Drug Utilization Review Board
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- Muriel Heath
- 6 years ago
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1 DUR Members present DUR members absent MDCH/MMA/MPA present Steven Bernstein, M.D., Chair Carrie Germain, R. Ph, Vice Chair Bob DeYoung, PharmD James Forshee, M.D. Debera Eggleston, M.D. Sahar Swiden, PharmD Denise Dribben, M. D. Rajita Dnyate Helen Walley Donna Johnson, PharmD Giovannino Perri, M.D. Catherine Reid, M.D. Guests : Ryan Segroves Kevin Gallagh Christine Soltezli Jeff Paba Molly Wehrenberg David Stephens Paul Ford Gregg McDonald Kris Wenslovas Dave Skibicki Joseph Marchant David Larga Michelle Mischley Brenda FAbisch Jennifer McGovern Paige Nardf Catherine Reiland Shelly O Connor Dr. Bernstein called the meeting to order at 3:07 p.m. The minutes were reviewed and approved as written. The agenda was presented as follows: Topic: Department Business Issues 1. DUR Business : DUR Board composition was discussed. Members are to contact the Department with recommendations. Dr. Catherine Reid was introduced as the new Department physician in the Office of Medical Affairs. She will eventually assume responsibility of the DUR Board. 1
2 The United States Government Accountability Office (GAO) issued a report titled, FOSTER CHILDREN: HHS Guidance Could Help States Improve Oversight of Psychotropic Prescriptions, on December 1, 2011 ( Michigan was one of the states included in this report which looked at three quality indicators: 1. Children under age one on an antipsychotic medication 2. Polypharmacy, and 3. Use of mediations at doses other than the FDA approved maximum dose. The report recommends that a practice and prescribing guideline be adopted or endorsed by the federal government in oversight of the care of foster care children. The Board encouraged editing at point of sale to prevent payment for mediations which fall outside best practices. The Department reminded the Board of the contraints that Michigan the Public Acts 248 and 250 of 2004 pose in managing this drug class. After the report was published the Department ran more current data to identify patients on antipsychotics under the age of one. There was one case. In follow up with the pharmacy that billed this prescription, it was discovered to be a billing error. The script was written for the mother of the beneficiary and needed to be billed under the mother s ID #. Action: Dr. Bernstein asked that Magellan Medicaid Administration (MMA) supply a comparison of other clients handling of the behavioral health drug classes, especially the atypical antipsychotics. The Board asked this information be disseminated prior to the next meeting. The meetings for next year were confirmed for the second Tuesday of the month in which we meet. The dates will be March 13, June 12, September 11 and December 11, Meeting dates will be posted to the website ( ). 2
3 1. Eligibility Numbers: Eligibility numbers were presented and reviewed. The numbers remain stable at this time. There was discussion regarding the Patient Protection and Affordable Care Act (PPACA) will have on the numbers with Medicaid expansion taking effect January 1, P & T Update: The drug classes of Analgesics and Central Nervous System will be discussed at the evening meeting with little changes along with the introduction of the new members and chair of the P & T committee. Ad Hoc Reports for the P & T committee were then discussed. a. Persistence of secretin mimetic utilization- The data was presented and discussed. There appeared to be limited persistence; however, continuous eligibility needs to be confirmed in this analysis. b. Secretin mimetic and other DM medication utilization- The data was reviewed. Dr. Bernstein indicated the VA requires Secretin mimetics to be add on therapy following initiation of other agents first. c. Adult Growth hormone utilization - The utilization data and FDA indications for each growth hormone (GH) were reviewed. The pediatric endocrinologists in the state meet routinely to discuss care of patients. They have issued a position paper regarding transitioning of patients into adulthood on GH. This document, which was prepared for Children s Special Health Care Services, was provided to the Board. In review of the 11 adult individuals using GH and their diagnoses, it appears the prescribing of GH in the adult population is appropriate based in paid claims. d. Biosimilarity of Growth Hormones-The Board supported the Department s interest in developing preferred agents in this drug class. Action: The Department will further analyze persistence for the secretin memetics. 3. Follow up for DUR Board a. Concurrent Use of 2 or more atypical antispychotics: Upon review of the data, the Board recommended a retro DUR letter be developed for mailing to 3
4 prescribers on this topic. The Pharmacists that review the patient detail reports should look for continuous enrollment of the beneficiary and at least two fills of the two different antipychotics before a letter is sent. The Board asked that when the pharmacists review profiles and decide against a letter being sent that an explanation be provided as well indicate why a letter was sent. The Board was interested in the number of cases when the same prescriber wrote two different antipsychotics as opposed to when there were 2 different prescribers. b. Concurrent Use of 2 or more SSRIs: Review of the data led the Board to recommend this as a possible future retro DUR letter. Many of the pharmacist review issues noted for the concurrent use of atypical antipsychotics apply to this topic as well. Dr. Forshee mentioned age edits would be helpful in prescribing of behavioral health medications to beneficiaries. Action: The Department will indicate the reason letters are sent or not sent in future retro DUR analysis. 4. Brand /Generic metrics: Presented and Reviewed. No new discussion. 5. Retro DUR Reports : Topics presented are as follows: a. Triptans without controllers b. Underutilization of beta-blockers in post-mi patients- Volume is quite low and probably does not warrant repeating. c. Low-dose Seroquel. Topic selections for future retro DUR letters include: ADHD medication initiation with appropriate follow up as set forth in HEDIS Polypharmacy of five or more mental health drugs broken out by age (<1, 1-5, 6-12, 13). The Board is interested in knowing why a beneficiary under one year of age, if one is found, would hit on this indicator before the next Board meeting 6. Academic Detailing: The current academic detailing project is educating prescribers of Suboxone about the Michigan Automated Prescribing System (MAPS). It appears approximately 200 prescribers are not registered with MAPS. This is the group with which the 4
5 detailers will start. Webinar training by Mike Wissel from LARA has been completed for the pharmacist detailers. A feedback form will be provided for the prescribers at each visit. Board members emphasized the need to determine if the deficit is related to knowledge, attitude, or behavior. 7. Public comment: There was discussion of the appropriateness of secretin mimetic prescribing and guidelines. The meeting was adjourned at 4:50 pm by Dr. Bernstein. 5
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