Tuberculosis Medication Policy
Purpose
The Indiana State Department of Health provides drugs to TB patients and suspects through a state-funded program for patients who reside in Indiana, with the exception of Marion and Allen Counties, which have their own drug program. The same program also will provide drugs for the treatment of latent TB infection (LTBI). Persons incarcerated in state or federal prisons are not eligible. Drugs will not be provided for: (1) the treatment of patients diagnosed with clinical conditions caused by mycobacteria other than tuberculosis, including disease caused by BCG vaccine; (2) patients who do not meet the Centers for Disease Control and Prevention (CDC) clinical case verification criteria for active TB, or (3) patients seeking treatment for LTBI whose tuberculin skin test reaction does not meet the CDC’s criteria for what is positive in accordance with the American Thoracic Society Standards found in the Core Curriculum on Tuberculosis, 4th edition, 2000.
Procedure
Drug requests will only be accepted from the local health departments. Prescriptions must be signed by a practitioner who has prescriptive authority. Verbal or telephone orders that have not been counter-signed will not be accepted.
When requesting drugs for TB patients and suspects, follow these steps:
1. Submit the following forms to the ISDH TB Control Program:
- Use only State Form 14058, “Report of Tuberculosis,” (revision 4, 10-2000 or later)
- State Form 48085, “Request for TB Drugs”
- A copy of the prescriptions
2. For TB suspects, a 3-month supply will be sent. If the patient is subsequently confirmed to have active TB disease, the remaining drugs are to be ordered using the same procedure outlined in step 1. If the patient is an out-of-area resident who is in your jurisdiction temporarily, order only what you need.
3. For patients already confirmed to have TB disease, drugs will be shipped in increments of 6-month supplies, unless the attending physician specifies a longer treatment period at the time of diagnosis, e.g., 9 months for cavitary pulmonary disease, or 12 months for meningeal, miliary, or bone and joint TB.
When requesting drugs for patients being treated for LTBI, follow these steps:
1. Submit the following forms to the ISDH TB Control Program:
- Use only State Form 49894, “Report of Treatment for Latent TB Infection”
- State Form 48085, “Request for TB Drugs”
- A copy of the prescriptions
2. Treatment regimens are on the back of State Form 49894.
3. As long as appropriate follow-up can be assured, drugs should be ordered for the entire treatment period. If the patient is going to be in your jurisdiction for only a brief period, it may be prudent to refer him or her to their new local health department for treatment.
Other important information:
ISDH will fax the drug request to Pharmaceutical Corporation of America (PCA), who then ships the order to the local health department via UPS. Keep a copy of your paperwork for your records. Do not write patient names or notes on the order form.
- Check your math. Do not order in amounts that exceed the number of refills on the prescription; i.e., if the physician orders 5 refills of INH, you cannot order 9 bottles. Make sure the prescriptions are properly written before sending to ISDH.
- Amounts requested that exceed what should have been ordered will automatically be adjusted. For example, PZA and ethambutol that are ordered for more than a two-month supply will be adjusted to conform to the number of tablets per day for 60 doses, unless the patient has drug resistance.
- Check your order upon receipt to insure that it is correct. Notify PCA if there are any discrepancies. Also notify PCA if your shipment does not arrive.
- Do not put labels on the bottles until they are dispensed. Patients are to receive no more than a 30-day supply at one time, since monitoring for side effects is an essential part of the treatment plan.
- Streptomycin and second-line drugs are special-order items and are not routinely stocked by PCA due to high cost and infrequent use. Second line drugs may be requested if they are medically necessary, such as rifabutin instead of rifampin for an HIV-positive patient who is on anti-retroviral therapy, or ciprofloxacin for multi-drug resistant TB.
- Unless they can be used immediately, unopened, unused drugs must be returned to PCA so that they can be placed back into the supply system. Coordinate all returns with PCA.
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