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.
|