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.
Medical Certification Form (MCF) (PDF : 134 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 June 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).
THMP Application Process: Before the First Medical Appointment (PDF : 354 kb)
How to Ensure Fast Access to HIV Medications for THMP Applicants (PDF : 278 kb)
Guidelines (PDF : 191 kb) - program guidelines for THMP applicants. (updated January 2016)
Guidelines (Español) (PDF : 44 kb) - a Spanish translation of the THMP guidelines. (note: the Spanish version of the guidelines was last updated in 2007; a newer version is still awaiting translation)
THMP Formulary (PDF : 76 kb) - the list of drugs currently available through the THMP. (updated January 2016)
Pharmacy Guidelines (PDF : 136 kb) - program guidelines for participating THMP pharmacies. (updated January 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 |