New York Medicaid Program Establishes Coverage For Trofile

Armen Hareyan's picture

New York Medicaid has established coverage and reimbursement for Monogram's Trofile Assay, a diagnostic used to determine patient candidacy for Pfizer's new HIV anti-viral medication Selzentry (maraviroc).

Initiated in 1989 to ensure early identification and access to quality care for New Yorkers who can't afford medical care, the HIV Primary Care Medicaid Program revised its reimbursement structure in response to advances in HIV treatment and testing technology. With the establishment of coverage by the medicaid program, coverage will also be available from the New York ADAP program so that comprehensive coverage will now be available from all public payers in New York.


"New York remains the epicenter of the HIV/AIDS epidemic in the U.S.," said Dennis deLeon, President of the Latino Commission on AIDS. "The state's coverage and reimbursement of Trofile allows greater access to an advanced treatment option for the most vulnerable of our population living with HIV."

"We are very pleased that New York Medicaid has established coverage for Trofile," said Bill Welch, Monogram Chief Commercial Officer. "Now the medical public assistance programs for the states with the largest numbers of residents living HIV/AIDS -- namely California, Texas, Florida and New York -- recognize the need and provide reimbursement for accurate tropism testing."

Trofile is now a covered benefit among 25 state Medicaid programs, including California, Florida, Illinois, Maryland, Massachusetts, Michigan, New Jersey, Ohio, Texas and Wisconsin. In addition, Trofile is a covered benefit by Medicare, the Veteran's Administration, the Corrections and Prison Systems and Department of Indian Affairs, as well as with a number of private payers.

Monogram introduced Trofile in August 2007, upon FDA approval of Pfizer's Selzentry (maraviroc), and since then, almost 6,000 tests have been performed for patients throughout the U.S. In January 2008 DHHS Guidelines for Use of Antiretroviral Agents in HIV - 1 infected Adults & Adolescents recommend the use of the Trofile assay whenever the use of a CCR5 inhibitor is being considered as well as to be considered for patients who exhibit virologic failure on a CCR5 inhibition.