Program Eligibility
As of November 5, 2024, eligibility requirements are in place for accessing latent TB infection (LTBI) medications through MDH due to a sudden shortage of rifampin. Effective immediately, MDH will not approve any new LTBI treatment regimens that include the drug rifampin. This is being done in order to preserve our rifampin supplies for active TB disease treatment. We will remove all restrictions and this notice when supply is availalbe again.
If your patient does not meet at least one of the six eligibility requirements listed below, please continue the prescription process through your patient's regular pharmacy of choice. MDH endorses CDC recommendations that all people living with latent TB infection receive treatment with regular monitoring and that the shorter treatment regimens are used where appropriate for greater completion rates.
In addition to the below criteria, your patient must first have a verified diagnosis of LTBI (presence of active disease has been ruled out). Criteria must be documented in patient's medical record.
- Local Public Health verified exposure to active disease within the last 2 years
- US arrival date ≤ 5 years
- Child < 5 years of age
- Highly immunocompromised due to presence of at least one of the following:
- HIV infection
- Presently taking immunosuppressive therapy:
- Beginning or currently in recipient process of stem cell or solid organ transplant
- Current daily treatment with moderate or high dose coricosteroid (i.e., equivalent to prednisone ≥ 15 mg for 1 month or longer)
- Beginning or currently receiving treatment with a TNF-alpha antagonist
- Silicosis
- Abnormal chest x-ray consistent with stable, inactive TB disease
- TB test conversion (i.e., documented change in TB testing status within a 2 year period):
- TST: a change from negative to positive with an increase of 10 mm or more in induration within 2 years
- IGRA: a change from negative to positive within 2 years
As of September 10, 2024, all prescriptions should be sent directly to MDH's contracted pharmacy.
Please send eScripts to:
Boynton Health Pharmacy
410 Church St S.E.
Minneapolis, MN 55455
Ph: 612-624-7655
or
fax Board of Pharmacy compliant prescriptions to 800-976-7671. Templates for compliant prescriptions can be found on the MDH TB Medications Program webpage for your convenience.
Medications will not be provided unless this request form for MDH is completed
AND
submit a prescription directly to Boynton Pharmacy.
To complete your request, you will need to answer all required fields. This includes:
- patient demographic information,
- medical history,
- LTBI screening information,
- LTBI prescription information,
- an electronic copy of the patient's insurance information.
Should you be unable to complete in one sitting, click "Save & Return Later" to navigate to the screen pictured below. On this screen, you will be provided a link and a code to resume your request within 31 days. Please retain a copy of these items to resume your request later.
A request will only be submitted to MDH after it is complete. After completing the form, you have the option of entering your email address to receive confirmation of request receipt. After the request is submitted, you will not be able to access it. You may contact the TB Medications Program by calling 651-201-5414 or toll-free 1-877-676-5414 with any questions or changes to submitted requests. See the program website for more information: https://www.health.state.mn.us/diseases/tb/meds/index.html. This link will open a new browser tab.
Available LTBI regimens:
4R (4 months of daily rifampin) TEMPORARILY SUSPENDED
3HR (3 months of daily isoniazid and rifampin) TEMPORARILY SUSPENDED
- 3HP (12 weekly doses of isoniazid and rifapentine)
- 6H or 9H (6 or 9 months of daily isoniazid)
- 9 months of daily levofloxacin (< 15 years of age) or moxifloxacin (> 15 years of age)
- For use in a verified contact to Multidrug Resistant (MDR) TB only.
More information on these regimens including dosing can be found on CDC's Treatment Regimens for Latent TB Infection (LTBI) page. This link will open in a new tab in your browser.
Providers must submit insurance information to MDH.
- If patient is uninsured:
- Indicate if they are being referred to health insurance navigator for assistance (submit coverage to MDH when acquired via fax) OR
- Indicate that uninsurable due to residency status
- MDH reserves the right to decline program participation and refer the provider to use regular pharmacy channels.
- Vitamin B6 will only be provided if medically indicated.
- Treatment regimens using medications supplied by MDH must follow the Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis, CID. Clicking this link will open a new tab in your browser.
Program eligibility and requirements may also be viewed on the Tuberculosis Medications Program Eligibility page on the MDH website. This link will open a new tab in your browser.