Texas HIV Medication Program

New Medication Added to THMP Formulary

The antiretroviral Complera has officially been added to the Texas HIV Medication Program Formulary and should be available for ordering as of February 13, 2012.

Information for Ryan White and Texas HIV Medication Program Clients who have Texas Medicaid Coverage

DSHS is working together with the Texas Health and Human Services Commission (HHSC) to make sure you know about changes that are coming to the Medicaid program in Texas. It’s important for your continuity of care that you know about these changes. Note: The changes described in the message only apply to you if you have Texas Medicaid coverage and a) you’re in the Primary Care Case Management (PCCM) Medicaid program or b) you’re in STAR or STAR+PLUS and there are new health plan options in your service area.

On March 1, 2012, the managed care model for Medicaid in Texas will expand statewide. If you get Medicaid services through Primary Care Case Management (PCCM), you should have gotten a packet in the mail from HHSC telling you about the change and encouraging you to pick a managed care medical plan. You also would have gotten this packet if you already have a Medicaid managed care plan and there are new medical plans to choose from in your service area. Here is more important information for you:

1. You need to pick a medical plan. If you have not yet picked a medical plan, you should have gotten a packet in the mail from HHSC encouraging you to do so. If you do not pick a medical plan by February 10, 2012, HHSC will pick one for you. The packet from HHSC will include information on the medical plans you can pick from and how to enroll. You can check the provider directories of the medical plans offered in your service area to find out which doctors are in which medical plan. Once you’ve picked your medical plan, call 1-800-964-2777. You also can call that number if you need help finding a provider or if you have questions. You can learn more about the medical plans and services by going to a meeting in your area. To see a list of these meetings, go to www.txmedicaidevents.com.
   
2. Your prescription drug benefit may be changing. If you get your Medicaid services through PCCM you are limited to 3 prescription drugs each month. On March 1, when you move from PCCM to STAR or STAR+PLUS that will change – you will no longer have a prescription limit. Since you’ll be able to get all your prescriptions through your STAR or STAR+PLUS medical plan, you will no longer be eligible to receive services from the Texas HIV Medication Program AIDS Drug Assistance Program (ADAP). Your medical plan will have network pharmacies where you can get your prescriptions filled. Contact information for your medical plan will be on the Your Texas Benefits Medicaid card and the member ID card that you will get from your medical plan. If you have both Medicare and Medicaid, you will continue to get your prescription benefit through Medicare.

Hurricane Preparedness Info for THMP Clients (PDF : 29 kb)

Introducing the Texas HIV State Pharmaceutical Assistance Program (SPAP)
The Texas HIV Medication Program is proud to announce the debut of the Texas HIV State Pharmaceutical Assistance Program (SPAP), which began on January 1, 2008. The Texas HIV SPAP was developed to help HIV-positive individuals that do not qualify for the full Low Income Subsidy (extra help) with their out-of-pocket costs associated with Medicare Part D prescription drug plans, including co-payments, deductibles, coinsurance, and during the coverage gap (the "donut hole").

Current THMP recipients with Medicare will be transitioned to the new Texas HIV SPAP after an enrollment process has been completed; this includes choosing a Medicare Part D prescription drug plan if not currently enrolled in a plan. Once eligible individuals are enrolled in the SPAP, they will no longer get their medications from the THMP. Enrollees will use approved retail or mail order pharmacies to fill all of their medications provided by their Medicare Part D prescription drug plan, including medications to treat HIV as well as medications to help with side effects and other conditions related to HIV.

Ramsell Public Health RX, a pharmacy benefit manager, will manage the Texas HIV SPAP through a contract with the Texas Department of State Health Services. Ramsell's contract responsibilities include finalizing the pharmacy network and administering the payments made to the Medicare plans on behalf of the Texas HIV SPAP.

To obtain additional information regarding the Texas HIV SPAP, the SPAP Fact Sheet is located on the THMP SPAP page.

If you have questions or concerns regarding the Texas HIV SPAP, please call the THMP at 1-800-255-1090 and ask to speak with either Juliet Garcia (ext 3004) or Katherine Wells (ext 3008) weekdays between 8 a.m. and 5 p.m. CST.