• Loading...

    DSHS HIV/STD Program

    Post Office Box 149347, MC 1873
    Austin, Texas 78714

    Phone: (512) 533-3000

Texas HIV Medication Program – Documents

Loading...

Client Application (PDF : 274 kb) - the current version of the THMP application for assistance, replacing all previous versions in circulation; it includes the supplemental SPAP application page as part of the formal application process, for those clients with Medicare coverage. (current as of 1/16/2013)

Client Application (Español) (PDF : 415 kb) - a Spanish translation of the THMP application for assistance. (current as of 7/9/2012)

Updated Medical Certification Form (MCF) (PDF : 20 kb) - allows physicians to request any and all medications currently available through the THMP. Please note that a separate form for the drug Fuzeon (enfuvirtide) is no longer required. (current as of 11/13/2012)

It is recommended that patients initiating Fuzeon treatment receive additional training and support through Nurse Connections. This service is provided free to new and existing patients. For information or to enroll a patient, please call 1-877-4Fuzeon (1-877-438-9366).

Guidelines (PDF : 63 kb) - program guidelines for THMP applicants. (current as of 7/15/2011)

Guidelines (Español) (PDF : 44 kb) - a Spanish translation of the THMP guidelines. (note: the Spanish version of the guidelines was last updated in 2007; an newer version is still awaiting translation)

THMP Formulary (PDF : 17 kb) - the list of drugs currently available through the THMP.

Pharmacy Guidelines (PDF : 57 kb) - program guidelines for participating THMP pharmacies. (current as of 7/15/2011)

Pharmacy Memorandum of Agreement (MOA) (PDF : 56 kb) - the actual form that pharmacists complete in order to become a participating THMP pharmacy.

To view and download documents related to the HIV SPAP (State Pharmaceutical Assistance Program), please visit the TEXAS HIV SPAP page.


THMP homepage | FAQ | Documents | Policies | Pharmacies
Advisory Committee | Medicare | SPAP | News | Contact Us


Last updated January 16, 2013