State Pharmaceutical Assistance Programs are state sponsored programs that help specific groups of people such as the elderly and disabled access prescription medications. SPAP program coverage varies from State to State. Ramsell Public Health Rx administers SPAP’s that provide wrap-around coverage to its members who enroll in a Medicare Part D Prescription drug plan. This can include coverage of premiums, deductibles, copays/coinsurance, coverage gap (commonly referred to as the “doughnut hole”) as well as coverage during the catastrophic coverage. SPAP’s contribute to cost-sharing that will count towards the beneficiary’s true-out-of-pocket expenditures (TrOOP).
The Texas HIV State Pharmacy Assistance Program (SPAP) is designed to assist Texas HIV Medication Program (THMP) members eligible for Medicare Part D Drug benefits. Members must enroll in a Medicare Part D Plan and will receive assistance through the Texas HIV SPAP with out-of-pocket medication costs associated with Medicare Part D prescription drug plans. Assistance will be provided until the member reaches the Texas HIV SPAP maximum benefit allowance. Medicare Part D is a tiered benefit that requires program members to satisfy expenditure requirements, called True-Out-of-Pocket costs (TrOOP), in order to move through the tiers and reach the maximum coverage level, termed catastrophic coverage. Costs incurred by the SPAP will count toward a member’s TrOOP, thereby allowing the member to reach the catastrophic coverage level faster and resulting in lower prescription co-payments. This, in turn, should increase the number of Texans who receive needed HIV medications.
EligibilityEligible Texas HIV SPAP clients must meet the THMP eligibility guidelines and be eligible for Medicare Part D coverage. Program members must be enrolled in a Medicare approved prescription drug plan. To be eligible for the Texas HIV SPAP, a member must be an HIV positive Texas resident with an adjusted gross income at or below 200% of the federal poverty level and be denied the full low-income subsidy assistance available through the Social Security Administration for Medicare Part D recipients. Eligibility determination services for all of the persons applying to the Texas HIV SPAP will be performed by DSHS[R2] staff. The Texas HIV SPAP will only assist with the Medicare Part D covered drugs and will not provide coverage for medications under Medicare Part B.
Texas HIV State Pharmacy Assistance Program (SPAP)
Phone Number: 1-800-255-1090
Fax: 512-371-4670
Oakland, Calif., May 12, 2008 - Ramsell Public Health Rx today announced that it will administer a full suite of Pharmacy Benefit Management (PBM) solutions for the Bridging the Gap, Colorado (BTGC) program, a State Pharmaceutical Assistance Program (SPAP) that covers the costs of a participant’s Medicare deductible, co-payment and coinsurance. The customizable PBM solution will provide a comprehensive package to meet BTGC’s service needs, including coordination of benefits, claims adjudication, pharmacy network management and data management.