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Special Pharmaceutical Benefits Program (SPBP) New Income Limits Effective October 1, 2025

The Special Pharmaceutical Benefits Program (SPBP), Pennsylvania’s state-administered AIDS Drug Assistance Program (ADAP), will implement new income eligibility limits on October 1, 2025.

SPBP, authorized under the Federal Ryan White HIV/AIDS Program, provides FDA-approved medications to low-income individuals living with HIV who are uninsured or underinsured. The program is funded through Part B of the Ryan White Program, 340B and ADAP supplemental rebates, and limited insurer recoveries.

New Income Limits

The new eligibility threshold will be set at 350% of the Federal Poverty Guidelines (FPG).

  • Individual: $54,775
  • Household of 2: $74,025
  • Household of 3: $93,275
  • Household of 4: $112,525
  • Household of 5: $131,775

An additional $19,250 is added per spouse or dependent.

Implementation Timeline

  • New applicants: The revised limits apply beginning October 1, 2025.
  • Current participants: The new limits take effect at the time of reenrollment. For example, an individual whose eligibility ends December 31, 2025, will be evaluated under the new limits for coverage effective January 1, 2026.

Program Adjustments

SPBP will also reduce the number of drugs covered on its formulary and apply other cost-saving measures. Officials state the formulary will remain extensive compared to other states.

Assistance Options

Individuals no longer qualifying for SPBP may seek resources through Pennie, Pennsylvania’s official health insurance marketplace. Open enrollment begins November 1, 2025, at www.pennie.com. Additional assistance may be available directly through drug manufacturer programs:

SPBP officials emphasized that the changes are necessary due to rising enrollment and medication costs and are intended to sustain the program’s long-term viability.

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Who We Are

The Franklin County Free Press, established by Vicky Taylor in 2019, emerged as a beacon of local journalism for the residents of Franklin County. Under Vicky's leadership, it quickly became an essential source of news, particularly at a time when major newspaper publications were increasingly overlooking local coverage.

On January 1, 2022, the torch was passed to Nathan Neil and his firm, Neil Publishing, LLC. Neil, a local entrepreneur with multiple thriving businesses in Chambersburg, shares Vicky's fervent commitment to both the community and the world of local journalism.

Rooted in the heart of Franklin County and powered by its residents, the Franklin County Free Press continues to bridge the gap, ensuring that the local stories, events, and issues that matter most to the community remain in the spotlight.

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