September 2019 DUR Board Meeting Minutes
Date: September 25, 2019
Members Present: Putsch, Caldwell, Nauts, Brown, McGrane, Blank, Maxwell, Sather, King
Members Absent: Anglim, Fitzgerald, Miller, Stone
Others Present: Shannon Sexauer, Dan Peterson, Dani Feist (DPHHS); Artis, Barnhill, Doppler, Opitz, Woodmansey (MPQH); representatives from Conduent and the pharmaceutical industry.
Introductions: Lisa Sather requested the members of the audience introduce themselves and identify which companies they represent. Lisa Sather introduced Tony King, the new DUR Coordinator with Mountain Pacific Quality Health who will replace Mark Eichler.
Public Comment: There was no public comment.
Meeting Minute Review: The meeting minutes from May 2019 were approved as written.
Department Update: The Department did not have an update at this time.
Board Discussion
1. Review of New Drug Criteria
The following clinical criteria were reviewed and the board recommended approval and implementation as follows:
A. Diacomit®(stiripentol) • Medication must be prescribed by or in consultation with a neurologist. • Patient must have a diagnosis of Dravet Syndrome (DS). • Patient must be > 2 years of age. • Patient’s seizures must have been inadequately controlled on at least 2 conventional epileptics for DS (valproic acid, topiramate, clobazam, levetiracetam). • Patient will concurrently receive clobazam. • Provider education only: Baseline neutrophil and platelet count have been performed and drug interactions have been reviewed. • Baseline seizure activity is documented (per month). • LIMITATIONS: Max 50 mg/kg/day. o Initial authorization will be for 6 months. Obtain current seizure activity (per month). Renewal will require provider attestation that patient has experienced a reduction in frequency of seizures from baseline. o Subsequent renewals will be for 1 year.
B. Codeine/hydrocodone/tramadol use in pediatrics • Codeine and hydrocodone-containing cough and cold products will not be approved for use in children < 18 years of age. • Codeine analgesics will not be approved to treat pain in children < 12 years of age. • Tramadol will not be approved to treat pain in children < 12 years of age.
The Board requested a review of changes in tramadol utilization be revisited in the 12-18 year old population at a later meeting.
C. Motegrity®(prucalopride) • Patient must be 18 y/o or older. • Diagnosis of Chronic Idiopathic Constipation (CIC) is required. • Patient must have been unsuccessful with documented treatment with a stimulant laxative (i.e. senna, bisacodyl) AND lactulose. • LIMITATIONS: Maximum of 1 tablet daily of either 1 mg or 2 mg tablet.
D. Zelnorm®(tegaserod) • Patient must be a female 18-65 years old. • Patient must not have a history of MI, stroke, TIA or angina. • Diagnosis of Irritable Bowel Syndrome with constipation (IBS-C) is required. • Patient must have been unsuccessful with documented treatment with a stimulant laxative (i.e. senna, bisacodyl) AND lactulose. • LIMITATIONS: Maximum of 2 tablets daily.
2. Existing Criteria Updates
The following existing clinical criteria were reviewed and recommended changes approved:
A. Growth Hormone for Small for Gestational Age (SGA) Approval for a diagnosis of SGA may be authorized according to the following criteria. This criteria change is in accordance with guidelines and stakeholder consensus. • Diagnosis of SGA as defined by: Birth weight and/or length SD of 2.0 or more below mean for gestational age AND • Must be at least 2 years old AND • Must not have attained a height above -2 SD by 2 years (failure to catch-up). • Open epiphyses required. • Bone age <14-15 yrs (female); < 15-16 (male) required.
B. Atypical Antipsychotic use ≤ 6 Pharmacy case management staff presented data and current statistics on case management interventions in children ≤ 6 and the impact of expanding the age up to age 8 or 9. After robust discussion on current patients and expansion, the Board requested additional information to be researched and reviewed at the next meeting.
3. PDL/DURB meeting follow-up items
A. Stimulant use in adults - RDUR Pharmacy case management staff presented retrospective data on stimulant use in the adult Medicaid population to include those with or without an ADHD or narcolepsy diagnosis. Additional data will be reviewed and possible educational interventions implemented with providers.
4. Other
A. Duplication of atypical antipsychotic injetions • Shannon Sexauer requested input from the Board regarding the use of >2 concurrent atypical antipsychotic injectables. • As a rule the Board said this was not standard practice, however, these requests should be reviewed on a case by case basis. • If necessary, cases can be brought for confidential case review by the Board.
B. Buprenorphine products counseling language
Lisa Sather reported updates to the language on Buprenorphine-containing products prior authorization form. These changes reflect current risk reduction recommendations and take in to consideration concerns for inadequate mental healthcare in some parts of Montana. Dr. Dan Nauts, MD, the addiction medicine specialist on the Board, added that these changes are supported by current SAMHSA recommendations.
Guests were escorted out and the Board went into executive session to review sensitive case requests.
Meeting adjourned at 3:50 PM.