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MEDI-CAL DRUG USE REVIEW (DUR) BOARD State of California

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MEDI-CAL DRUG USE REVIEW (DUR) BOARD State of California MEDI-CAL DRUG USE REVIEW (DUR) BOARD State of California DEPARTMENT OF HEALTH CARE SERVICES Notice is hereby given that the Medi-Cal DUR Board will conduct a public meeting on Tuesday, September 19, 2017, at the following location: Department of Health Care Services 1500 Capitol Avenue Training Rooms A+B Sacramento, CA 95814 Medi-Cal Drug Use Review Board Meeting Agenda September 19, 2017 9:30 AM-12:30 PM Report Agenda Item Presenter Time Type* C 1. Welcome/Introduction Pauline Chan, RPh, MBA 930- 935 A 2. Call to Order/Review and Approval of Previous Minutes Robert Mowers, PharmD 935- from May 16, 2017 940 3. Old Business A a. Review of Action Items from Previous Board Meeting: Pauline Chan, RPh, MBA 940- i. Submission of FFY 2016 DUR Annual Report to CMS and Hannah Orozco, 945 ii. Ingredient Duplication (ID) Alert PharmD iii. Late Refill (LR) Alert iv. Additive Toxicity (AT) Alert v. DUR Educational Outreach: Early Refill vi. DUR Educational Outreach: Fluoroquinolones vii. DUR Educational Outreach: OTC viii. DUR Educational Outreach: Triptans 4. New Business R/D a. Global DUR Board Dorothy Uzoh, PharmD 945- and Paul Nguyen, PharmD 1005 R/A/D b. Board Activities: DUR Board 1005- i. DUR Bylaws 1015 ii. Summary of DUR Board Conference Call iii. DUR Board Elections R/A/D c. Quarterly Report: 2Q2017 (April – June 2017) Amanda Fingado, MPH 1015- d. Review of Physician Administered Drugs (PADs): 1045 1Q2017 e. Prospective DUR i. Review of DUR Alerts for New GCNs: 2Q2017 ii. Ingredient Duplication (ID) Alert: EMTRICITABINE iii. Summary Report: Updates to Prospective DUR f. Review of DUR Educational Outreach to Providers i. Outcomes: Early Refill ii. Outcomes: Fluoroquinolones iii. Updated Outcomes: Metabolic Monitoring – 2016 R/A/D g. Academic Detailing Pilot Project: Late Refill Shalini Lynch, PharmD 1045- h. Review of DUR Publications 1110 i. DUR Bulletin (August, 2017): QT Prolongation ii. Discussion/Recommendations for Future Bulletins R/D i. PCSK9 Inhibitors for Treatment of High Cholesterol: Jeffrey A. Tice, MD [UCSF] 1110- Update on Clinical Efficacy and Cost-Effectiveness and Dhruv S. Kazi, MD, 1140 MSc, MS [UCSF and ZSFGH] R/D j. Low-Dose Aspirin Usage Among Fee-For-Service (FFS) Zhiwei Yu, MPH 1140- Medi-Cal Population [Office of the Medical 1155 Director, DHCS] R/D k. Pharmacy Update Pauline Chan, RPh, MBA 1155- i. Codeine/Tramadol Age Restrictions 1225 ii. Opioid Quantity Limits Policy Change iii. Triptan Quantity Limits Policy Change iv. DHCS $90M Grant to Fight Opioid Crisis v. Academic Detailing Conference: October 12, 2017 vi. Child/Adult Core Set – CMS Report vii. Review of FFY 2018 DUR Annual Report to CMS C 5. Public Comments 1225- 1230 6. Consent Agenda I a. Meeting feedback b. Next meeting: November 21, 2017 DHCS Training Rooms B+C 1500 Capitol Avenue Sacramento, CA 95814 c. Proposed DUR Board Meeting Dates for 2018: Tuesday, February 20, 2018 Tuesday, May 15, 2018 Tuesday, September 18, 2018 Tuesday, November 20, 2018 7. Adjournment 1230 * REPORT TYPE LEGEND: A: Action; R: Report; I: Information; C: Comment; D: Discussion ** Comments from the public are always appreciated. However, comments will be limited to five minutes per individual. Picture identification is required to gain access into the California Department of Health Services building. However, your security information will not be provided to the DUR Board. You can obtain the DUR Board agenda from the Medi-Cal DUR Main Menu Web site (http://files.medi-cal.ca.gov/pubsdoco/dur/dur_home.asp). MEDI-CAL DRUG USE REVIEW BOARD MEETING MINUTES Tuesday, May 16, 2017 9:30 a.m. – 12:30 p.m. Location: Department of Health Care Services 1500 Capitol Avenue Training Rooms A+B Sacramento, CA 95814 Topic Discussion 1) WELCOME/ The meeting was called to order by the Chair of the Board, Dr. Robert Mowers. INTRODUCTION Board members present: Drs. Andrew Wong, Randall Stafford, Robert Mowers, Patrick Finley, Timothy Albertson, Janeen McBride, and Marilyn Stebbins. Board members absent: none. Board members and attendees introduced themselves. Pauline Chan, RPh and Dorothy Uzoh, PharmD were present from DHCS Pharmacy Benefits Division. Hannah Orozco, PharmD (Conduent) announced that the DUR Board meeting is being recorded and encouraged everyone to sign the attendance sheet. Ms. Chan also reported that the annual conflict of interest attestation forms were distributed to the Board and will need to be completed and turned in before the next DUR Board meeting. Dr. Mowers stated that he is viewing a paper copy of the agenda and packet in order to follow the agenda and attachments being presented. However, he would like to acknowledge that personal computing devices are being used by some to view the same material electronically. This statement is required by Open Meeting rules. 2) CALL TO The Medi-Cal Drug Use Review Board (the “Board”) reviewed the February 21, 2017 ORDER/ minutes. Dr. Wong noted he had minor edits and motioned that the minutes be approved REVIEW AND with these changes. There was no discussion. The Board voted unanimously to approve the APPROVAL OF minutes as edited by Dr. Wong. FEBRUARY 2016 MINUTES AYE: Albertson, Finley, McBride, Mowers, Stafford, Stebbins, Wong NAY: None ABSTAIN: None ABSENT: None ACTION ITEM: Incorporate Dr. Wong’s edits into the minutes and post to the DUR website. 3) OLD BUSINESS a. Review of Action Items from Previous Board Meeting: i. Update on Additive Toxicity Alert – Dr. Orozco reported that the previous DUR Board recommendations regarding additive toxicity alerts are currently in progress. In addition, Amanda Fingado, MPH (UCSF) will be presenting drugs that still need a final additive toxicity alert decision for further discussion later in the meeting. 1 4) NEW BUSINESS a. Board Activities: i. Buprenorphine study – Dr. Stafford provided an update on his project facilitating increased BUPRENORPHINE prescribing. The intervention will include an online provider training program coupled with academic detailing by a pharmacist. Dr. Stafford described that the online training component will have clinical vignettes, evidence-based strategies, linkage to a coach, and information regarding the benefits of weaning and tapering patients off of opioids. Dr. Stafford explained that using a spoke and hub model, there will be an emphasis on referrals, then returning the patient to the provider. Remaining questions to be discussed with DHCS include how to incentivize providers for participating in the training. Dr. Stebbins asked if prescribers who treat cancer patients would be excluded. Dr. Stafford said that prescribers would be included if they had a certain number of patients with high prescribing of opioids but they will look at excluding cancer patients at the patient level, rather than at the provider level. b. DUR Annual Report to the Centers for Medicare & Medicaid Services (CMS) – Ms. Chan and Dr. Orozco reviewed the DUR annual report for Federal fiscal year (FFY) 2016, which is due to CMS by June 30, 2017. Ms. Chan highlighted several sections within the annual report survey, including the following: Page 3, question 5: Starting in FFY 2017 the DUR program will begin to follow-up with pharmacy providers at least annually. Page 9, questions 3 and 4: Ms. Chan reported the generic utilization percentage for FFY 2017 was 69.9%, representing 9.2% of expenditures. Ms. Fingado stated that these data are always skewed somewhat in the California data, as many of the carved- out drugs are branded medications. Page 10, question 4: Ms. Chan reported the estimated cost savings of the DUR program to be 6.5%. Ms. Fingado reviewed the methodology and calculations for cost savings, which is included in Attachment 5. Dr. Stafford asked what the range of cost savings is for other states. Ms. Fingado stated that California is in the bottom quarter of state DUR programs, as all of the Prospective DUR alerts can be overridden at the point of sale. Ms. Fingado also reported that other states have more robust interventions that generate cost savings from retrospective DUR. Ms. Chan agreed that cost savings are not limited to prospective DUR and that California will be able to calculate retrospective cost savings for the first time in the FFY 2017 report. Allen Schaad, RPh (California State Board of Pharmacy) asked Ms. Fingado to explain the parameters used to calculate prospective DUR cost savings. Ms. Fingado stated that the values are conservative in comparison to other states and reflect that only a percentage of cancelled claims will end up as paid claims. Lisa Ashton, PharmD (Johnson & Johnson) commented that the calculations used to determine cost savings from prospective DUR account for multiple overrides on one claim. Dr. McBride confirmed these calculations do not include physician-administered drugs (PADs). Page 11, questions 2 through 4: Ms. Chan reported that the DHCS Audits & Investigation Branch (IB) runs the lock-in program, as defined under 22CCR §50793. Dr. McBride said she would like to hear more about this program at a future DUR Board meeting. Page 12, question 7: Ms. Chan reported that the DHCS Audits & Investigation Branch (IB) uses all available information to develop and work cases, initiates audits, and assists in investigations. This includes review of claims data and trending reports for both controlled and non-controlled drugs. Page 13, question 2: Ms. Chan stated that CURES 2.0 became operational during FFY 2016, improving ease of registration and access. She also reported that both the California State Board of Pharmacy and the Medical Board of California have enacted requirements for mandatory review of CURES. Page 15, question 1 and page 16, question 2: Ms. Chan stated that effective July 2017, the maximum days’ supply of opioids has changed to 25 days. Page 23, question 5: Ms.
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