Minutes
Drug Utilization Review Board Meeting
DATE:  12/8/10



Meeting Purpose: Quarterly Open Board Meeting 
Meeting opened at 6:08 P.M. by Chair, Patrick 
Reilly.

Agenda Items:

I.	Welcome and Introductory Remarks

II.	Pharmaceutical Pipeline Preview

III.	MassHealth Drug List Update

IV.	DUR Operational Update

V.	MassHealth Update	Dr. Paul Jeffrey
	


Agenda Item

 Review of Minutes
                                             
Discussion



The September, 2010 Minutes were reviewed and 
accepted as written at the November DUR Board 
meeting.

Conclusions/Follow Up

Follow Up 


Action



Conclusion:
September Minutes approved as noted.



Agenda Item

Pharmaceutical Pipeline Preview

Discussion

A continuing education program, Drugs in the 
Pharmaceutical Pipeline, was presented. Recent 
FDA approval trends, emerging agents with 
currently available therapeutic options were 
compared and contrasted and a summary of 
expected generic availability of commonly used 
agents over the next three years was presented.

Conclusions/Follow Up

Follow Up


Action

The presentation was interactive, and a 
discussion around new oral anticoagulants and 
warfarin took place. Compliance and dosing issues, 
bleeding complications, stroke and cost were all 
discussed. It was noted that if medication changes 
would prevent only one intracranial hemorrhage 
the cost of savings would be significant.

The newer oral anticoagulants will continue to be 
closely monitored by MassHealth.


Conclusion: 
The year 2010 brought some interesting “firsts.” 

“Firsts” include a new treatment for lupus in 50 
years, oral anticoagulants, a weight loss product, 
hepatitis C protease inhibitor, and an oral 
multiple sclerosis disease modifier.

Continue monitoring the market for developments in 
anticoagulation, multiple sclerosis and hepatitis C. 
The year 2011 may bring some key approvals of new 
drugs and significant additions to the generic 
pipeline will occur. 



Agenda Item

MassHealth Drug List Update
                                              
Discussion

There are 16 new additions to the drug list 
effective February 7, 2011.   Changes in Prior 
Authorization (PA) for several drugs were noted.  
Three drugs Aceon, ephedrine injection and 
Sandimmune will no longer require PA. Drugs 
restricted to hospital use effective 2/7/11 
include Refludan and Acova. Both had previously 
required a PA. 

Effective 2/21/11, Angiomax will be restricted to 
hospital use only.  Blephamide, Poly-Pred, Pred-G, 
Tobradex and Zylet will all require a PA effective 
2/21/11.  

Proton Pump Inhibitor Quantity Limits (QL) of 
30 units/30 days will apply to ALL PPIs except 
generic omeprazole 20 mg - PA > 120 units/month.  
Points of sale (POS) rules are being developed to 
allow member’s with specific conditions to bypass 
the restrictions.

Conclusions/Follow Up

Follow Up


Action
Reminder: Actos and Avandia require PA effective 
January 1, 2011.

A new MassHealth Drug List is on the way. The URL 
will be the same, with a similar look and feel. 
New features will include a search function, drug 
class links, and fill-able PA request forms.


Conclusions/Follow Up
Conclusion
Informational




Agenda Item

DUR Operational Update
                                              

Discussion

The DUR call center averages 7,000 calls per month 
with an abandonment rate of approximately 1. % 
Average treatment time is up slightly, due to new 
staff and longer guidelines. The number of appeals 
varies per month with April having the highest. 
Provider outreach numbers peaked in June 2010 and 
show considerable growth (over 300) when comparing 
September 2009 to September 2010.

Informational

Action

 Conclusions/Follow Up
Informational


Conclusion: 

 Informational


Agenda Item

 MassHealth Update
                                             
Discussion


Budget issues continue and the effect on the 
Pharmacy Program is not known at this time. There 
has been relatively flat spending over the past 
nine years due an increasing generic dispensing 
rate which has allowed MassHealth to absorb 
growth in membership without increasing pharmacy 
program costs. It is not known how the fiscal 
2012 deficit will be resolved. It was noted 
that some states (e.g. Mississippi) limit the 
number of brand name or total number of 
medications that any one member may receive.

On a positive note, pharmacists have been 
recognized as mid-level practitioners to provide 
services such as administering vaccines. Last 
year 1,800 vaccinations were administered in one 
month. This year there have been 4,000 vaccine 
administrations in one month.  MassHealth is now 
able to reimburse pharmacists for services beyond 
those related to dispensing.

The preferred diabetes test strip initiative is 
fully operational with 99.5% conversion.      

Work continues on Smart PA and the next generation 
of POPS.

Informational


Meeting adjourned at 7:40 PM.

Respectfully Submitted,

Vincent Palumbo, R.Ph.
DUR Program Director 

Date: February 15, 2011