PA requests will be accepted on or after June 9, 2016

Qualified Patients:

The requirements of the law are (patient requirements):

  • 18 years of age or older
  • Able to make and communicate health care decisions
  • A California resident, verified through a driver's license or other state identification, voter registration or tax return
  • Has a terminal illness—a disease that will, within reasonable medical judgment, produce death in six months
  • Has made 3 voluntary requests, two oral (separated by 15 days between) and one written, which must be signed by two witnesses
  • Patient must sign a "final attestation" form before ingesting the drug, saying they are fully informed of the consequences and alternatives

Documentation Required (Approved Usage Guidelines):

  • End of life diagnosis AND

  • DMHC form completed with all pertinent information except medications tried/failed section need not be completed AND

  • The form must be marked the drug is for patient self-administration AND

  • Physician documented the patient completed the waiting period process and that the patient signed the final attestation AND

  • Request includes names of the following physicians:“Attending physician”, who writes the prescription, and a "consulting physician," who confirms the diagnosis, prognosis and the patient's capability to make an informed decision

Coverage Not Authorized:

  • When all of the documentation requirements stated above are not included with the request

Most Commonly Prescribed Drugs, Dosing Regimen, And Authorization Limit [note - these are examples - prior authorization consideration is based on the evidence-supported prescriber selected therapies and completion of all required documentation as stated above]:

  • Secobarbital is the medication most commonly prescribed for physician-assisted suicide, followed by pentobarbital. The lethal dose prescribed is typically 9 g of secobarbital in capsules or 10 g of pentobarbital liquid, to be consumed at one time

    • The pharmacist or physician should instruct patients to take the lethal dose on an empty stomach to increase the rate of absorption

    • The typical dose of pentobarbital as an oral hypnotic for adults is 100–200 mg at bedtime, and that of secobarbital is 100 mg orally at bedtime

    • Patients receiving the lethal dose of secobarbital or pentobarbital may be instructed to take an antiemetic (e.g., metoclopramide) about one hour before ingesting the barbiturate to prevent nausea and vomiting

  • Medications requests will receive a onetime approval


Last review date: July 25, 2016

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