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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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  • 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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