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Wisconsin Department of Health Services

Communicable  Diseases Subjects A-Z _________

AIDS/HIV

Immunization

Sexually
Transmitted
Diseases

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Tuberculosis
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Refugee Health

TB Drug Reimbursement Program (TBDRP)

Wisconsin Tuberculosis Program home 

Covered medications

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 covered:

  • amikacin
  • 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)
  • streptomycin

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®.

Billing instructions

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 your payment.

  1. Pharmacy name, street address, city, state, ZIP
  2. Pharmacy FEIN (federal employer identification number). This is needed to ensure payment to the appropriate pharmacy.
  3. Client ID number. This is indicated on the antituberculosis therapy authorization form.
  4. Client name.
  5. Date each prescription is filled.
  6. Product name.
  7. Metric quantity and/or number of pills dispensed.
  8. Days of supply:
    One month or a 30-day supply is the maximum amount dispensed to a patient at one time.
  9. National drug code (NDC) (labeler number, product number and package):
    Include all of the digits of the NDC, including zeros. Claim forms with incomplete numbers may be rejected.
  10. Ingredient cost:
    Enter your usual and customary price for the drug. Reimbursement is based upon the Wisconsin Medical Assistance Program (WMAP) allowable rate.
  11. Dispensing fee:
    Enter current Medical Assistance (MA) professional fee.
  12. Tax:
    The State of Wisconsin is exempt from paying state sales tax.
  13. Total price:
    Ingredient cost plus dispensing fee.
  14. Signature of pharmacist or employee.
  15. 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 (608) 261-6319.
  16. Deductible amount:
    Include the amount already paid per medication by the client’s insurance or other source of medication coverage (e.g., Medicaid).
  17. Balance:
    Indicate amount for which you are billing the TBDRP.

Claim submission

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 TBDRP.

  • Retain one copy of the completed invoice for your records
  • Send one copy in an envelope marked “confidential” to:

TBDRP
Tuberculosis Program
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
608-266-0049 - Secure Fax

      Jo Mercurio - Office operations
         608-266-9692
      Pa Vang - TB nurse consultant 
         608-266-9452 
      Philip Wegner - TB nurse consultant
         608-266-3729
      Norma Denbrook - Dispensary
         608-261-6388
      Savitri Tsering - Refugee health coordinator 
         608-267-3733

Last Revised: November 10, 2014