• DSHS HIV/STD Program

    Post Office Box 149347, MC 1873
    Austin, Texas 78714

    Phone: (512) 533-3000

    E-mail the HIV/STD Program

    E-mail data requests to HIV/STD Program - This email can be used to request data and statistics on HIV, TB, and STDs in Texas. It cannot be used to get treatment or infection history for individuals, or to request information on programs and services. Please do not include any personal, identifying health information in your email such as HIV status, Date of Birth, Social Security Number, etc.

    For treatment/testing history, please contact your local Health Department.

    For information on HIV testing and services available to Persons Living with HIV and AIDS, please contact your local HIV services organization.

Texas HIV Medication Program – Frequently Asked Questions (FAQ)


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 who meet income and residency requirements. View the THMP formulary (PDF : 13 kB).

 

Q2: Who is eligible for the THMP?

To be enrolled in the THMP, you must: a) be diagnosed as HIV-positive; 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?

THMP bases income qualification on your household size. Your household for eligibility determination includes only you, your spouse (whether legal or common law), and your biological, adopted, or step-children under age 18 that live with you.

Current income guidelines are at or below 200% of the Federal Poverty Income Guidelines (FPL) [U.S. Department of Health and Human Services]. THMP will verify your income and calculate your to determine your eligibility.

 

Q4: I have Hepatitis C.  Can THMP provide medications to treat this?

Yes, THMP has a pilot to treat persons who are HIV positive and have HCV. You will need to apply to THMP before you can receive assistance through the HCV pilot. Learn more about this program (PDF : 266 kB).

 

Q5: How do I apply to the THMP?

You may download a copy of the application ask your local community based organization for help in applying for THMP. You can call 2-1-1 to get information on local agencies in your area. You may also call THMP at 1-800-255-1090 and we will mail you the application.

We recommend that you ask your clinic or HIV service agency to help you complete your THMP application. They can help you complete the application or check over your application before you send it in to make sure it is complete. We can only process complete applications.

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 current prescriptions. We will need documents that show your income and residency, so please collect check stubs, benefit letters, utility bills, and other documents to prepare to apply.

 

Q6: I have been on THMP for a long time, and I also go to a doctor who provides me care through a Ryan White grant.  I filled out everything I needed at the doctor, why are you requiring more documents?  Aren’t you part of the same system?

While THMP is under the same Ryan White grant your clinic or community agency may be funded under, we have a separate eligibility process. We need our application completed to be able to provide you with services through THMP. Your community agency should be able to help you with your THMP application, and we strongly encourage you to ask for this help. They will help make the application process go more smoothly.

 

Q7: If I am approved for the THMP, what do I need to do to stay on the program?

THMP will recertify your eligibility at least every six months after you are approved for the program. You will need to submit a complete new application by the last day of your birth month every year. You will also need to submit a self-attestation form by the last day of your “half-birthday” month each year. The self-attestation process is much simpler, we will simply ask you to let us know what has changed about your income or residency and send us documents specific to those changes. For example, if you have a new job, we will ask for your latest paystubs. If nothing has changed for you, we will not need any documents. It is important that THMP always have your current address so we can send you the materials you need for recertification and self-attestation every year.

 

Q8: I heard that THMP is “payer of last resort.”  What does that mean?

THMP receives federal funding through a Ryan White grant. This grant requires that services be provided to those persons who don’t have another payer, like insurance. THMP can still help out for persons who have insurance or other payers, but only after other expected payments have been made and for payments that you would be expected to make yourself.

 

Q9: I'm currently enrolled in Medicaid in Texas. Should I still apply to the THMP?

THMP can help you if you have traditional Medicaid. THMP can provide assistance beyond the three prescription per month limit that may be imposed by your Medicaid plan. THMP can only assist when all three prescription slots have been used for your Medicaid plan.

 

Q10: I’m currently enrolled in Medicare in Texas.  Should I still apply to the THMP? 

Yes, the THMP program offers a State Pharmacy Assistance Program (SPAP), that assists with Medicare Part D plans for eligible persons. For more information, please visit the Medicare section.

 

Q11: I have health insurance.  Is THMP only for people who are uninsured?

THMP has a program called the Texas Insurance Assistance Program (TIAP) that can help people with health insurance with medication copayments. TIAP can also pay COBRA premiums for qualifying plans. Please fill out the Copayment Assistance page in the THMP application if you are interested in TIAP.

 

Q12: Are all the medications I need provided by this program?

Not necessarily -- the ADAP 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. If you are on the SPAP or TIAP program, most of the medications your doctor prescribes will be available through the program.

 

Q13: I've applied and been approved for the THMP. Now how do I get my medicine?

You will receive a letter in the mail that lists your assigned local pharmacy.  If you would prefer to go to a different pharmacy, simply call us. We can assign you to any pharmacy on the participating pharmacy list. Each month, you will go to your pharmacy ten days before you run out of medication to request your refill. We mail your medication from the DSHS Pharmacy Warehouse, so we need time to get the medication to your pharmacy. Your pharmacy should not ask for any fees from you.

 

Q14: 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 required by the program to provide you with eligibility services and medications (for example, your doctor, agency enrollment worker, and pharmacist) or as designated by you (for example, you may write on your application that we can talk to your friend or spouse). Please only designate a friend or relative that is aware of your health status as an authorized contact on your application.

 

Q15: I'm currently self-employed. What proof of income should I provide to the THMP?

If you are self-employed, provide a complete copy of your most recent IRS Tax Return Transcript. If you do not file taxes, please talk to your local agency enrollment worker to learn what else you may submit for proof of income.

 

Q16: 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?

Explain the changes in writing on your application. Documents that show changes should be included, such as a letter of termination from an employer or health insurance company, to help us understand your changed eligibility situation.

 

Q17: I received a letter stating that my application was denied due to incomplete income, but I don't have any income to report. What do I do?

This depends on your situation. In addition to income from work, retirement, or disability, THMP will also accept bank statements for applicants who are living off of savings or rental income, child support statements, student financial aid statements, a THMP supporter statement (provided in the application), or a letter from a homeless shelter or community based organization explaining how you are being supported.

 

Q18: 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?

THMP is funded through a federal grant, and our eligibility requirements are based on the requirements of this grant. We use the documents you provide to show you qualify for the program and information we receive through verification to show that we are only serving eligible Texans. This federal grant is what allows us to provide your medications.

 

Q19: What if I don’t qualify for THMP?  I really need medications to take care of my health, and I can’t afford health insurance.

THMP is just one resource for your medications. Your local agency can help you with medications through resources that are available in your area or by helping you apply for a Pharmacy Assistance Program offered by pharmaceutical companies.

 


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Last updated November 16, 2017