If you are in danger, call 911. If you need to exit this website quickly, click on the ESCAPE button. This button will immediately open a browser window for weather.com and replace your current window with google.com.
Skip to agency navigation
Skip to main content

Official Website

of the Commonwealth of Pennsylvania

    The .gov means its official.

    Local, state, and federal government websites often end in .gov. Commonwealth of Pennsylvania government websites and email systems use "pennsylvania.gov" or "pa.gov" at the end of the address. Before sharing sensitive or personal information, make sure you're on an official state website. 

    ​​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.

    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. Please download the PDFs below in order to complete the digital signature required on the applications.

    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 medications for people without insurance and provide coverage of copays, deductibles, and other out of pocket medication costs for people with insurance. In addition, SPBP will provide reimbursement for laboratory costs for people without insurance and payment of 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.

    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.

    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).