TB Drug Reimbursement Program (TBDRP)
Wisconsin Tuberculosis Program home
The TB Drug Reimbursement Program is administered by the
Tuberculosis Program of the Division of Public Health, Department of
Health Services. TBDRP will directly reimburse pharmacies for
covered medications for their eligible clients. Payment will be equal to or
greater than the Wisconsin Medicaid rate.
TBDRP covers the following antituberculosis medications:
- isoniazid (INH)
- rifampin (Rifadin, Rimactane)
- rifapentine (Priftin®)
- pyrazinamide (PZA)
- ethambutol (Myambutol)
- Rifater and Rifamate® (combination)
The following second line
antituberculosis drugs for drug resistant tuberculosis are also
- capreomycin (Capastat®)
- ciprofloxacin (Cipro®)
- clofazimine (Lamprene)
- cycloserine (Seromycin®)
- ethionamide (trecator-sc)
- gatifloxacin (Tequin®)
- kanamycin (Kantrex®)
- levofloxacin (Levaquin®)
- linezolid (Zyvox®)
- moxifloxacin (Avelox®)
- ofloxacin (Floxin®)
- parminosalicylic acid (PAS)
Under special circumstances, payment authorization is occasionally
given for medications not listed above.
Beginning in 2014, the following medications may also be covered:
- Anti-nausea prescription medications while taking TB medications.
- Vitamin B6 (pyridoxine) when INH is also prescribed, for pregnant
women; breast feeding infants; those with poor nutrition, diabetes,
uremia, alcoholism, malnutrition, HIV, or seizure disorders; OR
those with multi-drug-resistant TB.
- A multivitamin that contains vitamin D≥400 IU (10 mcg) for infants
0-12 months, ≥600 IU (15 mcg) for children and adults.
- Nutritional supplement such as Ensure®.
An invoice should be completed by the pharmacist and signed by both
the pharmacist and the customer or the patient's representative (signature can
also be on signature log rather than on each invoice). Claims should be
submitted monthly. Payments by TBDRP will be made directly to
the pharmacy. See list of covered medications above.
The invoice must include the information indicated below or your
claims may be returned for further information, resulting in a delay of
- Pharmacy name, street address, city, state, ZIP
- Pharmacy FEIN (federal employer identification number). This is
needed to ensure payment to the appropriate pharmacy.
- Client ID number. This is indicated on the antituberculosis therapy
- Client name.
- Date each prescription is filled.
- Product name.
- Metric quantity and/or number of pills dispensed.
- Days of supply:
One month or a 30-day supply is the maximum amount
dispensed to a patient at one time.
- National drug code (NDC) (labeler number, product number and
of the digits of the
NDC, including zeros. Claim forms with incomplete numbers may be
- Ingredient cost:
Enter your usual and customary price for the
drug. Reimbursement is based upon the
Wisconsin Medical Assistance Program (WMAP) allowable rate.
- Dispensing fee:
Enter current Medical Assistance (MA) professional fee.
The State of Wisconsin is exempt from paying state sales tax.
- Total price:
Ingredient cost plus dispensing fee.
- Signature of pharmacist or employee.
- Other third-party coverage:
WMAP also pays for all medications covered by the TBDRP.
WMAP must be billed first if the client has MA. If the pharmacy is aware
that an individual has health insurance with prescription drug coverage,
the pharmacy should bill insurance that portion for which the insurer is
responsible. The TBDRP should be billed only for the amount (copay
and/or deductible) that the pharmacy has been authorized by the TBDRP to
bill. If you have benefit coordination questions, call the TBDRP at
- Deductible amount:
Include the amount already paid per medication by the
client’s insurance or other source of medication coverage (e.g.,
Indicate amount for which you are billing the TBDRP.
If the client is eligible for MA or the pharmacy is aware of other
insurance coverage while enrolled in the TBDRP, the pharmacy must bill
them first. The TBDRP is the payer of last resort. Like the MA program,
pharmacies may not bill clients for the difference between their usual
and customary charges and the reimbursement rate they receive from the
- Retain one copy of the completed invoice for your records
one copy in an envelope marked “confidential” to:
Wisconsin Division of Public Health
PO Box 2659
Madison WI 53701-2659
Respiratory Diseases and International Health Unit
Division of Public Health
Bureau of Communicable Diseases and Emergency Response
1 West Wilson Street
Madison WI 53701-2659
Jo Mercurio -
Pa Vang - TB nurse consultant
Wegner - TB nurse consultant