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Texas State Pharmacy Assistance Programs (SPAP)

Texas Kidney Health Care Program (KHC) & Texas HIV State Pharmacy Assistance Program (SPAP)




Texas Kidney Health Care Program (KHC)


Eligibility Requirements: You must meet the following requirements:
  • You must be a Texas Resident.
  • You must have a diagnosis of end-stage renal disease (ESRD) from a licensed physician.
  • You must have an adjusted gross income less than $60,000 per year.
  • You must meet Medicare's definition of ESRD.
  • Must get regular dialysis treatments OR has received a kidney transplant.
  • You can NOT get Meidcaid medicial, drug, or travel benefits.
Important Notes: The Kidney Health Care Program (KHC) helps people with end-stage renal disease get their health care services. It helps clients with their Dialysis treatments, Access surgery, Drugs, Travel to health care visits, and Medicare premiums.

The Kidney Health Care Program (KHC) services include: prescription drug benefits, coordination of benefits and premium reimbursements for Medicare Part D Prescription Drug Program, co-insurance for immunosuppressive drugs covered under Medicare Part B, limited travel reimbursement and certain medical expenses. KHC will pay for up to four (4) prescriptions per month for Part B and D coverage. The drug must be on the KHC drug list and the Medicare Part D plan’s drug list.
Contact Information: Phone
(800) 222-3986
(512) 776-7150

Address
Kidney Health Care Program
Department of State Health Services, MC 1938
P.O. Box 149347 Austin, TX 78714
» Texas Kidney Health Care Program (KHC)





Texas HIV State Pharmacy Assistance Program (SPAP)


Eligibility Requirements: You must meet the following Texas HIV Medication Program (THMP) requirements:
  • Be diagnosed as HIV-positive, with a CD4 count and viral load on file with a licensed physician;
  • Be a Texas State resident;
  • Have an adjusted gross income less than 200% of the federal poverty level;
  • Eligible for Medicare otherwise uninsured (this information must be verifiable);
  • Enrolled in a Medicare Part D Prescription Drug Plan; and
  • Denied the full Low Income Subsidy or approved for the partial subsidy for prescription drug assistance by the Social Security Administration. A complete copy of the letter is required.
Important Notes: TX-HIV SPAP will cover all of the out-of-pocket costs, including the deductible, copayments and the coverage gap. Will not cover premiums. TX-HIV SPAP will pay for covered medications up to a maximum annual allowable amount per enrollee, which is determined on an annual basis. The TX-HIV SPAP will pay for all medications covered under the individuals Medicare Part D Prescription Drug Plan. TX-HIV SPAP eligibility is renewed every two years.

Submit the Texas HIV SPAP enrollment form to the THMP. On the application you will need to provide your Medicare Part D plan information and your Low Income Subsidy (LIS) status. Please note that the Texas HIV SPAP will require a complete copy of your LIS approval or denial letter before your SPAP enrollment will be complete. If you are not currently enrolled in the THMP you will also need to submit the complete THMP application. Once your enrollment is complete you will receive an enrollment packet from our contractor, Ramsell Public Health Rx, which will include a SPAP identification (ID) card.
Contact Information: Phone
(800) 255-1090 EXT: 3004

Address
ATTN: MSJA-MC 1873
P.O. Box 149347
Austin, TX 78714
» Texas HIV State Pharmacy Assistance Program (SPAP)




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Tips & Disclaimers
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  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
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  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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