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Skip Navigation LinksPennsylvania Department of Health > My Health > A-Z Health Topics > A-D > Act 139 of 2014

Opioid Abuse

 
 
 
Governor Wolf stood with Physician General Dr. Rachel Levine at the Pennsylvania Medical Society as Dr. Levine signed a statewide standing order for naloxone, a medication that can reverse an overdose that is caused by an opioid drug. The governor was also joined by Secretary Ted Dallas, Secretary Gary Tennis, Secretary Karen Murphy, and Chairman Josh Shapiro. 
 

STANDING ORDER DOH-002-2016 NALOXONE PRESCRIPTION FOR OVERDOSE PREVENTION - CLICK HERE
 
WHAT IS NALOXONE? 

Naloxone is a medication that can reverse an overdose that is caused by an opioid drug (i.e. prescription pain medication or heroin). When administered during an overdose, naloxone blocks the effects of opioids on the brain and restores breathing within two to eight minutes. Naloxone has been used safely by medical professionals for more than 40 years and has only one function: to reverse the effects of opioids on the brain and respiratory system in order to prevent death.
 
WHAT IS ACT 139?
 
Senate Bill 1164 was signed into law in late Sept. as Act 139 of 2014. This legislation allows first responders including law enforcement, fire fighters, EMS or other organizations the ability to administer a medication known as naloxone, a life-saving opioid reversal medication, to individuals experiencing an opioid overdoes. The law also allows individuals such as friends or family members that may be in a position to assist a person at risk of experiencing an opioid related overdose to obtain a prescription for naloxone. Additionally, Act 139 provides immunity from prosecution for those responding to and reporting overdoses.
 
HOW DO I GET NALOXONE?
 
Family members and friends can access this medication by obtaining a prescription from their family doctor or by using the standing order (a prescription written for the general public, rather than specifically for an individual) issued by Rachel Levine, M.D., PA Physician General.  The standing order is kept on file at many pharmacies, or may be downloaded here.
 
Naloxone prescriptions can be filled at most pharmacies.  Although the medication may not be available for same day pick up, it can often be ordered and available within a day or two. 
 
WHAT TYPES OF NALOXONE ARE AVAILABLE?
 
Two of the most common ways that naloxone is administered are intranasal (nasal spray) and the auto-injector. Please note, not all pharmacies stock both forms and insurance coverage may vary depending on the type of medication being purchased and each individual insurance plan. Check your insurance prescription formulary or call your benefits manager to determine if the medication is covered by your particular plan or if your purchase of the medication will be an out-of-pocket cost. 
Narcan (Naloxone) forms:

• Intranasal
 
  • FDA approved naloxone nasal spray  supplied as a single 4 mg dose of naloxone hydrochloride in a 0.1 ml nasal spray device.  The device requires no assembly, so no specialized training is required to administer the dose.  Non-medically trained individuals can administer this device.  Do not prime or test the device prior to administration as this is not necessary.  The device only delivers a single nasal spray dose of naloxone hydrochloride.
  • Generic non-FDA approved form with two easily assembled pieces: a prefilled medication tube and an atomization device which is sold separately.  The nasal piece may not be stocked at your local pharmacy; however, they may assist in ordering it.  Additionally, the nasal atomization device can be ordered from a number of medical supply companies without a prescription.  
 
• The Auto-injector comes in a manufactured dosage form (similar to an epi-pen) and has a recorded message to talk you through giving the medication.
 
 
How do I administer naloxone?
 
In addition to talking to your healthcare provider or the pharmacist about how to use naloxone, individuals giving this medication to someone should take the online training ahead of time.  Training is available at one of the Department of Health approved training sites www.getnaloxonenow.org or https://www.pavtn.net/act-139-training.  These easy to understand, brief trainings explain how to recognize the signs and symptoms of an opioid overdose, what to do in the event of an overdose, and instruct on how to give naloxone.  While it is not necessary to obtain a training certificate in order to purchase naloxone, learning these important details will help you respond properly in the event of an overdose and also meet the immunity requirements of PA Act 139.
 
Could I get in trouble for giving someone naloxone (statutory immunity)?
 
Good Samaritan:  Through the ‘Good Samaritan’ provision of Act 139, friends, loved ones and bystanders are encouraged to call 911 for emergency medical services in the event an overdose is witnessed and to stay with the individual until help arrives.  The provision offers certain criminal and civil protections to the caller so that they cannot get in trouble for being present, witnessing and reporting an overdose.
Administering Naloxone:  Physicians are permitted to write third party prescriptions for naloxone and you are immune from liability for giving naloxone if you believed the person was suffering from an opioid overdose (heroin or prescription pain medication) and you called for medical help/911 after giving the medication.  
 
Does insurance cover naloxone?
 
Insurance companies vary in how they cover naloxone and other drugs used to treat an opioid overdose. Prior to having a naloxone prescription filled with a pharmacy, consumers are encouraged to check with their insurance carriers to find out whether naloxone is a covered benefit under their policy, and, if so, what form of naloxone is covered, and any cost-sharing amounts that may apply under their policy. 
 
Will Fee-for-Service and the managed care organizations (MCOs) pay for naloxone dispensed under the standing order for Medical Assistance recipients?
 
Yes.
 
Will Medical Assistance require a prescription in order for the pharmacist to fill the naloxone for a Medical Assistance recipient? 
 
Yes, per 55 Pa Code, Chapter 1121 – Pharmaceutical Services - §1121.52, pharmacists can treat the standing order as a verbal order for Medical Assistance recipients.
 
Can a person other than the eligible Medical Assistance recipient (friend or family member) obtain the naloxone at the pharmacy on the recipient’s behalf?  Will the Medical Assistance Program make payment?

PA Medical Assistance will make payment for naloxone for the eligible Medical Assistance recipient. 
 
Is prior authorization required by Medical Assistance for any of the naloxone products or supplies?
 
The Evzio Auto-Injector is covered by Medical Assistance, but requires prior authorization.  Generic naloxone is covered without the need for prior authorization. 
 
Where can a pharmacy access Medical Assistance billing procedures for naloxone and the nasal actuator?
 
The Fee-for-Service Program will post information related to billing for naloxone on the DHS Pharmacy Services website.  Pharmacies will need to contact each MCO individually to obtain information about their billing procedures.
 
Will copays apply for the naloxone products and nasal actuator?
 
No, the Medical Assistance copay will not apply.  
 
Is there a limit to the number of times that a Medical Assistance recipient can get naloxone?
 
No, there is no limit to the number of fills that can be obtained.
 
How can someone with an addiction to prescription pain medicines, heroin or other drugs get help?
 
Treatment for drug abuse and addiction is available!  You can find out more by calling the County Drug and Alcohol Office where you live.  For more information or to get the contact information for your local office visit: https://apps.ddap.pa.gov/GetHelpNow/ or call 717-783-8200.
While it may be uncomfortable to talk to someone about their substance abuse problem, research shows that it is more likely for an individual to seek help for their problem within 30 days following an overdose if someone talks to them right after the overdose event about going to treatment. 
 
Are there any other standing orders in Pennsylvania?
 
Yes. There have been three well publicized standing orders that we are aware of to date that impact Pennsylvania which include: 1) CVS who has developed one for their pharmacies nationwide; 2) Montgomery County; and 3) Allegheny County.
 
The standing order being signed today does not affect these standing orders. Instead the Physician General’s standing order expands upon them to ensure statewide access.