Transcript Idaho Medicaid Drug Utilization Review Program

18 July 2013
1
Follow-up to Previous Reviews
 Botulinumtoxin DUR
 Hydrocodone/APAP DUR
 Nystatin/triamcinolone Combo DUR
2
Botulinumtoxin DUR
 Only payable on the medical side (not self-
administered and not safe for patient to “brown bag”
to physician’s office).
 Prior authorization was instituted 7/1/2013.
 Before June 2013:
 Prior authorization requests received were returned to
prescriber with a note that prior authorization was not
required at this time but would be required starting
7/1/13.
3
Botulinumtoxin DUR
 Starting June 1, 2013:
 Prior authorization requests were processed.
 Approvals were dated 7/1/13 with a note that prior to July,
prior authorization was not required.
 Denials were sent back with an explanation of why
request was denied. Claims still paid through 6/30/13.
4
Botulinumtoxin DUR
 Chronic daily headaches/migraines
 New prior authorization form specifically for Botox for
chronic daily headaches/migraines was written and
posted on the website in June 2013.
 Letter was sent in June with a copy of this prior
authorization form to the Boise physician that was
prescribing and administering the majority of Botox for
this indication.
5
Botulinumtoxin DUR
 Botox for indications other than chronic daily
headaches/migraines
 Another prior authorization form was created for all
other indications.
6
Botulinumtoxin DUR
 Therapeutic criteria for chronic daily
headaches/migraines
At least 15 days per month
2. At least four hours per day (on average)
3. Prophylactic medication tried and failed
4. Abortive medications (e.g. triptans) filled monthly for
at least 3 months
1.
7
Botulinumtoxin DUR
 Documentation provided by prescribers has dramatically
improved after feedback from Idaho Medicaid on what
information is needed.
 Prescriber is now sending us a “Chronic Daily Headache”
two page data collection sheet that the patient fills out.
 Majority of requests received for this indication have been
approved.
 For new patients, two injections (12 weeks apart) are
approved. This duration was chosen as in the licensing
trial, reduction in headache frequency was seen by this
length of time.
8
Botulinumtoxin DUR
 For patients who have already received one dose prior
to 7/1/13, a second dose will be approved if the patient
meets the therapeutic criteria.
 For patients with a positive response who have already
received two or more doses, therapy will be approved
for six months.
9
Hydrocodone/APAP DUR
 What are the utilization numbers on the various
hydrocodone/APAP products?
10
Hydrocodone/APAP DUR
GCN Seq Brand Name
Number
(GSN)
Strength Desc
60338
5MG-300MG
39
43
4.26
Q06
$1.41
7.5-300MG
20
22
2.85
Q06
$1.55
5MG-325MG
6,149
9,425
3.98
Q06
GAAC=$0.14
7.5-325MG
2,267
4,273
3.75
Q06
GAAC=$0.17
10MG-325MG
4,500
12,591
4.24
Q06
GAAC=$0.15
7
7
1.96
Q06
GAAC=$0.13
2,230
3,291
3.78
Q06
GAAC=$0.05
7.5-500MG
879
1,591
3.65
Q06
GAAC=$0.09
10MG-500MG
198
506
3.74
Q06
GAAC=$0.14
10MG-650MG
12
29
2.99
Q03
GAAC=$0.10
10-660MG
7
19
2.36
Q03
GAAC=$0.16
7.5-750MG
72
110
2.64
Q03
GAAC=$0.58
7.5-325/15
5
5
16.96
Q90
$0.25
7.5-500/15
1,367
1,647
32.80
Q60
GAAC=$0.18
60533
47430
47431
30623
4202
4204
4205
26439
16899
27684
4207
53582
53428
HYDROCODONEACETAMINOPHEN
HYDROCODONEACETAMINOPHEN
HYDROCODONEACETAMINOPHEN
HYDROCODONEACETAMINOPHEN
HYDROCODONEACETAMINOPHEN
HYDROCODONEACETAMINOPHEN
HYDROCODONEACETAMINOPHEN
HYDROCODONEACETAMINOPHEN
HYDROCODONEACETAMINOPHEN
HYDROCODONEACETAMINOPHEN
HYDROCODONEACETAMINOPHEN
HYDROCODONEACETAMINOPHEN
HYDROCODONEACETAMINOPHEN
HYDROCODONEACETAMINOPHEN
2.5-500 MG
5 MG-500MG
Unique
Total Avg Qty
Max Qty per Cost per tablet or ml
Recipients Claims per Days Day in System
(WAC)
Supply
Idaho Medicaid paid pharmacy claims between 1/1/2013 and 4/30/2013
11
Nystatin/Triamcinolone Combo DUR
 What are the utilization numbers on the various
nystatin/triamcinolone combo products?
12
Nystatin/Triamcinolone Combo DUR
Paid Pharmacy Claims 1/1/2013 through 4/30/2013
200
180
160
140
120
100
80
60
40
20
0
175
161
Recipients
Claims
39
Cream
44
Ointment
13
Nystatin/Triamcinolone Combo DUR
Paid Pharmacy Claims 1/1/2013 through 4/30/2013
100
90
80
70
60
50
40
30
20
10
0
90
80
60
66
34 34
Recipients
16
13 13
0 to 3
Claims
12
4 to 6
7 to 18
19 to 55
56 to 67
Age of Recipients
14
Current Interventions/Outcomes
Studies
 Hepatitis C DUR
 Demographics of the Idaho Medicaid Utilizer of Rx’s
Population
 CHIC – Children’s Healthcare Improvement Collaboration
 Geo‐Mapping Analysis
 Utilization of Narcotic Analgesics (HIC3 = H3A)
15
Current Interventions/Outcomes
Studies
 P&T Committee Narcotic Analgesic Studies
 Narcotic Analgesics in Chronic Non-Malignant Pain 2012
Update
 Participants Receiving More Than 1 Long Acting at a Time
 Suboxone and Participants Paying Cash for Other Opioids
16
Hepatitis C Agents
 Incivek and Victrelis
 Review past 6 months of data for usage





Are patients that started on therapy continuing therapy?
Will be requesting chart notes to determine why patients
discontinued therapy (e.g. intolerable side effects vs. nonresponders to therapy based on viral counts) vs. noncompliance.
Will look for trends in patients that discontinued therapy (e.g.
does rate vary between practices or geographically)
Are patients on TRIPLE therapy with ribavirin and
interferon? Check for adherence to all three medications.
Audit for checking viral counts at appropriate time intervals
17
Hepatitis C Agents
 Incivek and Victrelis
 Look at quarterly trends in usage since Incivek/Victrelis
were approved by the FDA in May 2011 as patients were
not started on double therapy (ribavirin/interferon) as
the specialists were waiting for triple therapy to be
available.
 In the future an all oral regimen is going to be available
for treatment of Hepatitis C so there may be patient
“warehousing” again.
18
Hepatitis C DUR
Incivek & Victrelis
50
40
30
20
10
0
Total Paid Claims
Unique Prescribers
Unique Recipients
19
Hepatitis C DUR
Incivek & Victrelis
60
50
40
30
20
10
0
2Q2011 3Q2011 4Q2011 1Q2012 2Q2012 3Q2012 4Q2012 1Q2013 2Q2013
Total Paid Claims
Unique Prescribers
Unique Recipients
20
Hepatitis C DUR
Incivek & Victrelis
35
30
25
20
15
10
5
0
2Q2011 3Q2011 4Q2011 1Q2012 2Q2012 3Q2012 4Q2012 1Q2013 2Q2013
Total Paid Claims Incivek
Total Paid Claims Victrelis
21
Hepatitis C DUR
Review from 5/1/2012 thru 5/26/2013
Total of 53 patients prescribed Incivek or Victrelis
 36 Incivek
 17 Victrelis
Mean age: 47 years (range: 18 – 61)
Female: 26
Male: 27
**All patients had a diagnosis for Hepatitis C (ICD-9
code 070.4 or 070.5)
22
Hepatitis C DUR
36 Incivek Patients
 Mean age: 46 years (range 28 – 61)
 Female: 16
 Male: 20
29 completed treatment (3 months)
5 did not complete treatment
 1 patient was co-infected with HIV (2 months)
2 patients exceeded 3 months
 5 months (50 y/o male)
 4 months (28 y/o male)
23
Hepatitis C DUR
Incivek Payment
 Total payment $1,613,601.00
 Payment/month $18,000.00
 6 months should not have been submitted ($108,000.00)
**All Incivek patients were started on Interferon and
Ribavirin
24
Hepatitis C DUR
17 Victrelis patients
Mean age: 47 years (range 18 – 60)
Female: 10
Male: 7
8 completed treatment
 Mean # of months: 7
2 did not complete treatment
7 active treatment
25
Hepatitis C DUR
Victrelis Payment
 Total payment $355,187.00
 Payment/month $5074.00
**All Victrelis patients were on Interferon and Ribavirin
for 4 weeks prior to Victrelis treatment
26
Hepatitis C DUR
Letters sent out requesting the following information:
 HCV Genotype
 Baseline Laboratory values (CBC, LFT’s, SVR)
 Follow-up Laboratory values while on Incivek or
Victrelis (SVR, LFT’s)
 Documentation/chart notes of follow-up treatment
and response to treatment
 If documented: Co-infection of HIV
 If applicable: reason why therapy was discontinued
(side effects, inadequate response, etc)
27
Demographics of the Idaho
Medicaid Utilizer of Rx’s Population
Paid Pharmacy Claims 1/1/2013 through 4/30/2013
Unique Recipients
25,000
20,000
15,000
10,000
5,000
-
0 to 9
10 to 19
20 to 29
30 to 39
40 to 49
50 to 59
60 to 69
70 to 79
80 to 89
90 to 99 100 to 109
Age in Years
Male
Female
28
Demographics of the Idaho
Medicaid Utilizer of Rx’s Population
Total Claims
Paid Pharmacy Claims 1/1/2013 through 4/30/2013
90,000
80,000
70,000
60,000
50,000
40,000
30,000
20,000
10,000
-
0 to 9
10 to 19
20 to 29
30 to 39
40 to 49
50 to 59
60 to 69
70 to 79
80 to 89
90 to 99 100 to 109
Age in Years
Male
Female
29
Demographics of the Idaho
Medicaid Utilizer of Rx’s Population
Paid Pharmacy Claims 1/1/2013 through 4/30/2013
$9,000,000
Total Payment Amount
$8,000,000
$7,000,000
$6,000,000
$5,000,000
$4,000,000
$3,000,000
$2,000,000
$1,000,000
$0 to 9
10 to 19
20 to 29
30 to 39
40 to 49
50 to 59
60 to 69
70 to 79
80 to 89
90 to 99 100 to 109
Age in Years
Male
Female
30
Demographics of the Idaho
Medicaid Utilizer of Rx’s Population
Paid Pharmacy Claims 1/1/2013 through 4/30/2013
$26,968,052
100,000,000
$23,059,720
10,000,000
260,503
1,000,000
100,000
$50,027,771
46,096
61,189
445,347 705,850
107,285
10,000
1,000
100
10
1
Unique Recipients
Total Claims
Male
Female
Total Payment Amount
Combined
31
Mental Health Learning Collaborative –
Depression Screening in Adolescent Patients
32
CHIC
 Target Prescribers: Pediatricians and Family Practice
 Goal: Increase screening for depression in adolescent
patients with appropriate follow-up for those patients
with positive screenings
 Psychosocial support including counseling
 Medications (e.g. SSRIs)
 Target Dates:
 Learning session for enrolled providers in August 2013.
Sessions to be held in Boise, Twin Falls, and Pocatello
 Start tracking screenings and follow-up in October 2013
 Duration of project: 6 months
33
CHIC
 Baseline Data for 2012
 3265 unique patients age 12-17 years with at least one
paid claim for an SSRI
 18,063 total paid claims for SSRIs
 $265,842
 4604 unique patients age 12-17 with at least one paid
claim for any antidepressant
 30,198 total paid claims for all antidepressants
 $467,419
34
Prepared by MMA 6/13/2013
Please refer to handout in Packet
35
P&T Committee Narcotic Analgesic
Studies
 Narcotic Analgesics in Chronic Non-Malignant Pain
2012 Update
 Participants Receiving More Than 1 Long Acting at a
Time
36
Follow-Up from 2011 Study
37
Profile Review
 Generated profiles for the top 150 recipients by total




narcotic claim count from the recipients who had at
least one narcotic claim in each of the 24 months of
the period ending March 2013
Time Period: October 1, 2012 through March 31, 2013
Original study: May 1, 2011 through December 31, 2011
Evaluated 142 Cancer Diagnosis found in 8
All profiles were hand reviewed by Idaho Medicaid
Pharmacists
38
Review Focus










Years of opioid use
Number of different opioids used
Daily morphine equivalents
Number of different prescribers
Other concurrent central acting/ potentially addictive
drugs
Diagnosis or indication for chronic opioid use
Average days between refills
History of abuse diagnosis
Currently in lock-in program?
Additional opioid use paid outside of Medicaid
39
Length of Time for Continuous Opioid
Use
40
Number of Different Opioids
 Includes different drugs or dosage forms
 May or may not be concurrent, but over course of therapy
41
Daily Morphine Equivalents
Lowest = 14 mg
Highest = 1340 mg
42
Number of Prescribers per Participant
43
44
Diagnosis/Indications
Most patients had multiples diagnoses
Diagnosis
Number of Participants
(incidence)
lubago: unspecified disorder of back; back pain
92
chronic pain; chronic pain syndrome; other chronic pain
73
intevertebral disc disorder; lumbar disc degeneration; cervical disc degeneration; cervicalgia; sciatica;
disc degeneration; spondylosis
30
knee injury; shoulder injury; pain in limb; lower leg pain; neck injury; hip and thigh injury; wrist injury
20
hand joint pain; osteoarthritis; rheumatoid arthritis; pain in joint of ankle and foot; ankylosing
spondylitis; other disorders of synovium tendon and bursa
headache; migraine
37
disorders of muscle ligament and fascia; other disease of bone and cartilage; myalgia
abdominal pain, generalized pain
9
2
12
multiple sclerosis
1
peripheral neuropathy; diabetic peripheral neuropathy
1
chronic pancreatitis
4
Unknown
2
45
Average Days Prior to Refill
46
Other Information Gathered
 Number on Medicaid Pharmacy Lock-In
 5 currently on lock-in
 Non-Medicaid Opioid Fills
 From Board of Pharmacy Reports

Many gaps in Board of Pharmacy Reports
 34 of the 142 patients ( 24%) had fills not paid for by
Medicaid
 Concurrent Drug Abuse Diagnosis 66 (46%)
47
Comparison of Original and Follow-up Data
2011
Current
Number with Cancer DX
6
8
Average # of Years on
Opioids
8.2 (Range 3-14)
9 (Range 2-13)
Average # of Different
Opioids
2.9 ( Range 1-10)
3 (Range 1-7)
Average Daily Morphine
Equivalents
256 (Range 10 mg -2421mg)
208 (Range 14 mg- )
Average # of
Prescribers/Participant
4 ( Range 1-12)
1 (Range 1-8)
Average Days Prior to Refill
27
25
Lock-in Patients
3
5
Patients with Prescriptions
Paid Outside of Medicaid
30%
24%
Concurrent Drug Abuse
Diagnosis
39%
46%
Does not include non-Medicaid paid
48
49
Long-Acting Narcotic Evaluation
 Goal: To evaluate impact of planned change that
would only allow one long-acting and one short-acting
narcotic analgesic per participant without further prior
authorization
 Report was run and profiles generated for participants
who had a claim for more than one unique long-acting
narcotic analgesic between 12/1/2012 and 5/31/2013
 N = 65
50
Evaluation
 Profiles were reviewed and all eliminated for further
review that did not meet the following criteria:
 Two or more consecutive months of receiving two or
more long-acting agents.
 Must include most recently evaluated month (May 2013)
 Participants meeting criteria = 6
 Refer to attached table for characteristics of use for
these 6 participants
51
Suboxone and Participants Paying Cash for Other Opioids
(includes Suboxone film, Suboxone tablets, buprenorphine/naloxone tablets, buprenorphine tablets)
52
Buprenorphine DUR
 Identified all participants with at least one paid claim by Idaho
Medicaid between 2/1/13 and 4/30/13.
 Ran Board of Pharmacy report for all of these participants to identify
anyone who had received any other opioid with overlapping days of
service and noted payment method (cash, Idaho Medicaid, other
insurance). This DUR includes opioid claims from January 2013 that
would overlap into February (e.g. paid cash for hydrocodone tablets
1/31/13 and had Idaho Medicaid pay for Suboxone 2/1/13). As the Board
of Pharmacy only reports number of tablets and not days of service, we
assumed a reasonable number of tablets used per day (e.g. six for
hydrocodone/acetaminophen, two for OxyContin). Idaho Medicaid
has a manual system for entering a block from paying for opioids for
patients on Suboxone therapy but an occasional participant is
overlooked allowing Idaho Medicaid to pay for opioids for patients also
on Suboxone.
53
Buprenorphine DUR
 Data Collected
1.
2.
3.
4.
5.
6.
7.
8.
Sex (M/F)
Age as of 4/30/13 (years)
Overlapping paid claims for opioids (Y/N)
What is opioid in addition to Suboxone ?
Quantity of paid claims
Duration of therapy of Suboxone
Concomitant benzodiazepine usage
Cost of therapy ($ and percentage) for patients paying cash for opioids
54
Buprenorphine DUR
 For those patients identified who had paid claims for
other opioids that overlapped with days of service for
Suboxone, a letter was sent to prescribers of both
Suboxone and any other opioid. The Board of
Pharmacy report was included as an attachment to
these letters. (See packet for copy of letter)
 One week after the letter was sent, payment for
Suboxone was blocked by Idaho Medicaid and the lock
on paying for other opioids was removed.
55
Buprenorphine DUR
Patients identified who paid cash for opioids
while Idaho Medicaid was paying for Suboxone
during time period 2/1/13 - 4/30/13
Paid Cash, 26,
13%
Did not pay
cash, 174, 87%
66 letters sent out between June 3-10, 2013 to 56 unique prescribers. Gave prescribers one week to
respond prior to initiating Suboxone payment block.
56
Buprenorphine DUR
Sex
132
140
# of patients
120
100
80
60
42
40
20
19
7
0
Paid Cash
Didn't pay cash
Male
Female
57
Buprenorphine DUR
Percentage in DUR study
151/200, 75.5%
160
140
120
100
80
60
49/200, 24.5%
40
20
0
Male
Female
58
Buprenorphine DUR
Paid Cash
19/26, 73%
20
18
16
14
12
10
8
6
4
2
0
7/26, 27%
Male
Female
59
Buprenorphine DUR
50
45
40
35
30
Average Age:
38.3
Standard
Deviation:
10.8
Average Age:
30.8
Standard
Deviation:
5.0
Average Age:
33.8
Standard
Deviation:
9.7
25
20
15
10
5
0
Paid Cash
Didn’t Pay Cash
All Patients in DUR
60
Buprenorphine DUR
All patients in DUR
Patients who paid cash for
opioids and who were also on
benzo's
60/200,
30%
16/26,
62%
140/200,
70%
benzo use
10/26,
38%
no benzo use
on benzo
not on benzo
61
Buprenorphine DUR: Analysis of Prescribers
16
14
14
# of patients
12
10
8
6
4
2
0
4
3
2
1
1
1
One prescriber for Two prescribers
Two prescribers Three prescribers Three prescribers Four prescribers
Ten prescribers
both Suboxone and (one for Suboxone
(one for
(one for Suboxone (two prescribers for (one for Suboxone (one for suboxone
other opioid
and one for other buprenorphine and and two for other buprenorphine, and three for other and nine for other
opioid)
Oxycontin, second
opioids)
third prescriber for
opioids)
opioids)
prescriber for
hydrocodone)
hydrocodone)
62
Buprenorphine DUR
Three Month Time Period
Suboxone paid
for patients
paying cash,
$25,889
Suboxone paid
for patients not
paying cash,
$202,230
11.3% of total expenditure - potential cost savings: $103,557 annually
63
Buprenorphine DUR
# of patients
# of opioid prescriptions paid cash for by patients
during 3 month time period
14
12
10
8
6
4
2
0
12
5
1
2
2
2
3
4
1
5
2
9
1
1
10
12
# of opioid prescriptions
64
Buprenorphine DUR
Of 12 patients with one cash paid opioid prescription
during the three month DUR study
had paid for additional
opioids before/after
study period
2
3
7
were patients recently
started on Suboxone
had been on Suboxone
for a while with only the
one paid opioid claim
65
Buprenorphine DUR
Opioids paid cash for
3
hydrocodone
2 1
15
oxycodone
hydromorphone
methadone
morphine
60
66
# of patients
Buprenorphine DUR
50
45
40
35
30
25
20
15
10
5
0
paid cash
did not take other
opioids
Suboxone Therapy Initiated
67
Buprenorphine DUR
 Bottom Line: Patients were found to be paying cash for
opioid therapy even after many years on Suboxone
therapy.
 Example – Patient who has been on Suboxone since
2006 paid cash 9 times for opioids during the 3
months of this DUR and 52 times total in the last two
years (42 fills for oxycodone and 10 fills for
hydrocodone).
68
Buprenorphine DUR
 Feedback from week 1
 One physician called and left message. Pharmacist
called back and spoke to his nurse to explain what was
happening. The physician never called back.
 One participant called to complain, Pharmacist called
and spoke to physician and re-authorized payment for
Suboxone (second chance).
69
Buprenorphine DUR
 Feedback from week 2
 Participant called to state that Norco was not filled by
her. Pharmacist called prescriber of both Suboxone and
Norco. Giving her a second chance.
 Physician called and stated that patient had knee
surgery and was “off” Suboxone immediately post-op
but plan is to stop other opioid and restart Suboxone.
 Physician called and stated that patient had one fill of
hydrocodone for dental surgery and would like patient
to continue on Suboxone.
70
Buprenorphine DUR
 Continued feedback
 Patient’s Suboxone discontinued by prescriber due to
other opioid use: 2 patients
 Prescriber requested (and was granted) re-authorization
for Suboxone after fill of other opioid s/p surgery: 2
patients
71
Buprenorphine DUR
 Future Plans
 The department plans on running routine Board of
Pharmacy reports every 3-6 months on all Suboxone
patients.
 Questions/Comments ?
72
Proposed Studies for Next Quarter:
 Synagis
 P&T Committee Narcotic Analgesic Studies – Next
Steps
 Use of Psychotropic Medications in Foster
Children – Next Steps
 2012 Data Analysis Update
 Three (3) or more concomitant mood stabilizer
medications
 IVIG
73
Proposed Studies for Next Quarter:
 Levofloxacin
 Antipsychotic Indication Evaluation- Hold for
Future
74
Synagis DUR
http://healthandwelfare.idaho.gov/Portals/0/Health/Epi/RSV/RSV%20graph.pdf
75
Synagis DUR
 What should the focus be for the DUR project for the
concluded 2012-2013 RSV season?
76
P&T Committee Narcotic Analgesic
Studies – Next Steps
77
Use of Psychotropic Medications in
Foster Children
 The U.S. Government Accountability Office released
the results from a study that they performed
examining the rates of psychotropic medications for
foster and nonfoster children in 2008.
 It was determined that HHS Guidance Could Help
States Improve Oversight of Psychotropic
Prescriptions.
78
7/18/2013
79
Red Flags
 Five (5) or more psychotropic medications prescribed





concomitantly (reviewed August 2012)
Two (2) or more concomitant antidepressants (reviewed October
2013)
Two (2) or more concomitant antipsychotic medications
(current)
Two(2) or more concomitant stimulant medications

long-acting plus short-acting ok
Three (3) or more concomitant mood stabilizer medications
Psychotropic polypharmacy (2 or more agents) for a given
mental disorder prescribed before utilizing psychotropic
monotherapy
80
Implementation of Red Flags
Retroactive
Evaluation
Identify
outliers
Profile
Review
DUR Board
Intervention
Reevaluation
Point of
service edits
• Targeted
education
• individuals
• overall
• Informational
(soft) –
pharmacist
override
• Hard Stop
Further
Action
81
40%
35%
Percent of Foster and Non-Foster Children Psychotropics by
36%
Drug Class
Calendar Year 2011
Total foster =2785
Total Non-Foster = 106,024
30%
25%
23%
21%
% Foster Children
20%
% Non-foster Children
15%
13%
10%
9%
6%
5%
4%
0%
0%
ADHD Drugs
Anti-depressants
Mood Stabilizers
Atypical Antipsychotics
82
Use of Psychotropic Medications in
Foster Children: Next Steps
 2012 Data Analysis Update
 Three (3) or more concomitant mood stabilizer
medications
83
IVIG
 IVIG follow-up as implemented prior authorization criteria
1-1-13. Will look at cost of therapy (pharmacy and medical)
January – June 2012 vs. same dates 2013 as well as some
comments on prior authorization requests received.
84
Levofloxacin
 Levofloxacin – changed minimum age from 16 down to
zero 11-1-12 so look at usage Jan – June 2012 vs. same dates
2013 for children and compare utilization.
85
Antipsychotic Indication EvaluationHold for Future
86
Prospective DUR Report
 History Errors:
• DD – drug-to-drug
• PG – drug to pregnancy
• TD – therapeutic duplication
• ER – early refill
• MC – drug-to-disease
 Non-History Errors:
• PA – drug-to-age
• HD – high dose
• LD – low dose
• SX – drug-to-gender
87
Prospective DUR Report
Idaho Medicaid Program
ProDUR Message Report
June-13
ProDUR
Message
Drug To Drug
Drug To Gender
Drug To Known Disease
Drug To Pregnancy
Duplicate Therapy
Min Max
Too Soon Clinical
ALL
ProDUR
Severity
1
2
3
1
2
1
2
3
1
2
A
B
C
D
X
0
0
0
Message
Count
1,381
13,026
67,204
146
2,195
65,499
229,816
291,920
23
15
4
70
126
7
10
108,162
29,517
19,545
Message
Amount
$373,620.15
$2,521,971.05
$12,025,994.08
$34,461.03
$265,410.63
$9,849,442.93
$42,448,043.20
$54,632,417.89
$301.97
$483.73
$39.35
$10,458.15
$12,492.54
$130.78
$844.76
$24,283,884.93
$4,838,004.04
$3,632,514.43
828,666
$154,930,515.64
Total Number of Claims with Messages 200,209
Average ProDUR Message Per Claim
4.14
88
DUR Summer Newsletter
 Copy of Spring Newsletter in packet
 Brainstorm for new topics
89
Medicaid Update
90