Connecticut Medical Assistance Pharmacy Program Drug Utilization Review (DUR) Program DUR Board Meeting

Transcription

1 September 2008 Minutes ATTENDEES Board Members Present: Kenneth Fisher, R.Ph. (Chair); Dennis Chapron, M.S.; Richard Gannon, Pharm.D.; Keith Lyke R.Ph., Mike Moore, R.Ph., MPH; Bhupesh Mangla, M.D., Ram Illindala, M.D.; Lori Jane Duntz, R.Ph., Charles Caley, Pharm. D., BCPP; Angela Moemeka, M.D., F.A.A.P. Ex-Officio Non-Voting Member Present: Heather L. Kissinger, Pharm. D. (HID DUR Board Coordinator and Secretary) Guests: Jason Gott, Pharm. D. (DSS); Robert Zavoski, M.D. (DSS); Ellen Arce, R.Ph., Carol McNeil (Eli-Lilly); Paul Fanikos (Boehringer Ingelheim) INTRODUCTORY BUSINESS The DUR Board Chairman, Kenneth Fisher called the meeting to order at 6:40 p.m. OLD BUSINESS The June 2008 DUR Board meeting minutes were approved by all members as submitted Heather Kissinger directed the board members to section 3 of the September 2008 DUR Board meeting packet, titled Tabled Criteria from the June 2008 DUR Board meeting. Heather Kissinger explained that if venlafaxine is added to criteria 12 as suggested by the board at the June 2008 meeting both criteria 11 and 12 will hit when a patient takes desvenlafaxine and venlafaxine. Heather Kissinger stated the two criteria were separated because the Prescribing Information said that the concurrent use of venlafaxine and desvenlafaxine is not recommended and it said to use the combination of desvenlafaxine and SSRIs, SNRIs and triptans with caution. If venlafaxine is added to criteria 12 it will suggest that you can use desvenlafaxine with venlafaxine if clinically warranted (desvenlafaxine is the major active metabolite of venlafaxine) when the

2 September 2008 Minutes prescribing information states it is not recommended. This is why the criteria were separated initially. Heather Kissinger suggested the addition of serotonin syndrome symptoms to the criteria 11 alert message to make it more like alert 12: Pristiq (desvenlafaxine) should not be used concurrently with venlafaxine (Effexor/Effexor XR). Desvenlafaxine is the major active metabolite of venlafaxine and concomitant use with venlafaxine may result in elevated plasma concentrations of desvenlafaxine and risk of adverse effects including serotonin syndrome (e.g. agitation, hallucinations, tachycardia, hyperthermia, hyperreflexia, nausea, vomiting). The board approved criteria 11 as amended and approved criteria 12 as written. Heather Kissinger discussed the next two criteria tabled from the June 2008 meeting, 13 and 14. Information was lacking in the literature regarding drug-drug interactions with desvenlafaxine and medications that affect hemostasis. Most information found was an extrapolation of data from venlafaxine and it s interaction with medications that affect hemostasis. The board decided to table criteria 13 and 14 until further information is published regarding desvenlafaxine specifically. RETROSPECTIVE DRUG UTILIZATION REVIEW A. Retrospective DUR Program Summary Review for 2 nd Quarter 2008 The Board reviewed the program summary review for 2 nd quarter Rich Gannon questioned why brand proton pump inhibitors made the top 25 medications. Ellen Arce stated that many products on the PDL for which the State receives supplemental rebates, are branded products. The supplemental rebates make the brand more cost effective than the generics. Heather Kissinger reviewed the trend summary analysis that was performed for the 2 nd quarter 2008.

3 September 2008 Minutes Charlie Caley commented that for all classes analyzed in the trend summary a large increase in utilization was seen between January 2008 and February Heather Kissinger commented the increase was due to the FFS population increase from the MCO carve out. It was stated that HID can perform trend summary analyses for any class of medications, or individual medications to show change in utilization patterns specific to previous clinical mailings. Heather Kissinger suggested she perform trend summary analyses on; NSAIDS, skeletal muscle relaxants, metformin, and the atypical antipsychotics for the December 2008 DUR Board meeting to illustrate the areas that might change due to the previous quarters mailings. The Board agreed to these trend summary analyses for the next meeting. Heather Kissinger directed the Board to review the top 50 drug by total price for the 2 nd quarter Angela Moemeka requested a query be run on the number of pediatric patients who are receiving lansoprazole. Heather Kissinger suggested for the next cycle a utilization review be performed on pediatric patients who are receiving lansoprazole. It was also stated the asthma query Angela Moemeka requested Heather Kissinger to run (pediatric patients <12 who are receiving a short acting beta-2 agonist with no controller medication) resulted in 157 patients that could be added to the next cycle along lansoprazole patients. The Board agreed with this recommendation. Rich Gannon requested Heather Kissinger do a literature search on lidoderm patches to determine the indications of use. It was also requested of Heather to run a query on the FFS population to determine the number of patients prescribed lidoderm patches with a diagnosis of post herpetic neuropathy and the number of patients prescribed lidoderm patches lacking the diagnosis of post herpetic neuropathy. Rich Gannon mentioned it would be interesting to run a query on the amount of patients who are prescribed diclofenac patches in the FFS population. Heather Kissinger stated she would run a query regarding the utilization of diclofenac patches.

4 September 2008 Minutes B. Intervention Activity Report It was stated that the Intervention Activity Report is a monthly summary of the distribution of letters mailed to prescribers. The Intervention Activity report also summarizes the main criteria that were reviewed and an intervention was created. Heather Kissinger stated the large gap between letters generated and letters sent for April and May resulted from the transition period from DEA to NPI. In June the gap closes and the letters generated almost equals the letters sent, illustrating the completion of the NPI file and update against the provider file sent from EDS. C. RetroDUR New Criteria Selections Criteria 1, Fluoroquinolones / Black Box Warning was rejected at this time. The Board requested that Heather Kissinger create a query of patients who were prescribed a fluoroquinolone and subsequently received a prescription for metronidazole or oral vancomycin within 6 weeks of being prescribed the fluoroquinolone. This would illustrate the amount of patients who were being treated for clostridium difficile (C.diff). The Board requested Heather Kissinger create a newsletter regarding the use of Fluoroquinolones and the increased risk of developing C.diff and also add the new information regarding the black box warning of Fluoroquinolones causing tendon rupture for the March 2009 quarterly newsletter. The Board requested the next newsletter (December 2008) topic to cover atypical antipsychotics and the risk of associated metabolic syndrome. Criteria 2, Conventional Antipsychotics / Black Box Warning, was approved as written by the Board. Criteria 3, Erythropoiesis Stimulating Agents / Black Box Warning, was rejected by the Board. Criteria 4, a modification of existing criteria: Topiramate / Carbonic Anhydrase Inhibitors, was approved by the Board. D. Newsletter

5 September 2008 Minutes The Board approved the September 2008 DUR Newsletter following modifications: o The first time palivizumab is mentioned add next to it: Synagis by Medimmune o Change the acronym of Chronic Lung Disease to CLD o Create a sentence addressing the high cost of the medication o Create a sentence about the weight based dosing The Board agreed that once those changes were made to the newsletter, Heather Kissinger would begin the mailings. The topic of the December 2008 DUR newsletter was again agreed upon by the Board to cover atypical antipsychotics and the risk of associated metabolic syndrome. F. Atypical Antipsychotic Utilization in the Pediatric Population Heather Kissinger explained the criteria and methods used to identify duplicate therapy of atypical antipsychotics in the pediatric population. Heather Kissinger stated the results of the search, a total of 243 patients met the criteria of receiving duplicate therapy of atypical antipsychotics. Dennis Chapron requested Heather Kissinger to evaluate the patients receiving high dose quetiapine and aripiprazole. He requested a further evaluation of their profiles to determine if they are also receiving an enzyme inducing anticonvulsant. NEW BUSINESS The date for the next meeting was confirmed for December 11, The meeting was adjourned at 8:40 pm.