Begin Main Content Area

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.

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.

Application

A person can apply online.

enroll online buttonenroll online button

Online Application Tutorial


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.

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.

HIPAA Privacy and Rights

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 - coming soon

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

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).