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Texas HIV SPAP

The Texas HIV Medication Program (THMP) runs its HIV State Pharmaceutical Assistance Program (SPAP), which began operating on January 1, 2008. The Texas SPAP was developed to help HIV-positive individuals 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").

Frequently Asked Questions

What is SPAP?

State Pharmaceutical Assistance Programs are state sponsored programs that help specific groups of people such as the elderly and disabled access prescription medications. SPAP program coverage varies from State to State. Ramsell administers SPAP's that provide wrap-around coverage to its members who enroll in a Medicare Part D Prescription drug plan. This can include coverage of premiums, deductibles, copays/coinsurance, coverage gap (commonly referred to as the "doughnut hole") as well as coverage during the catastrophic coverage. SPAP's contribute to cost-sharing that will count towards the beneficiary's true-out-of-pocket expenditures (TrOOP).

What is the Texas HIV SPAP Program?

The Texas SPAP program is designed to assist Texas HIV Medication Program (THMP) members eligible for Medicare Part D Drug benefits. Members must enroll in a Medicare Part D Plan and will receive assistance through the Texas HIV SPAP with out-of-pocket medication costs associated with Medicare Part D prescription drug plans. Assistance will be provided until the member reaches the Texas HIV SPAP maximum benefit allowance. Medicare Part D is a tiered benefit that requires program members to satisfy expenditure requirements, called True-Out-of-Pocket costs (TrOOP), in order to move through the tiers and reach the maximum coverage level, termed catastrophic coverage. Costs incurred by the SPAP will count toward a member's TrOOP, thereby allowing the member to reach the catastrophic coverage level faster and resulting in lower prescription co-payments. This, in turn, should increase the number of Texans who receive needed HIV medications.

What are the Texas HIV SPAP Eligibility Requirements?

Eligilble members must meet the THMP requirements of being a Texas resident, HIV positive and have an income at or below the Federal Poverty Level of 200%. Additonally, members must be elgible for Medicare Parts A and/or B. enrolled into a Medicare Part D Prescription Drug Plan, and denied the Low Income Subsidy through the Social Security administration or approved for partial subsidy. A complete copy of the letter is required.

How Does a patient Enroll in the Texas HIV SPAP?

Patient needs to submit the Texas HIV SPAP enrollment form listed below, to the THMP. On the application the patient will need to provide Medicare Part D plan information and your Low Income Subsidy (LIS) status. Please note that the Texas HIV SPAP will require a complete copy of the LIS approval or denial letter before SPAP enrollment will be complete. If patient is not currently enrolled in the THMP he/she will also need to submit a complete THMP application. Once the patient enrollment is completed, he/she will get an enrollment packet from our contractor, Ramsell, which will include a SPAP identification (ID) card.

  HIV SPAP Application Form click to download
  Application for Medication Assistance click to download
  Solicitud de Asistencia de Medicación click to download

What Drugs Are Covered?

Currently, the Texas HIV SPAP will pay the copayments for all of your medications on your Medicare Part D formulary. Changes may occur based on funding.

Where Can Patient's Prescriptions be Filled?

Patients can fill prescriptions through any one of the participating pharmacies in the state of Texas.

To locate the closest pharmacy, use the Pharmacy Locator on the left panel, or call Ramsell at 1-888-311-7632.

To process medications the pharmacist will need the patient's SPAP ID card, Medicare Part D Plan information and valid prescriptions.

Where Can I Get More Information About the Program?

For more information and questions on program enrollment, please contact:

Texas HIV State Pharmaceutical Assistance Program (SPAP)
Phone Number: 1-800-255-1090
Fax: 512-371-4670
Website: The Texas HIV Medication Program
Fax: 512-371-4670

Other Documents

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