Special Pharmaceutical Benefits Program
There are two components to this program: HIV/AIDS and Mental Health
Special Pharmaceutical Benefits Program: Mental Health
The Special Pharmaceutical Benefits Program – Mental Health (SPBP-MH) is administered by the Pennsylvania Department of Human Services, Office of Mental Health and Substance Abuse Services (OMHSAS) and provides payment for specific atypical antipsychotic medications for eligible participants. The SPBP-MH formulary is Abilify, Clozaril, Clozapine, Geodon, Invega, Risperdal, Risperidone, Seroquel or Zyprexa.
Individuals seeking to enroll in the SPBP-MH Program will need to complete the SPBP-MH application (MH821 dated January 2017) and must meet the requirements outlined in the application. The prior SPBP-MH application (MA442 dated June 2008) was obsoleted with the issuance of Bulletin OMHSAS-17-03 issued on August 29, 2017. SPBP-MH application MA 442 will not be accepted after December 31, 2017.
SPBP-MH cardholders are also eligible for Clozaril support services provided by physicians, outpatient psychiatric clinics or psychiatric partial hospitalization providers. The SPBP-MH does not reimburse any other providers for this service.
Medical Assistance (MA) program recipients, including individuals receiving services through HealthChoices, are not eligible for an SPBP-MH card and should not apply. The MA program covers medication for schizophrenia.
For general information, call the Customer Inquiry Line at (877) 356-5355 and select Option 2.
Special Pharmaceutical Benefits Program: HIV/AIDS
NOTE: This section of the Special Pharmaceutical Benefits Program has been moved to the Department of Health.
The Department of Health provides pharmaceutical assistance and specific lab services to low to moderate-income individuals living with a diagnosis of HIV/AIDS who are not eligible for pharmacy services under the Department of Human Services' Medical Assistance (MA) Program. Information is available at www.health.pa.gov/spbp