23 Miss. Code. R. 219-1.5 - Trofile Assay

A. The "Trofile Assay" is covered for beneficiaries who are HIV-positive and diagnosed with Acquired Immune Deficiency Syndrome (AIDS) who have evidence of viral replication and HIV-1 strain resistance to multiple anti-retroviral agents.

B. Medicaid covers "Trofile Assay" for beneficiaries age sixteen (16) and over with the following restrictions/guidelines:

1. The assay is to be obtained only in anticipation of treatment of HIV/AIDS patients with CCR5 antagonist agents who:

a) Are "treatment experienced" defined as having been previously treated with anti-retroviral regimen(s),

b) Have never received Maraviroc/Selzentry or other CCR5-antagonist agents, and

c) Have been deemed to have "virologic failure," or failed to obtain sufficiently low HIV viral loads despite prior appropriate anti-retroviral therapy.

2. Medicaid covers one (1) assay per beneficiary, per lifetime. Repeated testing or testing in follow-up of therapy with CCR5 agents is not covered.

3. The treating physician has expertise in Infectious Diseases and/or treating HIV patients with anti-retroviral agents; or the treating physician has consulted with an Infectious Disease physician prior to requesting the assay.

Notes

23 Miss. Code. R. 219-1.5

Miss. Code Ann. § 43-13-121