700.004 HIV Medications Ordering Process for Pharmacies

1.0 Purpose

To establish the process through which participating pharmacies order and dispense HIV medications through the Texas HIV Medication Program (THMP).
 

2.0 Authority

Texas Administrative Code (TAC), 25 TAC §98.107(D), THMP Benefits; 25 TAC §98.108, Limitations and Cost Containment. Part B of the Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87) provides grants to U.S. states and territories through the Ryan White HIV and AIDS Program (RWHAP).
 

3.0 Background

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). THMP uses this funding to provide medications for the treatment of HIV and its related complications for low-income Texans. THMP is the official AIDS Drug Assistance Program (ADAP) for Texas. The program provides medications listed in the current Texas HIV Medication Program Guidelines through participating pharmacies.
 

4.0 Ordering Medications

To place an order, the Pharmacy may either use the TCT Pharmacy Portal to order directly or fax THMP at 512-533-3171. THMP prefers the use of the TCT Pharmacy Portal. The fax line is open 24 hours a day, seven days a week. THMP expects the pharmacy to provide the following information when placing an order with THMP:

• Pharmacy ID number (assigned by THMP),
• Name of the pharmacy representative placing the order, and
• Client code number of the participant. Orders for HIV medication must include the participant’s assigned THMP code number (i.e., 09302) and the name, strength, and number of days’ supply of the medication(s).

The pharmacy must maintain records 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 bears responsibility for distributing the medications.

The ordering process follows Section 4.0 of this procedure, except 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.

THMP requires those pharmacies wishing to order using a distribution point to ensure they deliver medications to participants within ten (10) days from the participant’s request date. In addition, the pharmacies are also responsible for keeping program-required records and ensuring they meet other pharmacy requirements.
 

6.0 Verifying Participant Eligibility

THMP does not require participants to show proof of THMP eligibility to the pharmacy. The pharmacy is responsible for verifying the participant's eligibility with THMP prior to placing an order. Pharmacies are unable to view participants not assigned to them in TCT. 

Eligible Medicaid recipients who are also participants first utilize their Medicaid pharmacy benefits each month to be eligible to receive medications from THMP during that month. THMP is responsible for verifying Medicaid eligibility. The pharmacy is responsible for ensuring participants use the Medicaid benefits before requesting medications from THMP. Orders for Medicaid participants in TCT require an override by THMP staff after the pharmacy checks the participant's monthly Medicaid usage.
 

7.0 Medication Shipments

The DSHS Pharmacy ships medications from the DSHS pharmacy warehouse to the pharmacy. Medication shipments include a packing slip listing the order information the pharmacy provided. The pharmacy is responsible for reporting discrepancies in medication shipments to THMP as soon as possible.

Pharmacies log the receipt, partial receipt, or total non-receipt of medications on the TCT Order lookup page. This page also allows pharmacies to request a reorder of medications missing from partially or not received orders.
 

8.0 Dispensing Medications

Prior to dispensing medications, participating pharmacies ensure THMP approves the participant, the participant is currently active on THMP, and the participant is certified as eligible to receive specific THMP medications. THMP is not responsible for medications dispensed to a participant who THMP did not approve to receive them.

Pharmacies dispense medications unopened, without repackaging, in full-bottle increments, not exceeding the quantities stated in the current THMP Participating Pharmacy Guidelines. Pharmacies log the dispense date of the medication to participants on the TCT Order details page.

THMP operates as a provider program, not a reimbursement program. Participating pharmacies should not dispense medications to participants from the pharmacy's own inventory. THMP assumes no responsibility for replenishing pharmacy inventories. Participating pharmacies that dispense medications from their own stock and request replacement medications are subject to the rules outlined in this policy, and THMP does not guarantee reimbursement for medications dispensed from their own stock.
 

8.1 Dispensing

DSHS prohibits pharmacies from collecting fees directly from THMP participants for THMP medications. Pharmacies may invoice THMP directly each month for dispensed THMP medications, not to exceed $5.00 per medication. (See Texas HIV Medication Program Participating Pharmacy Guidelines).
 

8.2 Medication Replacements

DSHS does not replace lost, stolen, or damaged medication unless the participant or the participant’s representative provides adequate documentation of the circumstances. Participants complete and fax the THMP Temporary Out of State or Extra Medication Request Form to THMP when they require replacements.
 

8.3 Rebates

Pharmacies participating in 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 medication, the pharmacist informs the participant of this. THMP must receive replacement requests for medications dispensed prior to ordering from THMP within 30 days of the dispense date. THMP does not guarantee to honor them.
 

10.0 Revision History