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MENTAL HEALTH CLINICAL ADVISORY GROUP AGENDA REGULAR MEETING Thursday, March 7, 2019 1:00 P.M

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MENTAL HEALTH CLINICAL ADVISORY GROUP AGENDA REGULAR MEETING Thursday, March 7, 2019 1:00 P.M MENTAL HEALTH CLINICAL ADVISORY GROUP AGENDA REGULAR MEETING Thursday, March 7, 2019 1:00 p.m. – 4:00 p.m. In Person: Human Services Building, 500 Summer St, Rm 280, Salem, OR 97301 Skype Link: https://meet.dhsoha.state.or.us/amanda.b.parish/LHWCMH26 Conference Call: +1 (503) 934-1400 | Conference ID: 90178806# MHCAG Webpage: HTTPS://WWW.OREGON.GOV/OHA/HSD/OHP/PAGES/PT-MHCAG.ASPX TYPE OF MEETING Advisory Board FACILITATOR George Fussell NOTE TAKER Jonnaliz Corbett APPOINTED MEMBERS OHA Glena Andrews, Ph.D. Peter Grover, M.S., Ph.D., MSPsyPh Trevor Douglass, DC, MPH William Beck, Pharm.D. Lorinda Haynes, RPh Amanda Parish, LCSW Chris Bouneff Bob Joondeph, JD Jonnaliz Corbett Keith Cheng, MD Nick Kashey, MD Neil Falk, MD Lori Martin, MSN, PMHNP George Fussell, MD Davíd Nagarkatti-Gude, MD, PhD DISCUSSION TOPICS TIME RESPONSIBLE PARTY Call to order 10 min George Fussell/OHA Elect vice chair Review and approval of February 21, 2019 special meeting minutes 5 min George Fussell/OHA Discussion and update on the MHCAG’s SB 138 renewal 10 min OHA Discussion of Medicaid prescribing 20 min Roger Citron Public Comment 5 min George Fussell Review/Update Current Deliverables List 80 min All Will include review of updated medication tables (Bill Beck), MHCAG draft of a Bipolar treatment algorithm, review of CANMAT’s medication tables, review of MHCAG draft recommendations for treatment of Bipolar disorder for special populations draft of the integrated CANMAT and MHCAG guideline formats and future task delegation *May include discussion/review of differential diagnosis and comorbidity Break 10 min ---------------------------- Public comment 10 min George Fussell Review/Update Parking Lot 10 min All Round Table 20 min All Adjournment Page 1 **2019 Meeting Schedule Meeting Date/Time Skype Link Conference Call Location Type Special 2/21/2019 Join Skype Meeting +1 (503) 934-1400 HSB 556 1:00 p.m. – Trouble Joining? Try ID: 67967340 500 Summer Street NE 3:00 p.m. Salem, OR 97301 Skype Web App Regular 3/7/2019 Join Skype Meeting +1 (503) 934-1400 HSB 280 1:00 p.m. – Trouble Joining? Try ID: 90178806 500 Summer Street NE 4:00 p.m. Skype Web App Salem, OR 97301 **Special March 2019 **Special April 2019 Jonnaliz will contact members to finalize a date and time Regular 5/2/2019 Join Skype Meeting +1 (503) 934-1400 HSB 160 12:30 p.m. – Trouble Joining? Try ID: 6737895 500 Summer Street NE 4:30 p.m. Skype Web App Salem, OR 97301 Regular 7/11/2019 Join Skype Meeting +1 (503) 934-1400 HSB 166 12:30 p.m. – Trouble Joining? Try ID: 97924673 500 Summer Street NE 4:30 p.m. Skype Web App Salem, OR 97301 Regular 9/5/2019 TBD TBD TBD TBD Regular 12/5/2019 TBD TBD TBD ** Possible Dates, Times and Locations for March and April Special Meetings MARCH APRIL 3/14/2019------1-3PM (Salem Skype) Room 252 4/11/2019------1-3PM (Salem Skype) Room 166 4/25/2019------12:30-2:30 (Salem Skype) Room 352 Page 2 Oregon Mental Health Clinical Advisory Group Special Meeting Minutes February 21, 2019, 1:00 p.m. – 3:00 p.m. Human Services Building 500 Summer St, Room 352 Attendees: Mental Health Clinical Advisory Group Present: Glena Andrews (Skype), William Beck (Skype), Neil Falk (Skype), George Fussel, Chair (Skype), Nick Kashey (Skype), David Nagarkatti-Gude (Skype) OHA Staff: Trevor Douglass, Jonnaliz Corbett, Heidi Murphy (Skype) Public: N/A Welcome and call to order: The meeting was called to order by George Fussell, Chair, at 1:05 p.m. Date and location for upcoming meetings: Below is the current schedule for 2019. For any questions, please contact Jonnaliz Corbett at [email protected]. Type Date/Time Skype Link Materials Conference Call Location Due Regular 3/7/2019 Join Skype 3/5/18 +1 (503) 934-1400 HSB 280 1:00 p.m. – 4:00 Meeting ID: 90178806 500 Summer Street NE p.m. Trouble Joining? Try Salem, OR 97301 Skype Web App Special April 2019 TBD TBD TBD Jonnaliz will contact members to finalize a date and time Special April 2019 TBD TBD TBD Jonnaliz will contact members to finalize a date and time Regular 5/2/2019 Join Skype TBD +1 (503) 934-1400 HSB 160 12:30 p.m. – Meeting ID: 6737895 500 Summer Street NE 4:30 p.m. Trouble Joining? Try Salem, OR 97301 Skype Web App Regular 7/11/2019 Join Skype TBD +1 (503) 934-1400 HSB 166 12:30 p.m. – Meeting ID: 97924673 500 Summer Street NE 4:30 p.m. Trouble Joining? Try Salem, OR 97301 Skype Web App Regular 9/5/2019 TBD TBD TBD TBD TBD Regular 12/5/2019 TBD TBD TBD TBD Page 3 Review and approval of February 7, 2019 minutes The meeting packet is located on the Mental Health Clinical Advisory Group Webpage. The group reviewed and approved the minutes from the February 7, 2019 special meeting. Review of published research/practice guidelines for bipolar disorder Pharmacy utilization data was provided to the group in the packet on pages 6-11. There’s a carveout in the state for the Medicaid program. The fee for service (FFS) program pays the claims for all drugs in the classes that the Oregon Health Authority (OHA) designates as antipsychotics and antidepressants. Because Latuda is an antipsychotic, OHA pays for that out of the fee for service system. A lot of the top 40 drugs fall into those therapeutic classes because of the carveout. OHA services approximately one million Medicaid recipients for their mental health drug needs. Those numbers are expected to be higher considering the larger claim amounts and counts and higher cost associated with specific drugs. The group asked for guidance with cost information in the legislative report submitted, the group noted that one of the things the groups keeps in mind of the algorithms is the cost of the drugs, but the group also had the impression that cost is something we shouldn’t take into consideration. Trevor Douglass provided the group with information on supplemental rebates. OHA attempts to secure supplemental rebates through the manufacture, particularly when the state has control of who sets that preferred status on the preferred drug list. That’s where cost considerations come into play for the Pharmacy & Therapeutics (P&T) committee. It’s important for the MHCAG to understand what the whole sale acquisition cost is and use that as the measure for comparing costs. MHCAG is making recommendations for the standard of care across systems. The P&T committee may take the recommendations and amend them to reflect the net cost to the state when evaluating MHCAG’s recommendations and the evidence as its presented to them. The group brought up a concern on page 10 of the meeting packet. Latuda has fewer claims at a higher percentage of total FFS costs and amount paid and noted that Aripiprazole had a higher claim count with a significantly lower total amount paid and percentage of total FFS costs. Does it seem like the antipsychotics are playing an increasing role relative to mood stabilizers in bipolar? They show up prominently in CANMAT guidelines. The way the Canadian guidelines are organized, there’s one tier of 6 or 7 different monotherapies that don’t have evidence to distinguish between them in terms of efficacy. IT would seem reasonable and prudent to include cost when deciding between the cost of drugs if there isn’t clear superiority of one drug over another. Need to think about how we express that as a group. We want people to have best available medication but if there’s no superior efficacy, it doesn’t make sense to spend more. Bill Beck added that Latuda is a brand name that’s being sampled aggressively and often drives utilization. If it works, it’s followed up with a prescription. Generic drugs are typically not sampled. MHCAG would like to break down Latuda based on location, specialty, how and where it’s being prescribed. Keith Cheng provided the group with the article titled “Low doses of clozapine may stabilize treatment-resistant bipolar patients” on pages 12-13 in the meeting packet. This is one of those issues that hasn’t been an area that has prompted a lot of research but have seen case reports in treatment resistant psychotic depression 2 Page 4 Glena Andrews asked if there concern if the MHCAG recommends medications used off label, could that be problematic? Does the committee need to stay with the use of medications for which they have current FDA approval when a recommendation is made? The group suggested a section in the treatment care guide for treatments that have potential for those who have tried the treatment algorithm with little success. If the recommendations don’t work, it might be worth considering something different if the group could back that up with articles that would suggest (clozapine being an example). If there are options that could help people that aren’t being utilized, they should be listed as potential options. The group suggested framing recommendations in a separate section to include strongly evidence-based recommendations, so it presents a resource for people who have tried all the steps and need guidance on what to do next. The group discussed what makes a patient most successful in treatment, which includes antidepressants with a mood stabilizer and most importantly, time. Support, therapy and 3-6 months for mild to moderate depression. The group agreed that a message to put out that medication alone won’t fix everything and would like to emphasize auxiliary support, including therapy and social support.
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