Minutes
Drug Utilization Review Board Meeting
DATE:  3/14/12		

Meeting Purpose: Quarterly Open Board Meeting 
Meeting opened at 6:00 PM by Chair, Sarah McGee

Agenda Items:

I.	Welcome and Introductory Remarks
II. 	Benzodiazepine QA			
III.	Aloxi (palonosetron) QA
IV.	Anti-TNF Agent Therapeutic Class Review 
V. 	MassHealth Drug List Update 
VI.	DUR Operational Update
V.	MassHealth Update	Dr. Paul Jeffrey

Agenda Item	
                                              Discussion	
Conclusions/Follow Up	

Review of Minutes	
The December, 2011 Minutes were reviewed and accepted as written 	
Follow Up:
N/A	

Action
	
December Minutes approved as noted.	
Conclusion:
N/A 	

Agenda Item	
                                              Discussion	
Conclusions/Follow Up	

Benzodiazepine QA 
	
The benzodiazepine class was discussed including place in therapy, current PA requirements and utilization trends. 	
Follow Up: 
Informational	

Action
	Medications that require PA (prior authorization) include the following:
•	Alprazolam XR
•	Brand Name agents
•	Diazepam rectal gel if quantities exceed 10 syringes per month
•	Orally disintegrating tablets
•	Powders

Proposed changes include clarification of alprazolam XR criteria and considering PA approval for ODT (orally disintegrating tablet) formulations for doses unavailable in conventional dosage forms.

Benzodiazepines will no longer be excluded on Med D plans as of 2013. 	
Conclusion: 
Proceed with proposed changes as stated. 	

Agenda Item	
                                              Discussion	
Conclusions/Follow Up	

Aloxi (palonosetron) QA	
Aloxi (palonosetron) was discussed including place in therapy, current PA requirements and utilization trends 
	
Follow Up:  
Informational 	

Action

	Current consensus guidelines recommend the use of Aloxi® (palonosetron) as a preferred first line agent in moderate & highly emetogenic chemotherapy.

•	Utilization trends depict appropriate utilization with a combination of pharmacy and medical benefit claims. 

Proposed changes include:
•	Removal of the prior authorization requirement 
•	Add quantity limit of 1 unit/14 days
•	Create a designated PA form to assist in the review and prescribing of the antiemetics	
Conclusion:  
Proceed with proposed changes as stated.

Agenda Item	
                                              Discussion	
Conclusions/Follow Up	

Anti-TNF Agent Therapeutic Class Review	
The Anti-TNF Agent class was discussed including place in therapy, current PA requirements and utilization trends with the possible intent of selecting a preferred agent. 	
Follow Up: 
Informational	

Action

Discussed the following regarding the Anti-TNF Agent class:
•	Lack of randomized head-to-head trials 
•	Clinical guidelines lack of preference for one agent over another
•	Similar adverse event profiles
•	Comparable costs
•	Challenges with producing biosimilars

Proposed the following:
•	Consider selection of a preferred agent
•	Explore potential for supplemental rebate
•	Consider the use of a specialty pharmacy	
Conclusion:
MassHealth will consider proposal and determine the next steps to possibly select a preferred agent. 	

Agenda Item	
                                              Discussion	
Conclusions/Follow Up	

MassHealth Drug List Update	
Overview of the drug list additions effective March 12, 2012 and the drug list changes effective March 26, 2012	
Follow Up:
N/A	

Action

There are 9 new additions effective March 12, 2012. Changes in Prior Authorization status effective March 26, 2012, 2012 were also reviewed.

Other updates included:
•	2 new PA forms and Therapeutic tables for the following medication classes: Hereditary Angioedema Agents, Topical Anesthetics	
Conclusion:  
Changes in the MassHealth Drug List  will continue to be provided as needed

Agenda Item	
                                              Discussion	
Conclusions/Follow Up	

DUR Operational Update	
Quarterly Operations Update 	
Follow Up:  
Informational 	

Action

	
DUR Operations monthly workload includes the following:
•	Average of 6,500 PA requests 
•	Average of 8,000 calls 
o	Average abandonment rate of 1.5 % 
o	Average treatment time of 4 minutes 
•	Average of 10 appeals
•	Average of 500 Provider outreach calls 
•	Top 10 medications include: Suboxone, Lidoderm, Cymbalta, Advair, lansoprazole, Strattera, Singulair, Lyrica, Seroquel, and Nexium 
•	Upon examination of PA approvals, discovered that on average   
      20-25% of PA approvals are not subsequently utilized. 	
Conclusion: 
Quarterly operational updates will continue to be provided as needed. 

Agenda Item	
                                              Discussion	
Conclusions/Follow Up	

MassHealth Update	
Quarterly MassHealth Update 	
Follow Up  
Informational	

Action	
Provided MassHealth Overview (FY12) which includes the following estimates:
•	1.35M Members (4.6%> FY11) – Projected 1.4M in FY13
•	MassHealth Budget - $10.1B, Pharmacy Budget - $539M  
•	4% growth in FFS pharmacy spend 
•	Healthcare reform and CMS rules will result in changes to drug pricing and rebating 
•	Care Coordination and Integration is a prominent goal for the program. 
	
Conclusion: 
Quarterly updates will continue to be provided as needed. 

Respectfully submitted by: Vincent Palumbo, Director of DUR

Date: _________________