A person can also apply to SPBP with a paper application. A person may return a completed paper application to the Department of Health, Special Pharmaceutical Benefits Program. Please download the PDFs below in order to complete the digital signature required on the applications.

• Special Pharmaceutical Benefits Program Full Application - Effective May 2022
• Special Pharmaceutical Benefits Program Express Application - Effective May 2022
• Solicitud del Programa de Beneficios Farmacéuticos Especiales (SPBP) - Effective May 2022
  
• Solicitud Exprés del Programa de Beneficios Farmacéuticos Especiales - Effective May 2022

Enrollment Denials and Requests for Reconsideration

A person has the right to request reconsideration of a denial of SPBP eligibility. A person must file his or her request for reconsideration within 30 days after he or she receives a denial.

• Request for Reconsideration Form - coming soon
  

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

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 01-01-23)
  
• SPBP Covered Laboratory Services (Effective 09-01-20)
• SPBP Laboratory Network (Updated 06-01-18)
• SPBP Pharmacy Network (Updated 02-01-23)
  
• SPBP Medicare Part C and D Plans with Premium Payment Agreements 2023 (Updated 01-10-23)
  
• SPBP Medicare Part C and D Premium Assistance Program Overview and FAQ
  

HIPAA Privacy and Rights

• HIPAA Notice of Privacy Practices
  

SPBP Policy Manual

The SPBP Policy Manual explain the services and purpose of SPBP. The manual also describes the roles and responsibilities of providers. The manual provides the relevant federal, state, and contractual requirements that providers must adhere to.

• Provider Manual
  

SPBP Advisory Council

The Pennsylvania Department of Health (Department) created the SPBP Advisory Council in 2010. The SPBP Advisory Council helps the Department in carrying out federal grant responsibilities under the Ryan White HIV/AIDS Part B Program. The Council consists of 15-25 members. It includes clinicians, consumers, and interested members of the public. The Council meets quarterly. The Council provides guidance and recommendations to the Department about SPBP services, eligibility, and program management.

• Meeting dates
  
• Meeting minutes and meeting documents - coming soon
  
• Bylaws
  

Other Healthcare Resources

• HIV Program Home
• Other HIV Services
  
• Pennsylvania Integrated HIV Prevention and Care Plan  
• Medical Assistance (Medicaid)
  Medical Assistance pays for health care services for eligible people.
• Pennie
  Pennie is the state marketplace where people living in Pennsylvania can apply, shop, and enroll in health insurance coverage. Pennie also allows people to access financial assistance to make health insurance more affordable.
• Pharmaceutical Company Patient Assistance Programs
  Some pharmaceutical companies operate patient assistance programs (PAPs). PAPs provide free or reduced cost medications to people with low income.
• Special Pharmaceutical Benefits Program - Mental Health
  The Pennsylvania Department of Human Service helps provide medication for people with schizophrenia who do not respond to first-line drug therapies and are not eligible for pharmaceutical coverage under the Medical Assistance Program.

Additional Information about the Ryan White Program and SPBP Federal Requirements

The Public Health Service Act of 1990 created the Ryan White HIV/AIDS Program. This federal legislation created a national program that could address some of the care and needs of people with HIV. One part of the Ryan White HIV/AIDS Program created a medication and pharmacy benefit for people with HIV. This is the AIDS Drug Assistance Program (ADAP). Pennsylvania calls their ADAP the Special Pharmaceutical Benefit Program (SPBP).

• Ryan White HIV/AIDS Program Legislation
• More on the Ryan White HIV/AIDS Program