Drug Utilization Review (DUR) Board Meeting Summary - March 22, 2007

Board Meeting of March 22, 2007:

Items for discussion included the new edit scheduled for implementation for the newly issued serialized prescriptions and a presentation on "eClinical Works". Recommendations from the DOH Pharmacy and Therapeutics Committee (P&T) were noted with additions to include ophthalmic quinolones, otic quinolones, ophthalmic antihistamines, immunomodulators (injectable), and cholesterol absorption inhibitors (CAIs). ProDUR overrides were discussed, as well as the need for documentation as part of ongoing program integrity activities. The Board also reviewed the Centers for Medicare and Medicaid Service (CMS) Transformation Grant, materials related to intervention letter responses, physician responses by drug conflict, and institutional CHF medication prescribing.

New matters for Board consideration included review of cases of abuse or misuse of Medicaid services identified via the DUR Board and external review referrals to the Recipient Surveillance and Utilization Review Program for potential Recipient Restriction Program inclusion. Also considered was the integration of the P&T Committee and the DUR Board, and the rationale for transitioning the DUR program to DOH/OHIP.

DUR Board discussed the cooperative agreement between OMH and DOH to share ambulatory outpatient data on Medicaid recipients' drug histories. The focus in particular would be the prescribing of antipsychotic and antidepressant drugs and assigning a DOH contact person.

New RetroDUR Criteria:

New RetroDUR criteria were proposed by HID and carried unanimously by the Board for approval. The new criteria involved the medications paliperidone, posiglitazone, Ketek, HIV drug criteria, and erythropoieses-stimulating agents.

Meeting Summary Posted 5/19/09