SPECIAL PHARMACEUTICAL BENEFITS PROGRAM

The Special Pharmaceutical Benefits Program (SPBP) assists persons with HIV to obtain medication, pay for some laboratory services, and provide premium assistance with selected Medicare Part C and D plans.  Details are online at www.health.pa.gov/spbp.

Covered Services

A person can receive services through SPBP once enrolled. SPBP will provide reimbursement for medication, laboratory costs, copays and deductibles for people with insurance, and select Medicare Part C and D plan premiums. SPBP is the payer of last resort. This means that people must use all other third-party resources, such as insurance, before SPBP can help cover costs.

• SPBP Covered Drug List (Effective 10-01-23)
• SPBP Covered Laboratory Services (Effective 09-05-23)

Eligibility

To be eligible for SPBP, a person must:

• Live in Pennsylvania,
• Have a gross annual (household or individual) income of less than or equal to 500% of the federal poverty level,
• Have a diagnosis of HIV, and
• Not be eligible for pharmacy services under the Medical Assistance (Medicaid) Program.

Income Quick Reference Guide (Effective 01-16-23)

Customer Service and Contact Information

For assistance or additional information, please contact SPBP Customer Service at 1-800-922-9384 or by email at SPBP@pa.gov

Mail

Department of Health
Special Pharmaceutical Benefits Program
P.O. Box 8808
Harrisburg, PA 17105-8808

Fax

888-656-0372