PURPOSE: This rule establishes, via regulation, the Department of Social Services (DSS)/Division of Medical Services (DMS) guidelines regarding Medicaid coverage and reimbursement for the drug product Serostim used to treat advanced AIDS wasting.

1. (1) The availability of the drug product Mammalian cell-derived recombinant human growth hormone, r-hGH[m] (Serostim) for Missouri Medicaid coverage shall be limited to only those eligible Medicaid recipients infected with the human immunodeficiency virus (HIV) who meet the eligibility requirements established through the federal Food and Drug Administration under the treatment investigational new drug (TIND) study of this product in adults with AIDS-associated wasting.

2. (2) Reimbursement for the drug product approved for coverage under the provisions of this rule.

   1. (A) Providers shall be reimbursed for the drug in accordance with the pricing methodology established in 13 CSR 70-20.070.
   2. (B) The drug dispensed shall be subject to the recipient cost-sharing requirements as established in 13 CSR 70-4.051.

AUTHORITY: sections 208.152, 208.153 and 208.201, RSMo 1994.* Emergency rule filed Dec. 15, 1995, effective Jan. 1, 1996, expired June 28, 1996. Original rule filed Dec. 15, 1995, effective July 30, 1996. *Original authority: 208.152, RSMo 1967, amended 1969, 1972, 1973, 1975, 1977, 1978, 1981, 1986, 1988, 1990, 1992, 1993; 208.153, RSMo 1967, amended 1967, 1973, 1989, 1991; and 208.201, RSMo 1981.