Minutes
Drug Utilization Review Board Meeting
13 September 2006		
Meeting Purpose: Quarterly Open Board Meeting 6:00-8:00pm

Agenda
1.	Welcome and review of minutes
2.	Fuzeon QA 
3.	DUR Educational activites
4.	Controlled Substance Management program –update
5.	DUR Program update
6.	MHDL update
7.	Guest speaker, Elliot Sternthal, MD
8.	MassHealth update
	
Agenda Item	Discussion	Conclusions/Follow Up	
Review of Minutes

Announcements	The minutes to the June 12, 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 in the future. 

Dr. Lynda Young, Chair Elect, was selected as District #1 representative.
Paul Jeffrey recently received the UMMS “Employee of Distinction Award.”	Follow Ups
Minutes to the quarterly open DUR Board Meeting will be posted on the MassHealth Pharmacy website in the near future.
	
       Action		Minutes accepted as written	

Agenda Item	Discussion	Conclusions/Follow Up	
Fuzeon QA	Prior authorizations for Fuzeon that were received by the DUR program during the last year were reviewed. It was determined that the majority of denials were due to lack of information. When the PA was resubmitted with the missing information, all but one PA was approved. 
	Conclusions
Based on the small number of PAs yearly, and the high approval rating, it has been decided to remove PA requirements from Fuzeon at this time.
Follow Ups
DUR will trend Fuzeon claims over the next year to verify that that the number of patients receiving the drug does not escalate to unexpected numbers.	
Action		PA requirements for Fuzeon will be removed. This change will be posted on the 12/15 MHDL release.	

Agenda Item	Discussion	Conclusions/Follow Up	
DUR Educational Activities	The educational activities of the DUR program were presented to the Board Members. They consisted of:
1.	Ketek® (telithromycin ) educational letter;
2.	Fenofibrate; and
3.	Atypical antipsychotic preferred product mailing.
	Follow Ups
The Board members had some suggestions to the atypical antipsychotic mailing since it had not been distributed at the time.	
Action	1. The suggested changes to the atypical antipsychotic mailing were taken under advisement by MassHealth.

2. Further discussion prompted the review of quantity limits ( dose consolidation) on the atypical antipsychotic group as well as other medications that are often “flat priced.” 	1. Information regarding outcomes from the various mailings (prescribing trends, etc.) will be presented to the Board members in the future. Interventions will be preformed at various levels as indicated by trends.

2. DUR will work with MassHealth to determine where quantity limits (dose consolidation) may make sense, not just with atypical antipsychotic medications, but with other therapeutic classes as well. That information will be brought back to the Board at a future meeting 	

Agenda Item	Discussion	Conclusions/Follow Up	
CSMP update	A presentation was provided to the DUR Board regarding the Controlled Substance Management program. Also, with the help of MaryAnn Mark and Jessica Brewer from the PCC group that helps coordinate the CSMP program, utilization numbers were provided showing the effect that the program has had on the enrolled member’s cost/claim and ED visits. 
	Conclusions
Utilization numbers were not consistent across all cohorts studied but did appear to show a decrease in cost/claim and a very small decrease in ED visits.
 	
Action	Based upon findings of the CSMP work group 400 members were un-enrolled from the program in May. Approximately  135 members will be enrolled sometime in November.	•	The program will remain as is for now and utilization of services and RXs will be followed for enrolled members.	

Agenda Item	Discussion	Conclusions/Follow Up	
DUR Metrics 
Up-date	A review of the current phone and PA metrics in the DUR program was presented. 
	Conclusions
Medicare Part D has decreased operations by about 30%, as expected. Metrics appear well within acceptable values.
	
Action		•	Continue to follow metrics for trends and changes	

Agenda Item	Discussion	Conclusions/Follow Up	
MHDL Up-date	The MHDL (MassHealth Drug List) update for September 15th was released.
		
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	
Guest Speaker:
Elliot Sternthal, MD.	Elliot Sternthal, MD. asked for guest speaker time for this meeting regarding Byetta® restrictions.
His contention is that Byetta® has a particular niche in the treatment of diabetics and he feels that the MassHealth restrictions on Byetta® are potentially harmful to patients. He described how he uses Byetta® in his practice. 
	Follow Ups
DUR will review Dr. Sternthal’s Byetta® requests against current guidelines.	
Action	The Board members asked the DUR program attendees to review Dr. Sternthal’s requests and guidelines again for some of the points that Dr. Sternthal addressed in the meeting.	•	A focused review of Dr. Sternthal’s patients will be brought back to this group. Also, if necessary, Dr. Sternthal will be contacted by the DUR program to discuss issues brought about by the discussion	

Agenda Item	Discussion	Conclusions/Follow Up	
MassHealth 
Up-date	As a reminder, the minutes to this meeting will be published on the MassHealth Pharmacy web site. This posting will also contain the meeting agendas and schedules. A new e-mail address has been created ( DUR_Board@umassmed.edu ) for DUR inquiries. This new address will also be on the web site posting. 

The Deficit Reduction Act (DRA) will redefine the Federal Upper limit price (FULP) and generic ingredient cost as of November 1, 2007. The result of this appears to lower the reimbursement rate to the pharmacist for dispensing generic products. The Feds have recommended to compensate for  this decrease, states consider increasing the dispensing fee to Pharmacists. This would require legislative intervention to increase the current dispensing fee from $3.00.

The DRA  also mandates by 2008 that MassHealth begin collecting NDC data on physician administered drugs (office administered). Currently, information is only collected on the “J” code level. 
	Continue to review the DRA and the impact it will have on Pharmacy and Physician practice.