Minutes
Drug Utilization Review Board Meeting
March 14, 2007		
Meeting Purpose: Quarterly Open Board Meeting 6:00 P.M.-8:00 P.M.

Agenda
1.	Welcome and review of minutes, election results
2.	Fenofibrate Mailing Outcomes
3.	Statins Update
4.	Advair Update
5.	MassHealth Drug List Update
6.	Smart Prior Authorization (PA) presentation
7.	DUR Operational Update
8.	MassHealth Update
	
Agenda Item	Discussion	Conclusions/Follow Up	
Review of Minutes	The minutes to the December 2006 DUR Board meeting were reviewed and accepted as written with no changes noted. It was pointed out that the minutes will be posted to the MassHealth Pharmacy website. 

Brian O’Neil was introduced as chair elect.
Dr. Lynda Young will ascend to chair when Pat Reilly’s term expires in April, 2007.
	Follow Ups
Minutes to the quarterly open DUR Board Meeting will be posted on the MassHealth Pharmacy website. 
	
       Action		Minutes accepted as written	

Agenda Item	Discussion	Conclusions/Follow Up	
Fenofibrate Mailing Update	The Fenofibrate mailing activity was reviewed. This initiative was done to measure the effectiveness of a letter writing campaign to change prescribing habits to the therapeutic equivalent fenofbirate products vs. the branded Tricor. If this intervention was successful, the PA process would be avoided.

One suggestion concerning why the mailing failed might be because it did not list the prescriber’s patients on individual sheets to be placed in charts. 
	Conclusions
Based upon utilization numbers, the use of Tricor and the cost associated with the product appears to have gone up.
Follow Ups
Based on the failure of this intervention, Tricor will be placed on PA. Future mailings may include individual patient intervention sheets mailed to a prescriber.	
Action		Tricor will be place on PA with the June MassHealth Drug list up-date.	

Agenda Item	Discussion	Conclusions/Follow Up	
Statins Update	As part of the normal Quality Assurance (QA) process, DUR presented an update on the statin initiative that started on January 2, 2007. This initiative placed the previous reference drugs, Lipitor and Crestor on PA and removed PA status from generic products simvastatin and pravastatin.
	Follow Ups
Market share appears to be changing to the generic products. All approvals and denials for the non reference products appear to be acceptable.	
Action	 	Continue to monitor and perform a 6 month QA.	

Agenda Item	Discussion	Conclusions/Follow Up	
Advair Update	Advair was placed on prior authorization on January 2, 2007. As part of the normal QA process, an initial review of the intervention was preformed. 

A concern was voiced that DUR track the patients who were denied Advair and find out what they ultimately used i.e steroids, leukotrienes.	Conclusions
All approvals and denials appear to be appropriate. Also, the point of sale claims processing rule appears to be relieving some of the burden of PA on prescribers.
 	
Action		DUR will continue to monitor and perform a six month QA. Attempts will be made to track members who were denied Advair to find out what therapeutic alternative they ended up with.  That review will be presented with the 6 month QA review.	

Agenda Item	Discussion	Conclusions/Follow Up	
MHDL Up-date	The MHDL (MassHealth Drug List) update for March 15, 2007 was reviewed
		
Action		Drugs that have been reviewed were updated for PA vs. non-PA status and added to the list.	

Agenda Item	Discussion	Conclusions/Follow Up	
Smart PA®	ACS State Healthcare provides the electronic claims processing for MassHealth. ACS has purchased another company (Heritage), that has “smart” decision making software capabilities. This program known as Smart PA®, takes guidelines developed by MassHealth and converts them into algorithms or rules that can be used at the point of sale and also by the pharmacist consultants at DUR. A demonstration using the Advair guidelines was presented. It was noted that the program only used diagnosis information available in the MMIS computer system and diagnosis can not be added by the pharmacist processing the prescription in the store. This does not prevent or negate the role of the DUR pharmacist reviewing the PA to make a decision outside the algorithm as needed for medical necessity. All prior authorizations received by DUR are reviewed and acted upon even if it is noted that the member did not need a PA because of the point of sale rule.
	Conclusions
This technology has been put in place to help relieve the burden of PA but still keep some controls on the selected drugs managed through the process.
	
Action		Approximately 25 rules using Smart PA® have been put in place and we will continue to add more.	

Agenda Item	Discussion	Conclusions/Follow Up	
DUR Metrics Update	A review of the current phone and PA metrics in the DUR program were presented. 
	Conclusions
Metrics appear well within acceptable values.
	
Action		Continue to follow metrics for trends and changes.	

Agenda Item	Discussion	Conclusions/Follow Up	
MassHealth 
Update	With the advent of the new administration and a new state budget, Pharmacy will be expected to contribute to the savings initiatives proposed to balance the state budget. Several pharmacy cost saving programs being discussed are a specialty pharmacy program and the increased use of supplemental rebate. MassHealth is still waiting for final AMP data from CMS to help determine what the impact of the Deficit Reduction Act (DRA) on retail pharmacies.
	MassHealth Pharmacy and DUR will team up to review cost saving proposals. The impact on retail pharmacies by the AMP should be known soon.	

Respectfully Submitted,

Amy Levy, RPh, MHP
DUR Program Director