    • Combivent® Inhalation Aerosol
    • Combivir®
    • Compazine
    • Complera™
    • Comvax
    • Copegus
    • Covera-HS®
    • CRESTOR® (rosuvastatin calcium) Tablets
    • CRIXIVAN®
    • Cutivate
    • Cymbalta® (duloxetine) delayed release capsules
    • Cytovene
  • D

    • d4T
    • Dapsone
    • Daraprim®
    • ddC
    • ddI
    • Deca-Durabolin
    • Decadron
    • Deltasone
    • Depakote® Sprinkle Capsules*
    • Detrol®
    • Diazepam
    • Dicloxacillin Sod. Monohydrate
    • Digoxin Tablet
    • Diprolene® lotion
    • Doxycycline
    • DURAGESIC® (fentanyl) Transdermal System CII
    • Dynacin
  • E

    • EDURANT®
    • Elavil
    • Elidel®
    • Enablex®
    • Engerix-B
    • Epivir®
    • EPOGEN® (EPOETIN ALFA) for dialysis use only
    • Epzicom®
  • F

    • Famvir®
    • Fansidar
    • Floxin®
    • Fortovase
    • Foscavir
    • Fungizone
    • Furosemide
    • Fuzeon
  • G

    • G-CSF
    • Garamycin
    • Glucophage
    • Glynase®PresTab®
  • H

    • Havrix
    • HCTZ
    • HIVID
    • Humatin
    • Hydrocortisone
    • Hydroxyurea
  • I

    • Ibuprofen
    • Imdur tablets
    • Imodium
    • INTELENCE®
    • Invirase
    • ISENTRESS®
    • Isosorbide Dinitrate
  • K

    • KALETRA®
    • KALETRA® Oral Solution
    • Keflex
    • Ketoconazole
    • Klonopin
    • Kytril®
  • L

    • Lamictal®
    • Lamictal® XR
    • Lamisil®
    • Leucovorin
    • LEVAQUIN® (levofloxacin) Tablets/Oral Solution
    • Lexapro®
    • Lexiva®
    • Lipitor®
    • Liquid Pred
    • Lithium Carbonate
    • Lomotil®
    • Lonox
    • Lopid®
    • Lorazepam
    • Lotrimin®
  • M

    • Macrobid
    • Marinol
    • Megace Oral Suspension
    • Menactra® Meningococcal (Groups A, C, Y and W-135) Polysaccharide Diphtheria Toxoid Conjugate Vaccine
    • Menomune® (Meningococcal Polysaccharide Vaccines Groups A, C, Y and W-135 combined)
    • Mepron®
    • Methadose
    • Metocorten
    • MetroCream
    • Motrin®
    • Myambutol
    • Mycobutin®
    • Mycostatin
    • Mykinac
  • N

    • Naprosyn
    • Nasacort® AQ Nasal Spray
    • Nasonex®
    • Neupogen®
    • Neurontin®
    • NEXIUM® (esomeprazole magnesium) Delayed Release Capsules
    • Nilstat
    • Nitroglycerin SA
    • Nizoral®
    • Normodyne
    • Nortriptyline
    • Norvasc®
    • Norvir® Oral Solution
    • Nystex
  • O

    • O-V Statin
    • Orasone
    • Orudis
    • Oxandrin
  • P

    • Panasol
    • Paxil®
    • Pegasys®
    • Pepcid tablets and oral Suspension
    • Percocet
    • Peridex
    • Plavix®
    • Pravachol®
    • Prednicen-M
    • Prednisone
    • Prevacid®
    • Prezista®
    • Primaquine Phosphate
    • Prinivil tablets
    • PROCRIT® (epoetin alfa) Injection
    • Proloprim
    • Protonix®
    • Proventil® Inhalation Solution
    • Prozac® (fluoxetine)
    • Purified Insulin Lente
  • Q

    • Quarzan
  • R

    • Rebetol
    • Recombivax HB®
    • Relenza®
    • Rescriptor®
    • Restoril™ (temazepam)
    • Retrovir®
    • Reyataz®
    • Rhinocort Aqua®
    • Rifampicin
    • RISPERDAL® (risperidone) Tablets/Oral Solution
  • S

    • Selzentry®
    • Serevent Diskus®
    • SEROQUEL® (quetiapine fumarate)
    • Serostim
    • Spectracef
    • Spironolactone
    • SPORANOX® (itraconazole) Capsules
    • Strovite Forte
    • Sulfadiazine Tablets
    • Sustiva®
    • Synthroid®
  • T

    • Tamiflu
    • Tegretol
    • Temovate
    • Tenormin® Tablets
    • Tequin®
    • TERAZOL® 3 (terconazole) Vaginal Cream
    • TERAZOL® 7 (terconazole) Vaginal Cream
    • Toprol® XL
    • Trazodone
    • TriCor®
    • TRILIPIX™
    • Trizivir®
    • Truvada®
    • Tussi-Organidin S-NR
    • Twinrix
  • U

    • ULTRAM® (tramadol HCL) Tablets
  • V

    • Valcyte
    • Valtrex®
    • VAQTA®
    • Vasotec
    • Veetids
    • Vfend®
    • Videx
    • Viramune® Oral Suspension
    • Vistide®
  • W

    • Welchol® Tablets
    • Wellcovorin
  • X

    • Xanax®
  • Z

    • Zantac®
    • Zerit®
    • Zestril® Tablets
    • Zetia®
    • Ziagen®
    • Zithromax®
    • Zofran®
    • Zoloft®
    • Zovirax®