Pennsylvania Code & Bulletin
COMMONWEALTH OF PENNSYLVANIA

• No statutes or acts will be found at this website.

The Pennsylvania Bulletin website includes the following: Rulemakings by State agencies; Proposed Rulemakings by State agencies; State agency notices; the Governor’s Proclamations and Executive Orders; Actions by the General Assembly; and Statewide and local court rules.

PA Bulletin, Doc. No. 96-1338

NOTICES


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 NameProduct NameNDC Purchase NumberUnitDoseAWP/Dose
DIPHTHERIA TETANUS PERTUSSIS VACCINE (DTP):
ConnaughtDTP49281-0280-847.5 ml0.5 ml$18.35
Wyeth-AyerstTri-Immunol00005-1948-337.5 ml0.5 ml$17.82
SK BeechamDTP00007-3555-015.0 ml0.5 ml$16.68
DIPHTHERIA TETANUS acellular PERTUSSIS VACCINE (DtaP):
ConnaughtTripedia49281-0282-157.5 ml0.5 ml$30.98
Wyeth-AyerstAcel-Immune00005-1950-315.0 ml0.5 ml$29.15
DIPHTHERIA TETANUS pediatric VACCINE (DT pediatric):
ConnaughtDT (Pediatric)49281-0275-105.0 ml0.5 ml$2.21
Wyeth-AyerstDT (Pediatric)00005-1858-315.0 ml0.5 ml$2.08
SclavoDT (Pediatric)42021-0210-115.0 ml0.5 ml$1.13
DIPHTHERIA TETANUS PERTUSSIS/HAEMOPHILUS INFLUENZAE B (DTP-HIB):
ConnaughtActHIB+DTP49281-0549-1010 x 0.50.5 ml$46.26
Wyeth-AyerstTetramune00005-1960-315.0 ml0.5 ml$41.83
TETANUS DIPHTHERIA adult VACCINE (Td adult):
SclavoTd (Adult)42021-0211-095.0 ml0.5 ml$1.13
ConnaughtTd (Adult)49281-0271-835.0 ml0.5 ml$2.21
Wyeth-AyerstTd (Adult)00005-1875-315.0 ml0.5 ml$2.08
Wyeth-AyerstTd (Adult)/syringe00005-1875-4710 x 0.50.5 ml$5.74
HAEMOPHILUS INFLUENZAE B VACCINE (HIB):
ConnaughtProHIBit49281-0541-105.0 ml0.5 ml$27.44
ConnaughtProHIBit49281-0541-052.5 ml0.5 ml$27.45
ConnaughtProHIBit49281-0541-015 x 0.50.5 ml$31.31
Wyeth-AyerstHibTITER53124-0201-105.0 ml0.5 ml$30.68
Wyeth-AyerstHibTITER53124-0104-414 x 0.50.5 ml$34.00
Merck & CoPedvax HIB00006-4792-000.5 ml0.5 ml$30.00
Merck & CoPedvax HIB00006-4797-005 x 0.50.5 ml$30.00
SK BeechamOmniHIB00007-4408-055 x 0.5 0.5 ml$26.72
TRIVALENT ORAL POLIO VACCINE LIVE (Sabin T-OPV):
Wyeth-AyerstOrimune/pipette00005-2084-0810 x 0.50.5 ml$23.30
Wyeth-AyerstOrimune/pipette00005-2084-1250 x 0.50.5 ml$21.71
INJECTABLE POLIO VACCINE INACTIVATED (Salk Enhanced IPV):
ConnaughtIPOL/syringe49281-0860-510.5 ml0.5 ml$27.90
ConnaughtIPOL/syringe49281-0860-5210 x 0.50.5 ml$27.90
MEASLES MUMPS RUBELLA VACCINE (MMR):
Merck & CoM-M-R II00006-4749-000.5 ml0.5 ml$54.71
Merck & CoM-M-R II00006-4681-0010 x 0.50.5 ml$48.13
MEASLES RUBELLA VACCINE (MR):
Merck & CoM-R-VAX II00006-4751-000.5 ml0.5 ml$39.89
Merck & CoM-R-VAX II00006-4677-0010 x 0.50.5 ml$34.04
RUBELLA MUMPS VACCINE (RM):
Merck & CoBIAVAX II00006-4746-000.5 ml0.5 ml$42.86
Merck & CoBIAVAX II00006-4669-0010 x 0.50.5 ml$38.52
MEASLES VACCINE (RUBEOLA):
Merck & CoATENUVAX00006-4709-000.5 ml0.5 ml$27.20
Merck & CoATENUVAX00006-4589-0010 x 0.50.5 ml$22.93
MUMPS VACCINE (MUMPS):
Merck & CoMUMPSVAX00006-4753-000.5 ml0.5 ml$30.44
Merck & CoMUMPSVAX00006-4584-0010 x 0.50.5 ml$27.93
RUBELLA (GERMAN MEASLES):
Merck & CoMERUVAX00006-4747-000.5 ml0.5 ml$28.20
Merck & CoMERUVAX00006-4673-0010 x 0.50.5 ml$24.87
HEPATITIS B VACCINE (HEP-B):
Merck & Co(1) RECUMBVX HB00006-4799-000.5 ml0.5 ml$33.75
Merck & Co(1) RECUMBVX HB00006-4874-0010 x 0.50.5 ml$31.93
Merck & Co(1) RECUMBVX HB00006-4761-003.0 ml0.5 ml$30.31
Merck & Co(2) RECUMBVX HB00006-4769-000.5 ml0.5 ml$43.26
Merck & Co(2) RECUMBVX HB00006-4876-0010 x 0.50.5 ml$42.79
Merck & Co(2) RECUMBVX HB00006-4773-003.0 ml0.5 ml$44.94
Merck & Co(3) RECUMBVX HB00006-4775-001.0 ml1.0 ml$89.85
Merck & Co(3) RECUMBVX HB00006-4872-0010 x 1.01.0 ml$88.89
SK Beecham(4) ENGERIX-B58160-0859-010.5 ml0.5 ml$35.18
SK Beecham(4) ENGERIX-B58160-0859-055 x 0.50.5 ml$35.18
SK Beecham(4) ENGERIX-B58160-0859-065 x 0.50.5 ml$35.18
SK Beecham(5) ENGERIX-B58160-0860-011.0 ml1.0 ml$81.53
SK Beecham(5) ENGERIX-B58160-0861-055 x 1.01.0 ml$81.53
SK Beecham(5) ENGERIX-B58160-0860-1625 x 1.01.0 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/ml
INFLUENZA (SPLIT VIRUS) VACCINE:
AdamsFLUVIRON53014-0100-0110 x 0.50.5 ml$5.67
Adams FLUVIRON53014-0100-105.0 ml0.5 ml$7.34
ConnaughtFLUZONE/syringe49281-0352-1110 x 0.5 0.5 ml$6.38
Park DavisFLUOGEN/syringe00071-4096-4010 x 0.50.5 ml$7.34
Park DavisFLUOGEN00071-4096-085.0 ml0.5 ml$7.00
Wyeth-AyerstFLU-SHIELD/tubex00008-0848-0210 x 0.50.5 ml$7.13
Wyeth-AyerstFLU-SHIELD00008-0848-015.0 ml0.5 ml$4.40
INFLUENZA (WHOLE VIRUS) VACCINE:
ConnaughtFLUZONE49281-0350-155.0 ml0.5 ml$5.98
RABIES VACCINE:
ConnaughtIMOVAX49281-0250-101.0 ml1.0 ml$210.84
PNEUMOCOCCAL VACCINE:
Wyeth-AyerstPNU-IMMUNE 23/sy00005-2309-335 x 0.50.5 ml$23.95
Wyeth-AyerstPNU-IMMUNE 2300005-2309-312.5 ml0.5 ml$21.35
Merck & CoPNEUMOVX 2300006-4741-005 x 0.50.5 ml$17.85
Merck & CoPNEUMOVX 2300006-4739-002.5 ml0.5 ml$15.91
MENINGOCOCCAL VACCINE:
ConnaughtMENOMUNE-13549281-0489-010.5 ml0.5 ml$78.57
ConnaughtMENOMUNE-13549281-0489-915.0 ml0.5 ml$42.20
VARICELLA VIRUS VACCINE LIVE (Chickenpox):
Merck & CoVARIVAX00006-4827-0010 x 0.50.5 ml$73.95
Merck & CoVARIVAX00006-4826-005.0 ml0.5 ml$74.90
GAMMA GLOBULIN/IMMUNE GLOBULIN (GG/IG):
ArmourGAMMAR00053-7595-0210.0 ml2.0 ml*$6.64
Miles-CutterGAMIMUNE N (5%)00161-0640-1210.0 ml2.0 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):
NABIH-BIG/syringe597-303-99-110.5 ml0.5 ml$82.50
NABIH-BIG597-303-99-011.0 ml0.5 ml$48.75
NABIH-BIG597-303-99-055.0 ml0.5 ml$33.38
Miles-CutterHyperHep/syringe00161-0616-000.5 ml0.5 ml$65.63
Miles-CutterHyperHep00161-0616-011.0 ml0.5 ml$70.31
Miles-CutterHyperHep00161-0616-055.0 ml0.5 ml$51.56
MSDHEP-B-GAMMA-G00006-4692-005.0 ml0.5 ml$59.08
VARICELLA-ZOSTER IMMUNE GLOBULIN (VZIG):
Mass PHBLVZIG14362-0118-02250 u250 u*$132.00**
Mass PHBLVZIG14362-0118-10625 u250 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):
ConnaughtIMOGAM RABIES49281-0180-022.0 ml1.0 ml*$96.38
ConnaughtIMOGAM RABIES49281-0180-1010.0 ml1.0 ml*$80.79
Cutter-MilesHyperRab00161-0608-022.0 ml1.0 ml*$65.63
Cutter-MilesHyperRab00161-0608-1010.0 ml1.0 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-CutterHYPER-TET/syringe00161-0614-01250 u250 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.]



No part of the information on this site may be reproduced for profit or sold for profit.

This material has been drawn directly from the official Pennsylvania Bulletin full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.