Client Application - the THMP application for assistance is available in English and Spanish in Word and PDF formats. The application includes the supplemental SPAP application page as part of the formal application process, for those clients with Medicare coverage. Watch this
short video [Vimeo] with tips on how to make the application process run smoothly
Medical Certification Form (MCF) -
Word (35 kb) |
PDF (325 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. (updated December 2016)
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 : 197 kb) - program guidelines for THMP applicants. (updated February 2017)
THMP Formulary (PDF : 9 kb) - the list of drugs currently available through the THMP. (updated December 2016)
Pharmacy Guidelines (PDF : 141 kb) - program guidelines for participating THMP pharmacies. (updated December 2016)
Pharmacy Memorandum of Agreement (MOA) (PDF : 128 kb) - the form that pharmacists complete in order to become a participating THMP pharmacy. Our links have changed, please see the pharmacy guidelines above and the workplace guidelines (updated September 2016)
Vendor Information Form (PDF : 36 kb) - pharmacies should also complete the Vendor Information form and include it with the Memorandum of Agreement to become a participating pharmacy. (added April 2015)
To view and download documents related to the HIV SPAP (State Pharmaceutical Assistance Program), please visit the TEXAS HIV SPAP page.
THMP homepage |
Advisory Committee |