Q1: What is the Texas HIV Medication Program (THMP)?
The Texas HIV Medication Program (THMP) is the government funded AIDS Drug Assistance Program (ADAP) for the State of Texas. The THMP provides certain prescription drugs to persons with HIV infection lacking the financial means to pay for them. The drugs provided are approved by the Food and Drug Administration (FDA) and are used in the treatment of illnesses caused by the human immunodeficiency virus (HIV) and other opportunistic infections. Since its inception in 1987, the THMP has provided access to HIV medications to over 45,000 Texans. Currently the program receives and approves more than 277,000 medication orders each year. Working through over 400 participating Texas pharmacies, the THMP purchases and distributes over $84 million annually in antiretrovirals and other prophylactic medications. These medications help delay the onset of symptomatic disease and prevent opportunistic infection in persons living with HIV.
Q2: Who is eligible for the THMP?
To be enrolled in the THMP, you must: a) be diagnosed as HIV-positive, with a CD4 count and viral load on file with a licensed physician; b) be a Texas State resident; c) meet certain income guidelines; and d) be otherwise uninsured or underinsured for prescription drug coverage (this information must be verifiable).
Q3: What are the income guidelines?
To qualify financially for the THMP, you, your spouse (whether legal or common law), and your children under age 18 that reside with you must have an annual adjusted gross income that falls at or below 200% of the current Federal poverty income guidelines. The poverty guidelines are updated annually; please contact the THMP for specific figures. Proof of your household's income is required at the time of application to the THMP.
Q4: I'm currently eligible for Medicaid in Texas. Should I still apply to the THMP?
Certainly! In fact, even HIV-infected Texans who are receiving Medicaid prescription coverage are encouraged to apply to the THMP for assistance beyond the three prescription per month limit imposed by standard Texas Medicaid, with the understanding that the THMP can only provide assistance once your Medicaid slots have been filled for the month.
Please note: for the latest information regarding Medicare RX (Medicare Part D) plans and its impact on THMP coverage for our clients, please visit the Medicare section.
Q5: How do I apply to the THMP?
You can get an application and program guidelines by calling our program's hotline: either 1-800-255-1090 statewide, or (512) 533-3000. You may also write to our program at the following address: Texas HIV Medication Program, Texas Department of State Health Services, 1100 West 49th Street, Austin, TX 78756-3199, Attention: MSJA, or by downloading a copy
Many hospitals, clinics and HIV service agencies also have copies of the application available, and staff to help you complete it. In addition to the pages of the application that you complete, your physician must fill out the Medical Certification Form (MCF) included in the application packet to verify your HIV status and qualifying medical criteria. While you wait for the packet to arrive, please collect check stubs, W-2 forms, copies of benefit entitlement letters, or other facts about your income. This information will help you to speed up the application process with the THMP.
Q6: Are all the medications I need provided by this program?
Not necessarily -- the THMP provides only antiretroviral medications and specific drugs to treat HIV-related opportunistic infections, so you may need to utilize local resources and/or the manufacturer's patient assistance programs for other medications. Please contact the THMP via one of the aforementioned methods for further details.
Q7: I've applied and been approved for the THMP. Now how do I obtain the medications?
Once approved for the THMP, you will be assigned to a designated pharmacy. Both you and the pharmacy will be mailed a notification letter listing your client code number, approved drugs, and assigned pharmacy. You will then be eligible to obtain your medications each month from that pharmacy with a valid prescription from your physician.
Q8: What will be done with the information I provide?
The Texas Department of State Health Services regards all information in the application as CONFIDENTIAL. No information that could identify you will be released, except as allowed by law (for example, your doctor and pharmacist will be aware of your HIV status) or as specifically designated by you (such as a specific case manager or social worker you've authorized us to speak to on your behalf).
Q9: I'm currently self-employed. What proof of income should I provide to the THMP?
All applicants to the THMP who are self-employed must provide a copy of their most recent Federal Income Tax Return. The Internal Revenue Service (IRS) requires citizens with net self-employment income of more than $400 annually to file an income tax return, so you should provide either a copy of your most recently filed return or a copy of the form you submitted to the IRS requesting an extension to file your income tax return. You will be expected to submit a copy of the completed tax return to the THMP once the deadline to file the extension has passed in order to continue receiving benefits through the THMP.
Q10: My income verification doesn't reflect recent changes to my household situation, living arrangements, marital status, employment status, etc. What should I do in this situation?
Document the changes and all pertinent information as best as you possibly can when submitting your application. For the purposes of applying to the THMP, there is no such thing as "too much information" - the THMP staff needs to fully understand your income situation and household information to make an informed decision as to your eligibility status, so anything you can document to clarify or explain your situation is welcome.
Q11: I received a letter stating that my application has been placed in pending due to incomplete or inconclusive income verification, but I don't have any income to report. What do I do?
What the THMP is going to need in order to continue processing your application is documentation that provides a clear picture of how you are currently able to live on zero income and zero cash assistance. Were you recently employed but lost your job? How are you able to meet basic living expenses such as food and shelter? Who pays your rent and utility bills? These are the type of questions that need to be addressed in written supplements to your THMP application. For example, if your rent is paid by a local program using HOPWA funds for rent and housing assistance, please provide a verification statement from that organization. If you have access to a case manager or social worker locally, you may want to request their assistance in documenting the particulars of your living situation. Current THMP policies dictate that applications placed in pending status will be held for a period of 90 days; if no additional information is received within that timeframe, that application will be considered invalid and purged from our pending files, and you would have to reapply with an updated application.
Q12: Why do you need to have so much documentation to prove I qualify for assistance? Why can't you just take my word on this?
Please understand that the THMP does not wish to discourage anyone from applying for assistance; on the contrary, we want every possible qualified Texan to receive assistance from our program. However, the funding we receive from the Federal Ryan White Title II Program (not to mention the funding approved by the Texas State Legislature) has been given to the THMP with the contingency that we be payer of last resort, which means the THMP is expected to take steps to ensure that each applicant we provide medications to truthfully meets the eligibility qualifications for the program and has exhausted all other resources available to them. In order to fulfill these requirements, it is necessary to provide documentation verifying your household's gross annual income and lack of alternate resources such as health insurance prescription coverage. The THMP has the right to request any additional documentation we deem necessary to verify that the eligibility criteria is been fully satisfied. Applicants are encouraged to contact the THMP directly at any step of the application process in which they may have questions or concerns.
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