Texas Register

TITLE 25 HEALTH SERVICES
PART 1DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 98TEXAS HIV MEDICATION PROGRAM
SUBCHAPTER CTEXAS HIV MEDICATION PROGRAM
DIVISION 1GENERAL PROVISIONS
RULE §98.107THMP Benefits
ISSUE 11/11/2022
ACTION Final/Adopted
Preamble Texas Admin Code Rule

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.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on October 28, 2022

TRD-202204235

Cynthia Hernandez

General Counsel

Department of State Health Services

Effective date: November 17, 2022

Proposal publication date: June 10, 2022

For further information, please call: (737) 255-4300



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