Pharmacy and Therapeutics Committee November 14, 2018 Community Health Plan of Washington 11:00am 12:30pm

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1 Pharmacy and Therapeutics Committee November 14, 2018 Community Health Plan of Washington 11:00am 12:30pm Attendees Voting: Diane Schwilke, Pharm D, Columbia Valley CHC Jamie Bowers, Pharm D, Moses Lake Community Health Center Alan Chun, MD, International Community Health Services Putter Scott, MD, NeighborCare Health Carri Jo Timmer, DO, Community Health Care Tony Stupski, DO, MS, Clinic Director, Sea Mar Jessica Bergstrom, Pharm D, NeighborCare Health Sridhar Balasubramanyan, RPh, PhD Yakima Valley Farm Workers Patricia Lambro, PharmD Peninsula Community Health Services Partha Gonaavaram, MD, Comm. Health Care Don Dann, PharmD, Moses Lake Community Health Center Deborah Wiser, MD, Community Health Association of Spokane Mark Spencer, MD, Yakima Valley Farm Workers Clinic Rachel Koh, RPh, International Community Health Services Attendees Non-Voting: Keith Brown, MD, CMO, CHPW LuAnn Chen MD, Medical Director, CHPW Terry Lee MD, Director of Behavioral Health, CHPW Yusuf Rashid, RPh, Director of Pharmacy, CHPW Fran McGaugh, Pharm D, Pharmacy Director, CHPW Catherine Vu, Pharm D, Clinical Pharmacist, CHPW Jennifer Farley, Pharm D, UM Pharmacist, CHPW Pasha Pechenov, CI Program Manager, CHPW Shama Patel, Pharm D, ESI Account Representative Alison Ryan, MD, Community Health Care Swati Gosavi, RPh, ESI Account Representative Richard Leigh, RPh, Tri-Cities Community Health Center Gea Caballero, RPh, Sea Mar Community Health Center Lisa Nelson, PharmD, Unity Care Northwest Chair: LuAnn Chen MD, Community Health Plan of Washington Number of Voting Members Present: _8_ Number of Voting Members absent: _10_ No cited Conflicts of Interest per Committee members for included medications in this meeting

2 Agenda: Introduction Approve last meeting s minutes Medicaid Single Preferred Drug List CPG, Newsletters, HCA DUR materials MAT/ Pharmacist training opportunity Medicare 2019 Opioid limits MAVEN project for CHCs FWA & Member/Provider Concerns Recalls Prior Authorization & Appeals DUR Trends Medicaid Opioid Policy Updates from HCA P4P Quality measures 90 Day Fill Option Utilization PRC annual review Roles & Responsibilities CHPW Attendees LuAnn Chen, MD, Medical Director Saleem Memon, MD, Associate Medical Director Yusuf Rashid, RPh, VP of Pharmacy and Vendor Relationship Management Fran McGaugh, PharmD, Pharmacy Director Catherine Vu, PharmD, Clinical Pharmacist Roles & Responsibilities Pharmacy Benefit Manager, Express Scripts Inc., Attendees Shama Patel, PharmD, MBA, Senior Clinical Account Executive Swati Gosavi, RPh, MHA, Senior Clinical Benefit Manager

3 Pharmacy and Therapeutics Committee Renders evidence-based clinical decisions regarding formulary and reviews utilization controls for medications on CHPW s Drug Formulary. Meets 3 times a year Minimum of four voting members Board certification reflective of CHPW s population Currently contracted provider with CHPW Discipline record with CHPW in good standing Appointments effective for 3 years May relinquish position at any time Considered for removal if unable to attend a minimum of 2/3 P&T meetings per year Voting attendees include Medical providers and Clinical Pharmacists from CHCs CHPW Drug Utilization Review Board Extension of CHPW P&T Committee in advising on additional utilization controls of drugs within CHPW s formulary Approval of July 13, 2018 P&T/DUR Minutes (Jamie 1 st, LuAnn 2 nd ) Single Preferred Drug List (PDL) On June 30, 2017 Senate Bill (SB) 5883 passed, stipulating the Washington State budget. SB 5883 directs the Health Care Authority (HCA) to develop and implement a single preferred drug list (PDL) to be used by Managed Care Organizations (MCOs) and WA Fee-For-Service (FFS) utilize on or before January 1, The goal is to ensure access to clinically effective and appropriate drug therapies while maximizing federal and supplemental rebates. The single PDL will ensure continuity of formulary and criteria for coverage across all MCOs and FFS. It will provide patients, prescribers, and pharmacists access to consistent and accurate information regarding medications.

4 Creation of PDL The HCA is creating the PDL in partnership with all of the MCOs that serve Apple Health clients and other stakeholders. The HCA holds monthly Pharmacy and Therapeutics (P&T) Committee/Drug Utilization Review (DUR) Board meetings to vote on PDL changes. The meeting materials can be found here: Managed care plans will continue to use their own preferred drug lists for drugs that are not included in the Apple Health PDL. CHPW searchable formulary tool will merge the PDL with our own drug list. PDL Implementation Phase 1: The Health Care Authority (HCA) implemented the Apple Health Preferred Drug List (PDL) on January 1, All managed care plans and the fee-for-service program serving Apple Health clients will use this PDL. Phase 2: The second batch of drug classes (~40) went live 7/1/2018 Phase 3: 56 drug classes went live on 10/1/2018 Phase 4: 74 drug classes will go live on 1/1/2019 By the end of 2019, the MCOs and HCA will have an automated process to accommodate formulary changes. The current Prior Authorization process will remain the same. Medical benefit drugs will be included in the PDL. The 340B program will operate as normal. How to use the Apple Health Preferred Drug List (PDL) The Apple Health PDL has products listed in groups by drug class. Unless otherwise indicated, the authorization criteria is that the client must have tried and failed, or is intolerant to, at least two or more preferred drugs within the drug class unless contraindicated, not clinically appropriate or only one drug is preferred. Note: For continuity of care, all plans will use the same PA criteria, step therapy edits, and quantity limits developed by the HCA.

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7 SPDL Class Additions ANORECTAL AGENTS ANTIDEPRESSANTS ANTIFUNGALS ANTIPARASITICS ANTIPSYCHOTICS/ANTIMANIC AGENTS ANTIVIRALS ASTHMA AND COPD AGENTS CONTRACEPTIVES CORTICOSTEROIDS DERMATOLOGICS VAGINAL PROGESTERONES GASTROINTESTINAL AGENTS GENITOURINARY AGENTS GOUT AGENTS HEMATOLOGICAL AGENTS HEMATOPOIETIC AGENTS HEMOSTATICS HYPNOTICS MUSCULOSKELETAL AGENTS NEUROMUSCULAR AGENTS OPHTHALMIC AGENTS MOVEMENT DISORDER AGENTS SMOKING DETERRENTS CYSTIC FIBROSIS AGENTS SUBSTANCE USE DISORDER

8 Additional PDL Resources Apple Health Preferred Drug List (PDL) can be found here: Provider and Pharmacy newsletters can be found here: HCA P&T DUR meeting materials can be found here: HCA FAQ can be found here: Newsletters November Newsletter 1/1/19 Medicaid negative formulary changes Educational Webinar opportunity: Pharmacist Roles in Expanding Access to Medication Assisted Treatment for Opioid Use Disorder 2019 Medicare Part D Opioid Edits: Initial opioid fills limited to 7-Day supply. >90 MME/day requires Rph to consult with the prescriber for care coordination.

9 MAVEN Project We are a nonprofit organization committed to increasing access to quality health care for underserved populations by engaging physician volunteers in over 30 specialties, including primary care and pediatric sub-specialties, to offer clinical advice, education, and mentoring to providers like you. Through our partnership with your community health center, you are granted access to MAVEN Project educational sessions. You can register now for our upcoming sessions! For more information, please see below, and check out the attached flyer. Please don t hesitate to reach out to us at scheduling@mavenproject.org with questions <image031.jpg>overactive Bladder Evaluation and Treatment Dr. Brian Dorman, Urology Wednesday, October 10, 9:00am PT/12:00pm ET Overactive bladder (OAB) is very common in both men and women, particularly as we age. Diagnosis and treatment including non-drug treatment will be discussed. Register here! Fraud Waste Abuse & Other Concerns Examples: Suspected prescription forging, quality of care given/received, services overutilization Reporting referrals: CHPW Customer Service at (206) All reports will be routed to the appropriate department; investigated and tracked by the Compliance department as needed

10 Recalls CHPW does not have lot number information on dispensed medications Maintains recall reports on those sent to any member receiving the medication FDA website: Prior Authorization and Appeals Q Prior Authorizations Requests Q3 Number of Denials by Drug 173 (13%) 155 (11.7%) 75 (5.6%) 60 (4.5%) 38 (2.9%) 37 (2.8%) PPI's Inhalers Opioids Lyrica Modafanil, Armodafinil Lidocaine

11 Quarterly Trends 600 Prior Authorization Denials by Drug Class Denials PPIs Opioid Analgesics Q Q Q

12 Q Appeals Pharmacy Appeals 7% 5% 75% 5% 5% 3% PPIs Modafinil/Armodafinil Lyrica Opioid Analgesics Buprenorphine Other

13 Q3 Appeals and Resolutions by Drug Class PPIs Modafinil/Armoda finil Lyrica Opioid Analgesics Buprenorphine Appeals Overturned Upheld Withdrawn

14 DUR Trends 2018 Medicaid CDUR DUR Trends DUR Trends # of DURs Jan-18 Mar-18 May-18 Jul-18 Sep-18 Nov-18 Adverse Drug Risk Omission of Essential Care # of DURs Additive Toxicity Adverse Drug Adverse Drug Drug Age Drug Allergy Drug Gender Drug Pregnancy Drug Therapy Excessive Dosing Potential Drug Prescriber Refill Too Suboptimal Under Dosing Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Month Type of DUR Sep-18

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16 Medicaid RDUR # of DURs Jan-18 Mar-18 DUR Trends 2018 May-18 Jul-18 Month Sep-18 Nov-18 Adverse Drug Risk Omission of Essential Care # of DURs DUR Trends 2018 Additive Toxicity Adverse Drug Adverse Drug Drug Age Drug Allergy Drug Gender Drug Pregnancy Drug Therapy Excessive Dosing Potential Drug Prescriber Refill Too Suboptimal Under Dosing Type of DUR Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18

17 WA Healthcare Authority Opioid Policy Monitoring: Medicaid Opioid Policy Update More Information:

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19 P4P Quality Performance 2018 CHNW 2018 P4P Measures Q3 Performance

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21 Q3 AMM by CHC 70% 60% 50% 40% 30% 20% 10% 0% AMM Interim HEDIS Performance by CHC (n=50+) Acute Rate Cont Rate Acute 75th Target Cont 75th Target 90-Day Fill List Improved medication adherence through 90-day fills will result in better clinical outcomes and less ER visits The 90-day fill list focuses on oral medications that treat depression, type 2 diabetes, hypertension, hypercholesterolemia, hypertriglyceridemia and heart failure Supports CHC Pay for Performance All CHC pharmacies eligible along with select ESI 90-day network pharmacies Additional fax blast sent to pharmacies 10/18 Evaluation of trends Use? Expansion of list Asthma/COPD maintenance inhalers as of 1/1/19

22 90-Day Fill List Utilization 30 DAY FILL % 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 90 DAY LIST OF UTILIZATION OF ELIGIBLE MEMBER Q CHC

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25 Open Discussion Meeting Adjourned P&T Committee Next Meeting Next P&T Meeting Date TBD March 2019 Chair Signature: LuAnn Chen 11/27/2018 Date