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.

Source Note: The provisions of this §98.107 adopted to be effective November 17, 2022, 47 TexReg 7557