• DSHS HIV/STD Program

    Post Office Box 149347, MC 1873
    Austin, Texas 78714

    Phone: (737) 255-4300

    Email the HIV/STD Program

    Email 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.

700.100

Texas HIV Medical Program Cost Comparison Calculation

Procedure
Procedure Number 700.100
Effective Date  June 14, 2007
Revision Date  June 14, 2007
Subject Matter Expert THMP Research Specialist
Approval Authority  Branch Manager
Signed by Felipe Rocha, M.S.S.W., L.M.S.W.

1.0 Purpose

The purpose of this procedure is to outline the process for tracking expenditures of the Texas State Pharmacy Assistance Program (SPAP) and calculating costs that would have been incurred by the Texas HIV Medication Program (THMP) had SPAP clients remained in the THMP. The actual costs of the SPAP and the estimated costs that THMP would have incurred will be compared. This data will be used along with numerous other factors to evaluate the effectiveness of the SPAP.

 

2.0 Authority

Health and Safety Code, §85.003, §85.013, §85.016, §85.061, §85.063, §85.064, Government Code, §531.0055, and Health and Safety Code, §1001.075.

 

3.0 Policy

Expenditures through the State Pharmacy Assistance Program (SPAP) will be calculated on a quarterly basis.

 

4.0 Procedure

The cost of administering the Texas HIV State Pharmacy Assistance Program (SPAP) will be compared to the estimated cost of providing the same medications through the Texas HIV Medication Program (THMP) for each fiscal quarter to determine any savings realized by the state as a result of the SPAP.

Note: Although costs will be calculated quarterly, the total fiscal impact to the state will not be determined until the end of each fiscal year. This is due to the high costs to the SPAP at the beginning of the calendar year for payments of the enrollee’s deductibles, co-pays and coinsurance during the initial and coverage gap levels. Once the enrollee reaches the catastrophic coverage level, the SPAP cost share for the medications is reduced.

The total SPAP costs will be calculated by:

  1. Determining SPAP direct service and administration costs. SPAP direct service costs include all payments made by the SPAP for deductibles, co-pays, and coinsurance on behalf of SPAP enrollees for the quarter. SPAP administration costs include payments made by the Department of State Health Services for the quarter to the contract entity that administers the SPAP.
  2. Subtracting any manufacturer rebates received.
  3. Calculating estimated THMP costs by multiplying the number of units of each medication dispensed through the SPAP by the THMP current cost for each medication on the THMP formulary at the close of the fiscal quarter. The calculated cost for each medication will then be totaled and listed as the estimated THMP medication cost.
  4. The total SPAP cost will then be compared to the estimated THMP medication cost. This information will be made available for use, along with other data, for SPAP evaluation purposes.

The program will submit this report to the Budget Section on a quarterly basis.

 

5.0 Revision History

Date Action Section
Revision History
10/8/2014 Converted format (Word to HTML) -

 


 

Last updated March 1, 2017