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Executive Summary

VIRGINIA MEDICAID VOLUNTARY AUTHORIZATION FOR SMOKING CESSATION DRUGS was announced to providers & by the state's Department of Medical Assistance Services in a Dec. 1 memo. In advance of a Jan. 1, 1994 start-up, Virginia notified pharmacists, physicians and other Medicaid providers in the state that prescriptions beyond an initial 90-day treatment period should contain a special, eight-digit code. To identify the prescriber, part of the code will include the doctor's initials. The code must be handwritten on the prescription form. The system is being tested by Virginia as a form of "self- authorization" in lieu of a strict prior authorization procedure ("The Pink Sheet" Nov. 29, p. 4). The state memo explains that the doctor's handwritten code indicates that the prescriber "believes that the patient remains motivated to stop smoking and is taking part in a behavioral smoking cessation program." In the Virginia plan, the first 90 days of nicotine patch and nicotine gum therapy can be prescribed without any restraints or special notification. Virginia adopted the voluntary authorization approach as an alternative to a prior authorization plan mandated by the 1992 state appropriations act. The state cautions, however, that "failure of providers to participate...may lead to a reconsideration of a mandatory [prior authorization] program." The nicotine prescribing guidelines are described as "the first set of guidelines to which the practitioners will be expected to adhere voluntarily." Other diseases that the state may address in future guidelines include asthma, arthritis and otitis media. As part of the voluntary approach, the state and professional organizations will undertake an educational program to "encourage more efficient and cost-effective prescribing and dispensing." The Task Force on Compliance, a group of 22 pharmaceutical companies, will provide funding for the educational effort. The task force is an outgrowth of an effort put together by the National Pharmaceutical Council.

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