Source: https://www.dshs.texas.gov/hivstd/policy/procedures/700-100.shtm
Timestamp: 2020-05-28 05:17:50
Document Index: 112152366

Matched Legal Cases: ['§85', '§85', '§85', '§85', '§85', '§85', '§531', '§1001']

Texas DSHS HIV/STD Program - HIV/STD Program Procedure 700.100
Texas HIV Medical Program Cost Comparison Calculation
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.
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.
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.
Expenditures through the State Pharmacy Assistance Program (SPAP) will be calculated on a quarterly basis.
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:
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.
Subtracting any manufacturer rebates received.
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.
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.
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