Emergency Sections 
 An agency may adopt a new or amended section or repeal an existing section on 
an emergency basis if it determines that such action is necessary for the public 
health, safety, or welfare of this state. The section may become effective 
immediately upon filing with the Texas Register, or on a stated date less than 
20 days after filing, for no more than 120 days. The emergency action is 
renewable once for no more than 60 days. 
 Symbology in amended emergency sections. New language added to an existing 
section is indicated by the use of bold text. [Brackets] indicate deletion of 
existing material within a section. 
 
   
  TITLE 25. HEALTH SERVICES 
 Part I. Texas Department of Health 
  
  Subchapter 98. HIV and STD Control 
   
  Subchapter C. Texas HIV Medication Program 
 
  General Provisions 
 
  25 TAC sec.98.104, sec.98.105 
 
  The Texas Department of Health (department) adopts on an emergency basis 
amendments to existing sec.98.104 and sec.98.105, concerning the Texas HIV 
Medication Program. The sections implement the provisions of the "Communicable 
Disease Prevention and Control Act," Health and Safety Code, Chapter 85.063, 
Subchapter C, concerning the Texas HIV Medication Program. The program assists 
hospital districts, local health departments, public or nonprofit hospitals and 
clinics, nonprofit community organizations, and HIV infected individuals in the 
purchase of medications approved by the board that have been shown to be 
effective in reducing hospitalizations due to HIV related conditions. Generally, 
the sections cover eligibility for participation and medication coverage. 
 The amendments expand coverage of the program to include atovaquone for 
eligible participants and adds language to make the two sections uniform. 
Atovaquone will be used as an oral treatment for acute mild to moderate 
<nl>Pneumocystis carinii Pneumonia (PCP)<ol> in patients who are intolerant to 
trimethoprim-sulfamethoxazole (SMZ-TMP) to reduce the hospitalization and 
decline of the general health of the HIV infected persons on this program. These 
amendments are being proposed for permanent adoption in this issue of the Texas 
Register. 
 The amendments are adopted on an emergency basis in order to expeditiously 
provide medications to HIV infected individuals. It is imperative to address 
this serious and imminent health condition by providing approved medications as 
soon as possible. Also these amendments are proposed for permanent adoption in 
this issue of the Texas Register.  12> 
 The amendments are adopted on an emergency basis under the Health and Safety 
Code, sec.85.063, which provides the Texas Board of Health with the authority to 
adopt rules concerning a Texas HIV Medication Program; and Health and Safety 
Code,  s12.001, which provides the Texas Board of Health with the authority to 
adopt rules for the performance of every duty imposed by law on the Texas Board 
of Health, the Texas Department of Health, and the Commissioner of Health; and 
Texas Civil Statutes, Article 6252-13a, sec.5, which provide the Board with 
authority to adopt rules on an emergency basis. 
 
 
  sec.98.104. Medication Coverage. <nl>The following medications will be 
provided to each eligible participant. 
 
  <nl>(1)<ol>[(a)]  Zidovudine capsules must be provided in increments of 100 
not to exceed 400 capsules per month. Zidovudine syrup must be provided in eight 
ounce bottles. 
   
  <nl>(2)<ol>[(b)] Pentamidine for inhalation solution must be provided in one 
300 mg. vial per month. 
   
  <nl>(3)<ol>[(c)]  Sulfamethoxazole-trimethoprim (DS) tablets must be provided 
in increments of 100 tablets for a maximum of 200 per month. Sulfamethoxazole-
trimethoprim suspension must be provided in bottles of 480 ml. 
   
  <nl>(4)<ol>[(d)]  Didanosine tablets must be provided in increments of 60 
tablets not to exceed 120 tablets per month. 
   
  <nl>(5)<ol>[(e)] Fluconazole must be provided in increments of 30 tablets not 
to exceed 120 tablets in three months. 
   
  <nl>(6)<ol>[(f)] Erythropoietin is provided through the Texas HIV Medication 
Program for children younger than 18 years of age. Adults and children that meet 
the financial and drug specific criteria will be eligible to receive this drug 
under the Ortho Biotech program. 
   
  <nl>(7)<ol>[(g)]  Immune Globulin Intravenous (Human) will be provided in 2.5 
and 5 gm. vials. 
   
  <nl>(8)<ol>[(h)] Texas HIV Medication Program will reimburse the Tuberculosis 
Elimination Division for the following listed drugs used to treat atypical 
mycobacterial infections in individuals that are HIV infected: 
 
  <nl>(A)<ol>[(1)] Amikacin-1 g vial; 
   
  <nl>(B)<ol>[(2)]  Capreomycin-1 g vial; 
   
  <nl>(C)<ol>[(3)] Ciprofloxacin-750 mg. tablets; 
   
  <nl>(D)<ol>[(4)] Cycloserine-250 mg. capsules; 
   
  <nl>(E)<ol>[(5)] Ethambutol-100 mg. tablets; 
   
  <nl>(F)<ol>[(6)]  Ethambutol-400 mg. tablets; 
   
  <nl>(G)<ol>[(7)] Ethionamide-250 mg. tablets; 
   
  <nl>(H)<ol>[(8)] Isoniazid (INH) syrup; 
   
  <nl>(I) <ol>[(9)] Isoniazid (INH)-100 mg. tablets; 
   
  <nl>(J)<ol>[(10)]  Isoniazid (INH)-300 mg. tablets; 
   
  <nl>(K)<ol>[(11)] Kanamycin-1 g vial; 
   
  <nl>(L)<ol>[(12)] Pyrazinamide-500 mg. tablets; 
   
  <nl>(M) <ol>[(13)] Pyridoxine (Vit.B-6)-50 mg. tablets; 
   
  <nl>(N)<ol>[(14)]  Rifampin-300 mg./Isoniazid (INH) 150 mg. capsules; 
   
  <nl>(O)<ol>[(15)]  Rifampin-300 mg. capsules; 
   
  <nl>(P)<ol>[(16)] Sodium P.A.S. tablets; and 
   
  <nl>(Q)<ol>[(17)] Streptomycin-5 g. 
     
  <nl>(9) <ol>[(i)] Acyclovir capsules must be provided in increments of 100, 
not to exceed 200 per month. Acyclovir suspension must be provided in 473 ml. 
bottles of 200 mg./ml., not to exceed two bottles per month. Acyclovir powder 
for injection must be provided in 500 mg. vials, not to exceed 2-10 ml. vials 
per month. 
   
  <nl>(10)<ol>[(j)] Zalcitabine tablets must be provided in increments of 100 
not to exceed 100 tablets per month. 
   
  <nl>(11)<ol>[(k)]  IV Pentamidine must be provided in 300 mg. vials not to 
exceed 14 vials per course of therapy (one vial per day for 14 days). 
   
  <nl>(12)<ol>[(l)]  Interferon-Alpha must be provided in  <nl>commercially 
available vials not to exceed 450 million units<ol> [50 million unit vials not 
to exceed nine] per month. 
   
  <nl>(13)<ol>[(m)] Amphotericin-B must be provided in 50 mg. vials not to 
exceed 40 per month. 
   
  <nl>(14) Atovaquone must be provided in increments of 200 tablets not to 
exceed 200 tablets per 21-day treatment therapy following each diagnosis. 
 
     
  sec.98.105. Drug specific eligibility criteria. A person is eligible for: 
 
  (1)-(9) (No change.) 
   
  (10) Interferon-Alpha for the treatment of disseminated Kaposi's sarcoma in 
HIV infected persons with T-cell counts over 500. The total amount to be 
expended on this drug is $122, 600. The requesting physician must complete a 
form to be returned to the program which will allow the program to evaluate the 
benefits of providing this medication; [and] 
   
  (11) Amphotericin-B for the treatment of patients with progressive, and 
potentially fatal disseminated fungal infections. The total amount to be 
expended on this drug is $46,200. The requesting physician must complete a form 
to be returned to the program which will allow the program to evaluate the 
benefits of providing this medication<nl>; and <ol> [.] 
   
  <nl>(12) Atovaquone for the oral treatment of acute mild to moderate 
Pneumocystis carinii Pneumonia (PCP) in patients who are intolerant to 
trimethoprim-sulfamethoxazole (TMP-SMX). 
       
  Issued in Austin, Texas, on March 23, 1993. 
 TRD-9320724 
  Robert A. MacLean, M.D. 
 Deputy Commissioner 
 Texas Department of Health 
    Effective date: March 23, 1993 
 Expiration date: July 21, 1993 
 For further information, please call: (512) 458-7500