700.004 HIV Medications Ordering Process for Pharmacies
|March 25, 1996
|January 31, 2018
|HIV/STD Prevention and Care Branch Manager
The purpose of this policy is to establish the process through which participating pharmacies will order and dispense HIV medications through the Texas HIV Medication Program (THMP).
Texas Administrative Code (TAC), 25 TAC §98.113, Participating Pharmacy; 25 TAC §98.114, Prescription Fees.
The Texas Department of State Health Services (DSHS) receives funding to help offset the cost of medications approved by the Food and Drug Administration (FDA) for the treatment of HIV infection. Access to the THMP is available to eligible indigent persons with HIV infection (clients). The Program provides medications, listed in the current Texas HIV Medication Program Guidelines, through participating pharmacies.
4.0 Ordering Medications
To place an order, fax the THMP at 512-533-3171. The fax line is open 24 hours a day, seven days a week. The pharmacy is expected to provide the following information when placing an order with the THMP:
pharmacy ID number (assigned by the Program),
name of the pharmacy representative placing the order,
client code number of the client for whom the medication is being ordered. All orders for HIV medication must include the client’s assigned THMP code number (i.e., 09302), and name, strength, and number of days’ supply of the medication(s) being ordered.
All records must be maintained according to the Memorandum of Agreement signed between the participating pharmacy and the DSHS.
5.0 Ordering Medications for Chain Pharmacies
Pharmacies that are part of a chain may request a central distribution point as a participating pharmacy location, from which the chain will bear responsibility for distributing the medications.
The ordering process is similar to that described in Section 4.0 of this Policy, except that the central distribution point then takes responsibility for shipping the medications to their local pharmacies and any additional shipping or replacement costs incurred when shipping the medications.
Those pharmacies wishing to order using a distribution point, are also required to ensure the medications are delivered to clients within ten (10) days from the client’s request date. In addition, the pharmacies are also responsible for keeping all program required records and ensure that all other pharmacy requirements are also met.
6.0 Verifying Client Eligibility
Clients are not required to show proof of THMP eligibility to the pharmacy. The pharmacy is responsible for reviewing the client approval letter for verifying the client's eligibility with the THMP prior to placing an order. Pharmacies requesting copies of a client’s approval letter for its files should call the THMP at 1-800-255-1090. The THMP will mail the requested copy to the pharmacy within five working days.
Eligible Medicaid recipients who are also clients must first utilize their Medicaid pharmacy benefits each month in order to be eligible to receive medications from the THMP during that month. The THMP is responsible for verifying Medicaid eligibility. The pharmacy is responsible for ensuring that the Medicaid benefits are used before requesting medications from the THMP.
7.0 Medication Shipments
Medications are shipped from the DSHS pharmacy warehouse to the pharmacy. Medication shipments will include a packing slip listing the order information provided by the pharmacy. The pharmacy is responsible for reporting discrepancies in medication shipments to the Program as soon as possible.
8.0 Dispensing Medications
Prior to dispensing medications, participating pharmacies should ensure that the client is approved, currently active on the THMP, and certified as eligible to receive specific THMP medications. The THMP will not be responsible for medications that are dispensed to a client who is not approved to receive them from the THMP.
All medications should be dispensed unopened, without re-packaging, in full-bottle increments, not to exceed the quantities stated in the current Texas HIV Medication Program Participating Pharmacy Guidelines.
The THMP operates as a provider program, not a reimbursement program. Participating pharmacies should not dispense medications to clients from the pharmacy's own inventory. The THMP assumes no responsibility for replenishing pharmacy inventories. Participating pharmacies whose policy is to dispense medications from their own stock and request replacement medications, are subject to the rules outlined in this policy and are not guaranteed to receive reimbursement for medications dispensed from their own stock.
Pharmacies will no longer collect a $5.00 dispensing fee from clients for each prescription filled (see Texas HIV Medication Program Participating Pharmacy Guidelines). Pharmacies will invoice the THMP directly each month for dispensed THMP medications, not to exceed $5.00 per medication. This includes Medicaid eligible and non-eligible clients.
8.2 Medication Replacements
DSHS will not replace any medication that is lost, stolen, or damaged unless adequate documentation of the circumstances is provided.
Pharmacies participating and receiving medications through this program are NOT eligible to file for drug manufacturer rebates for those medications.
9.0 Time Frames
Pharmacies should allow three to five working days to receive medication shipments from the pharmacy warehouse. Upon receipt of the prescription, the pharmacist should inform the client of this. Replacement requests for medications dispensed prior to ordering from the THMP must be received by the THMP within 30 days of dispense date and are not guaranteed to be filled.
10.0 Revision History
|Changed section 8.1 to reflect that clients will no longer be charged a dispensing fee. Pharmacies will bill THMP for dispensing fees.
|New sections 5.0 and 8.3 added to reflect ordering by chain pharmacies. Other minor revisions to remaining sections to reflect addition of sections 5.0 and 8.3.
|5.3 and 8.0
|Update references, phone numbers and procedures.
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