Changes to List of Immunizing Agents and Average Wholesale Prices[26 Pa.B. 3958] Under 31 Pa. Code § 89.807(b) (relating to immunizing agents, doses and AWPs), the Department of Health has established a table setting forth immunizing agent and dose information extracted from recommendations of the Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention, United States Department of Health and Human Services. The relevant ACIP recommendations are those which prescribe child immunization practices and are currently in effect.
That table, ''Immunizing Agents and Doses,'' is set forth in Appendix H of 31 Pa. Code Chapter 89 (relating to approval of life, accident and health insurance) and is updated when new ACIP recommendations which meet the standards in 31 Pa. Code § 89.806(a) (relating to coverage of child immunizations) are published in the Morbidity and Mortality Weekly Report (MMWR), a weekly publication of the United States Department of Health and Human Services. The child immunization practices specified in those recommendations are subject to the insurance coverage required by the Childhood Immunization Insurance Act (act) (40 P. S. §§ 3501--3508) as explained in 31 Pa. Code § 89.806(a).
Under 31 Pa. Code § 89.807(b), the Department of Health is to also periodically publish a notice in the Pennsylvania Bulletin setting forth the average wholesale prices (AWPs) for dosage units of immunizing agents which the relevant ACIP recommendations prescribe for use in child immunizations. The AWPs are calculated as described in 31 Pa. Code § 89.807(a) and should be recalculated monthly as explained in that subsection.
The Department of Health, through the following table, provides notice of changes in immunizing agent, dose and average wholesale price information and recommends, under 31 Pa. Code § 89.807(b), that that table, except for information relating to AWPs, be substituted in Appendix H for the table currently set forth in that appendix.
Vaccine Type: Company Pct Name Product Name NDC Purchase Number Unit Dose AWP/Dose DIPHTHERIA TETANUS PERTUSSIS VACCINE (DTP): Connaught DTP 49281-0280-84 7.5 ml 0.5 ml $18.35 Wyeth-Ayerst Tri-Immunol 00005-1948-33 7.5 ml 0.5 ml $17.82 SK Beecham DTP 00007-3555-01 5.0 ml 0.5 ml $16.68 DIPHTHERIA TETANUS acellular PERTUSSIS VACCINE (DtaP): Connaught Tripedia 49281-0282-15 7.5 ml 0.5 ml $30.98 Wyeth-Ayerst Acel-Immune 00005-1950-31 5.0 ml 0.5 ml $29.15 DIPHTHERIA TETANUS pediatric VACCINE (DT pediatric): Connaught DT (Pediatric) 49281-0275-10 5.0 ml 0.5 ml $2.21 Wyeth-Ayerst DT (Pediatric) 00005-1858-31 5.0 ml 0.5 ml $2.08 Sclavo DT (Pediatric) 42021-0210-11 5.0 ml 0.5 ml $1.13 DIPHTHERIA TETANUS PERTUSSIS/HAEMOPHILUS INFLUENZAE B (DTP-HIB): Connaught ActHIB+DTP 49281-0549-10 10 x 0.5 0.5 ml $46.26 Wyeth-Ayerst Tetramune 00005-1960-31 5.0 ml 0.5 ml $41.83 TETANUS DIPHTHERIA adult VACCINE (Td adult): Sclavo Td (Adult) 42021-0211-09 5.0 ml 0.5 ml $1.13 Connaught Td (Adult) 49281-0271-83 5.0 ml 0.5 ml $2.21 Wyeth-Ayerst Td (Adult) 00005-1875-31 5.0 ml 0.5 ml $2.08 Wyeth-Ayerst Td (Adult)/syringe 00005-1875-47 10 x 0.5 0.5 ml $5.74 HAEMOPHILUS INFLUENZAE B VACCINE (HIB): Connaught ProHIBit 49281-0541-10 5.0 ml 0.5 ml $27.44 Connaught ProHIBit 49281-0541-05 2.5 ml 0.5 ml $27.45 Connaught ProHIBit 49281-0541-01 5 x 0.5 0.5 ml $31.31 Wyeth-Ayerst HibTITER 53124-0201-10 5.0 ml 0.5 ml $30.68 Wyeth-Ayerst HibTITER 53124-0104-41 4 x 0.5 0.5 ml $34.00 Merck & Co Pedvax HIB 00006-4792-00 0.5 ml 0.5 ml $30.00 Merck & Co Pedvax HIB 00006-4797-00 5 x 0.5 0.5 ml $30.00 SK Beecham OmniHIB 00007-4408-05 5 x 0.5 0.5 ml $26.72 TRIVALENT ORAL POLIO VACCINE LIVE (Sabin T-OPV): Wyeth-Ayerst Orimune/pipette 00005-2084-08 10 x 0.5 0.5 ml $23.30 Wyeth-Ayerst Orimune/pipette 00005-2084-12 50 x 0.5 0.5 ml $21.71 INJECTABLE POLIO VACCINE INACTIVATED (Salk Enhanced IPV): Connaught IPOL/syringe 49281-0860-51 0.5 ml 0.5 ml $27.90 Connaught IPOL/syringe 49281-0860-52 10 x 0.5 0.5 ml $27.90 MEASLES MUMPS RUBELLA VACCINE (MMR): Merck & Co M-M-R II 00006-4749-00 0.5 ml 0.5 ml $54.71 Merck & Co M-M-R II 00006-4681-00 10 x 0.5 0.5 ml $48.13 MEASLES RUBELLA VACCINE (MR): Merck & Co M-R-VAX II 00006-4751-00 0.5 ml 0.5 ml $39.89 Merck & Co M-R-VAX II 00006-4677-00 10 x 0.5 0.5 ml $34.04 RUBELLA MUMPS VACCINE (RM): Merck & Co BIAVAX II 00006-4746-00 0.5 ml 0.5 ml $42.86 Merck & Co BIAVAX II 00006-4669-00 10 x 0.5 0.5 ml $38.52 MEASLES VACCINE (RUBEOLA): Merck & Co ATENUVAX 00006-4709-00 0.5 ml 0.5 ml $27.20 Merck & Co ATENUVAX 00006-4589-00 10 x 0.5 0.5 ml $22.93 MUMPS VACCINE (MUMPS): Merck & Co MUMPSVAX 00006-4753-00 0.5 ml 0.5 ml $30.44 Merck & Co MUMPSVAX 00006-4584-00 10 x 0.5 0.5 ml $27.93 RUBELLA (GERMAN MEASLES): Merck & Co MERUVAX 00006-4747-00 0.5 ml 0.5 ml $28.20 Merck & Co MERUVAX 00006-4673-00 10 x 0.5 0.5 ml $24.87 HEPATITIS B VACCINE (HEP-B): Merck & Co (1) RECUMBVX HB 00006-4799-00 0.5 ml 0.5 ml $33.75 Merck & Co (1) RECUMBVX HB 00006-4874-00 10 x 0.5 0.5 ml $31.93 Merck & Co (1) RECUMBVX HB 00006-4761-00 3.0 ml 0.5 ml $30.31 Merck & Co (2) RECUMBVX HB 00006-4769-00 0.5 ml 0.5 ml $43.26 Merck & Co (2) RECUMBVX HB 00006-4876-00 10 x 0.5 0.5 ml $42.79 Merck & Co (2) RECUMBVX HB 00006-4773-00 3.0 ml 0.5 ml $44.94 Merck & Co (3) RECUMBVX HB 00006-4775-00 1.0 ml 1.0 ml $89.85 Merck & Co (3) RECUMBVX HB 00006-4872-00 10 x 1.0 1.0 ml $88.89 SK Beecham (4) ENGERIX-B 58160-0859-01 0.5 ml 0.5 ml $35.18 SK Beecham (4) ENGERIX-B 58160-0859-05 5 x 0.5 0.5 ml $35.18 SK Beecham (4) ENGERIX-B 58160-0859-06 5 x 0.5 0.5 ml $35.18 SK Beecham (5) ENGERIX-B 58160-0860-01 1.0 ml 1.0 ml $81.53 SK Beecham (5) ENGERIX-B 58160-0861-05 5 x 1.0 1.0 ml $81.53 SK Beecham (5) ENGERIX-B 58160-0860-16 25 x 1.0 1.0 ml $81.54 (1) Pediatric low risk formulation @ 5 mcg/ml
(2) Adolescent/infant high risk formulation@ 10 mcg/ml
(3) Adult Formulation @ 10 mcg/ml
(4) Pediatric formulation @ 10 mcg/0.5 ml
(5) Adult formulation @ 20 mcg/mlINFLUENZA (SPLIT VIRUS) VACCINE: Adams FLUVIRON 53014-0100-01 10 x 0.5 0.5 ml $5.67 Adams FLUVIRON 53014-0100-10 5.0 ml 0.5 ml $7.34 Connaught FLUZONE/syringe 49281-0352-11 10 x 0.5 0.5 ml $6.38 Park Davis FLUOGEN/syringe 00071-4096-40 10 x 0.5 0.5 ml $7.34 Park Davis FLUOGEN 00071-4096-08 5.0 ml 0.5 ml $7.00 Wyeth-Ayerst FLU-SHIELD/tubex 00008-0848-02 10 x 0.5 0.5 ml $7.13 Wyeth-Ayerst FLU-SHIELD 00008-0848-01 5.0 ml 0.5 ml $4.40 INFLUENZA (WHOLE VIRUS) VACCINE: Connaught FLUZONE 49281-0350-15 5.0 ml 0.5 ml $5.98 RABIES VACCINE: Connaught IMOVAX 49281-0250-10 1.0 ml 1.0 ml $210.84 PNEUMOCOCCAL VACCINE: Wyeth-Ayerst PNU-IMMUNE 23/sy 00005-2309-33 5 x 0.5 0.5 ml $23.95 Wyeth-Ayerst PNU-IMMUNE 23 00005-2309-31 2.5 ml 0.5 ml $21.35 Merck & Co PNEUMOVX 23 00006-4741-00 5 x 0.5 0.5 ml $17.85 Merck & Co PNEUMOVX 23 00006-4739-00 2.5 ml 0.5 ml $15.91 MENINGOCOCCAL VACCINE: Connaught MENOMUNE-135 49281-0489-01 0.5 ml 0.5 ml $78.57 Connaught MENOMUNE-135 49281-0489-91 5.0 ml 0.5 ml $42.20 VARICELLA VIRUS VACCINE LIVE (Chickenpox): Merck & Co VARIVAX 00006-4827-00 10 x 0.5 0.5 ml $73.95 Merck & Co VARIVAX 00006-4826-00 5.0 ml 0.5 ml $74.90 GAMMA GLOBULIN/IMMUNE GLOBULIN (GG/IG): Armour GAMMAR 00053-7595-02 10.0 ml 2.0 ml* $6.64 Miles-Cutter GAMIMUNE N (5%) 00161-0640-12 10.0 ml 2.0 ml* $13.68 * Dosage will vary depending upon the weight of the child and the disease for which the child is being immunized. 150 Pct AWP/Dose is to be calculated based upon the dosage used. HEPATITIS B IMMUNE GLOBULIN (HBIG): NABI H-BIG/syringe 597-303-99-11 0.5 ml 0.5 ml $82.50 NABI H-BIG 597-303-99-01 1.0 ml 0.5 ml $48.75 NABI H-BIG 597-303-99-05 5.0 ml 0.5 ml $33.38 Miles-Cutter HyperHep/syringe 00161-0616-00 0.5 ml 0.5 ml $65.63 Miles-Cutter HyperHep 00161-0616-01 1.0 ml 0.5 ml $70.31 Miles-Cutter HyperHep 00161-0616-05 5.0 ml 0.5 ml $51.56 MSD HEP-B-GAMMA-G 00006-4692-00 5.0 ml 0.5 ml $59.08 VARICELLA-ZOSTER IMMUNE GLOBULIN (VZIG): Mass PHBL VZIG 14362-0118-02 250 u 250 u* $132.00** Mass PHBL VZIG 14362-0118-10 625 u 250 u* $113.55** *Dosage will vary depending upon the weight of the child. If any portion of a vial is used to immunize a child, and the remainder can not be used to immunize another individual, the entire vial shall be considered as part of the dosage used. 150 Pct LST/Dose is to be calculated based upon the dosage used. **LST (list price) is used instead of AWP. This product has no AWP. LST may fluctuate slightly, depending on where the project is purchased. RABIES IMMUNE GLOBULIN (RIG): Connaught IMOGAM RABIES 49281-0180-02 2.0 ml 1.0 ml* $96.38 Connaught IMOGAM RABIES 49281-0180-10 10.0 ml 1.0 ml* $80.79 Cutter-Miles HyperRab 00161-0608-02 2.0 ml 1.0 ml* $65.63 Cutter-Miles HyperRab 00161-0608-10 10.0 ml 1.0 ml* $51.75 *Dosage will vary depending upon the weight of the child. Each 1.0 ml contains 150 IU units. If any portion of a vial is used to immunize a child, and the remainder can not be used to immunize another individual, the entire vial shall be considered as part of the dosage used. 150 Pct AWP/Dose is to be calculated based upon the dosage used. TETANUS IMMUNE GLOBULIN (TIG): Miles-Cutter HYPER-TET/syringe 00161-0614-01 250 u 250 u $36.20 Questions regarding this notice should be directed to Robert E. Longenecker, Program Coordinator, Immunization Program, Department of Health, P. O. Box 90, Harrisburg, PA 17108, (717) 787-5681. Persons with a disability may submit questions in alternative formats, such as by audio tape, braille or using TDD: (717) 783-6514. Persons with a disability who require an alternative format of this document should contact Robert E. Longenecker so that he may make the necessary arrangements.
DANIEL F. HOFFMANN FACHE,
Acting Secretary[Pa.B. Doc. No. 96-1338. Filed for public inspection August 16, 1996, 9:00 a.m.]
