THMP – Medical Certification Form Quick Facts

THMP receives and processes numerous MCFs for our clients every day.

Below is a quick reference for some of the most frequently asked questions about MCFs. Medical Certification Form Quick Facts print version
 

How can my client receive a 90-day prescription?

A 90-day supply is available for a limited number of medications and as an exception to the normal dosing schedule, for example as a vacation supply.
 

What other important information do I need to know about MCFs?

• MCFs must be signed by a physician, physician’s assistant, or nurse practitioner.
• When a client’s medication regimen changes a new MCF must be submitted to THMP with the complete regimen selected.
• MCFs have a four (4) anti-retroviral (ARV) drug limit – some drug “boosters” are allowable as a fifth drug (see Formulary).
• THMP Pharmacy Coordinator must approve medication requests that exceed five (5) drugs or unusual combinations. A letter from the provider must be included justifying the request.
• High dosages require a signed letter of justification from the provider. Please refer to the THMP Medication Formulary and Maximum Quantities Table for available mediations/dosages.
• MCFs with a new request for Selzentry must include a copy of Trofile/CCR5 test.
• THMP will provide the generic equivalent of prescribed medication when available- refills may be different generic equivalents depending on inventory at the time of each refill.
• Address and pharmacy changes may not be requested on MCF.
   

What if my client is prescribed Hepatitis C medications or Trogarzo?

Hepatitis C medication pilot is currently suspended. Please see the Trogarzo MCF.
 

How do I submit an MCF to THMP?

• For new applicants, the MCF should be included with the THMP application. In the Take Charge Texas (TCT) portal, the MCF can be scanned in as a proof of positivity document.
• Always fax a MCF for medication changes to THMP at 512-989-4003.
• NEVER email a MCF or any information that has identifying/personal health information.
   

What do I need to check before submitting an MCF?

• All client information must be completely filled out.
• Lab values are requested but are not required if client is new and does not have labs completed.
• Each medication requested is checked on MCF.
• All physician/provider information must be filled out.
• MCF includes physician/provider’s signature.