Texas Administrative Code
Title 25 - HEALTH SERVICES
Part 1 - DEPARTMENT OF STATE HEALTH SERVICES
Chapter 98 - TEXAS HIV MEDICATION PROGRAM
Subchapter C - TEXAS HIV MEDICATION PROGRAM
Division 1 - GENERAL PROVISIONS
Section 98.107 - THMP Benefits
Universal Citation: 25 TX Admin Code ยง 98.107
Current through Reg. 49, No. 38; September 20, 2024
THMP provides drugs at the best price available, including purchasing health insurance if the criteria are met, and THMP participates in the 340B Drug Pricing Program to ensure program medications are available at the best price.
(1) AIDS Drug Assistance Program (ADAP) Medication Coverage.
(A) The medications provided under ADAP are
listed on the THMP formulary, found at
https://www.dshs.texas.gov/hivstd/meds/files/formulary.pdf .
(B) THMP does not approve the dispensing of
ADAP medications in excess of a 90-day supply, or full bottle increments,
whichever is greater. The program may also dispense medications in 30-day or
60-day supplies.
(C) Prescribers
must attest that certain medications meet specific prescribing requirements,
including lab testing, before requesting these medications from THMP. These
requirements are outlined in the THMP formulary found at
www.dshs.texas.gov/hivstd/meds/document.shtm.
(D) The department may contract with a
pharmaceutical wholesaler for purchase of drugs. The department distributes
drugs to pharmacies participating in ADAP and to a mail order pharmaceutical
distributor for the dispensing of drugs directly to individuals who reside
outside areas covered by participating pharmacies.
(E) The department delivers services directly
or through external pharmacies approved by THMP that have signed a Memorandum
of Agreement with the department.
(F) A dispensing fee may be collected from
the department by a participating pharmacy for each prescription dispensed in
accordance with the existing Memorandum of Agreement with the department.
Eligible individuals shall not be charged any dispensing fees directly by a
participating pharmacy.
(2) SPAP and TIAP Medication Coverage.
(A) The department may contract with a claims
processor to interface with plans that provide eligible health insurance plans
on behalf of the programs.
(B)
Benefits payable by THMP:
(i) Eligible health
insurance policy out-of-pocket expenses, which include deductibles, copays, and
coinsurance amounts.
(ii) THMP may
assist eligible individuals in obtaining public or private health insurance by
providing insurance premium payment assistance to the insurance company, and if
paying for such health insurance, it can reasonably be expected to be cost
effective for THMP.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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