PACE

PROVIDER BULLETIN

October 8, 2004

DUR Edits

Effective October 18, 2004, several new initial therapy , appropriate diagnosis , maximum quantity, initial quantity, maximum duration, maximum quantity and duplicate therapy criteria will be added to the PACE ProDUR Program. The criteria is as follows:

Drug Name	Initial Therapy	Approved Diagnosis	Maximum Quantity	Initial Qty.	Maximum Duration	Duplicate Therapy
Xanax XR®		Approved only for Panic Disorder ”CH” –Call Help Desk response returned.
Duragesic® Patches	Conversion with an opiate is required prior to reimbursement of a 25mcg patch. *DUR Conflict code: PP –“Plan Protocol” response returned.		10 patches will be permitted every 30 days. An additional 10 patches will be permitted if dose is increased
Actiq®		Approved only for diagnosis of Cancer. ”CH” –Call Help Desk response returned.	A maximum of 48 units will be reimbursed every 30 days.	Initial quantity cannot exceed 6 units
Duragesic®, acetominophen w/hydrocodone Oxycontin®, acetominophen /oxycodone					Therapy beyond 180 days will require diagnostic information from the physician.
MS Contin®	Prior conversion with an opiate must be shown before approval of 200 mg. *DUR Conflict code: PP –“Plan Protocol” response returned.
Duragesic®, MS Contin®, Oramorph®, Oxycontin®, Kadian						Duplicate Therapy edit will be applied.

Providers are encouraged to examine their DUR response for additional information.

Note: PP—“Plan Protocol” may be over-ridden based on additional information from provider.

Questions may be directed to PACE ProDUR operators at 1-800-835-4080.

PPB-04-016