• DSHS HIV/STD Program

    Post Office Box 149347, MC 1873
    Austin, Texas 78714

    Phone: 737-255-4300

    Email the HIV/STD Program

    Email HIV, STD, Hepatitis C, and TB data requests to the Program – This email can be used to request data and statistics on HIV, STDs, Hepatitis C, and TB in Texas. It cannot be used to get treatment or infection history for individuals, or to request information on programs and services. Please do not include any personal, identifying health information in your email such as HIV status, Date of Birth, Social Security Number, etc.

    For treatment/testing history, please contact your local health department.

    For information on HIV testing and services available to persons living with HIV, please contact your local HIV services organization.

023.002

STD Medications Allocation Formulary Including Managing Cephalosporin Allergy

Policy Number 023.002
Effective Date July 30, 1995
Revision Date July 26, 2001
Approval Authority TB/HIV/STD Section Director

1.0 Purpose

This policy establishes how the Texas Department of State Health Services (DSHS), TB/HIV/STD Section (Section) through the HIV/STD Medication Program (Program) allocates and/or pays for medications to achieve the Unit's mission of preventing, managing and treating sexually transmitted diseases (STD) in Texas. The policy explains: the basis for allocating medications in the state; and how payments to approved Medicaid pharmacies for persons with cephalosporin allergy are managed.

 

2.0 Authority

The Section Director, in collaboration with the Program Administrator of the HIV/STD Medication Program, determine the allocation of STD medications and their appropriate distribution based on the following: Morbidity and Mortality Weekly Report (MMWR), vol. 42, No. RR-14 published by the Centers for Disease Control and Prevention (CDC), and the DSHS Disease Prevention News, Vol. 54, No. 10. The Section Director assigns responsibility for implementation of this policy to the Program.

 

3.0 Allocation Method

Yearly medication allotments to treat gonorrhea, chlamydia, syphilis, and pelvic inflammatory disease are based upon morbidity from each county as reported by the DSHS public health regions for the last fiscal year. Allotments are computed according to the county of residence of the reported case. Incarcerated persons in detention facilities are counted as residents of the county in which the detention facility is located.

Medications are allocated by region. Allocations are shipped to regional offices and local health departments. Distribution of medications to clinics that perform STD services in the region can be done by regional offices and local health departments. This distribution must remain within the allocation for the region. Stock levels and maximum total allotments for the year will not be changed from the current allotment as the result of supplying new clinics. Stock levels and maximum yearly allotments will only be changed in the event of documented increases in reported STD morbidity for the area.

The actual dosage amount per reported case is based on the treatment guidelines published by the CDC.

 

4.0 STD Treatment Formulas

The following formulas are based upon treatment for the case and two contacts, according to the packaging quantities (indicated in parentheses) and guidelines published in MMWR (vol. 42, no. RR-14) and Disease Prevention News (vol. 54, no. 10). All contacts are presumed not to be pregnant.

 

4.1 Syphilis

Pen-G Benzathine (1.2mu) Number of cases x 6

EXPLANATION: Primary, secondary, and early latent syphilis require two (1.2mu) vials to treat the case and four (1.2mu) vials to treat two contacts. Therefore, a total of six (1.2mu) vials is allocated for each reported case of primary, secondary or early latent syphilis. Late latent syphilis requires six (1.2mu) vials to treat the case. Contacts to late cases are not treated. Therefore, a total of six (1.2mu) vials is allocated for each reported case of late latent syphilis.

 

  Doxycycline 100mg (14): Primary, Secondary, Early Latent: ((Number of cases x .05)x2)x3
    Late latent: (Number of cases x .05)x4

EXPLANATION: The assumption is that 5% of all reported syphilis cases will be truly allergic to penicillin (manifest by hives, shortness of breath, and/or rash), so doxycycline will be allocated in addition to the Pen-G Benz.

 

FOR PRIMARY, SECONDARY, AND EARLY LATENT: FOR LATE LATENT:
STEP 1.     Figure 5% of reported cases.
STEP 2.     Multiply that number by two (because the required treatment is 2.4 mu Pen-G Benz, which is equal to a treatment using two bottles of Doxycycline (14)).
STEP 3.     Multiply that number by three (to treat three people - the case and two contacts).
STEP 1.     Figure 5% of reported cases.
STEP 2.     Multiply that number by 4 (because four weeks of treatment is required).

 

4.2 Chlamydia

NOT PREGNANT: Doxycycline 100 mg (14): Number of cases x three (case and contacts)
PREGNANT: Erythromycin 250mg (56): Number of cases x one (case)
  Doxycycline 100mg (14): Number of cases x two (contacts)

 

4.3 Pelvic Inflammatory Disease

NOT PREGNANT: Rocephin 250mg: Number of cases x two (case requires 250mg, contacts 125mg each)
  Doxycycline 100mg (14): Number of cases x two (case and contacts)
  Doxycycline 100mg (28): Number of cases x one (case)
 

OR

  Rocephin 250mg: Number of cases x one (case requires 250mg)
  Suprax 400mg (1): Number of cases x two (contacts)
  Doxycycline 100mg (14): Number of cases x two (contacts)
  Doxycycline 100mg (28): Number of cases x one (case)
PREGNANT: Rocephin 250mg: Number of cases x two (case requires 250mg, contacts 125mg each)
  Erythromycin 250mg (56): Number of cases x one (case)
  Doxycycline 100mg (14): Number of cases x two (contacts)
 

OR

  Rocephin 250mg:  Number of cases x one (case requires 250mg, contacts 125mg each)
  Suprax 400mg (1): Number of cases x two (contacts)
  Erythromycin 250mg (56): Number of cases x one (case)
  Doxycycline 100mg (14): Number of cases x two (contacts)

 

4.4 Gonorrhea

NOT PREGNANT: Rocephin 250mg: (Number of cases x .5) x three*
  Doxycycline 100mg (14): Number of cases x three (case and contacts)**
 

OR

  Suprax 400mg (1): Number of cases x three (contacts)
  Doxycycline 100mg (14): Number of cases x three (case and contacts)

EXPLANATION: * The number of Rocephin 250mg vials required is one half (.5) the number of reported cases (because the required treatments is 125mg). Then multiply by three (to treat the case and two contacts).

** BECAUSE OF THE CONCOMITANT OCCURRENCE OF CHLAMYDIA.

PREGNANT: Rocephin 250mg: Number of cases x two (case requires 250mg, contacts 125mg each)
  Erythromycin 250mg (56): Number of cases x one (case)
  Doxycycline 100mg (14): Number of cases x two (contacts)
 

OR

  Rocephin 250mg: Number of cases x one (case)
  Suprax 400mg (1): Number of cases x two (contacts)
  Erythromycin 250mg (56): Number of cases x one (case)
  Doxycycline 100mg (14): Number of cases x two (contacts)

 

 

5.0 Cephalosporin Allergy

The Program pays participating Medicaid pharmacies who provide oral ciprofloxacin (500mg) or ofloxacin (400mg) for a person who has a documented cephalosporin allergy. Payments are only paid for pre-approved cases referred by a health care provider, and only if the medications are obtained from a participating Medicaid pharmacy. These medications are not stocked or dispensed by the DSHS Regional Office or the Program.

No payments will be made directly to clients or to non-Medicaid pharmacies.

 

5.1 Allocation methodology

The Program used 1% of the total number of reported gonorrhea cases in a region during the last fiscal year as the basis for determining the number of cases for which payments will be made during the allotment year.

 

5.2 Health care provider responsibility

The client's health care provider determines and documents the cephalosporin allergy. The health care provider contacts the Regional STD Program manager to initiate arrangements for service to the client. When eligibility for the payment on behalf of the client is approved, the health care provider refers the client to a participating Medicaid pharmacy.

 

5.3 Regional STD Program Manager responsibilities

The regional STD Program Manager coordinates Program payments with local health care providers and participating Medicaid pharmacies. The STD Program Manager directs the provider to refer the client to a participating Medicaid pharmacy if funds are available to pay for the medication.

Direct all questions regarding DSHS allotments of STD medications to the STD Program Manager in the DSHS regional office. The STD Program Manager will either answer the questions or refer the questions to appropriate central office program staff.

 

5.4 Central office responsibilities

Central office notifies the DSHS regional STD Program Manager of the number of cases to be served in the region. The Program will also notify the regional STD Program Manager when the maximum number of cases to be served in a region has been reached. No payments will be paid to pharmacies within the region for the remainder of the allotment year when the maximum number of cases has been served.

 

6.0 Supplying Medication During and Outbreak or an Emergency

The DSHS Regional STD Program Manager will contact the Section Director and the Director of the HIV/STD Epidemiology Division to report an outbreak. The Section Director and/or the Director of the HIV/STD Epidemiology Division will coordinate the provision of additional medications to the local area with the assistance of the Program and the Pharmacy Division.

 

7.0 Revision History

Date Action Section
Revision History
9/1/2017 Changed "TB/HIV/STD Unit" to "TB/HIV/STD Section" to reflect new program designation
10/3/2014 Converted format (Word to HTML) -
11/13/2002 Converted format (WordPerfect to Word) -

 


Last updated February 4, 2021