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Dur Annual Report-6 2 2011 State of Indiana Draft Medicaid DUR Annual Report For Federal Fiscal Year 2010 (October 1, 2009 through September 30, 2010) Presented to: Centers for Medicare and Medicaid Services (CMS) By: State of Indiana—Office of Medicaid Policy and Planning Approved by the Indiana Medicaid DUR Board, June 17, 2011 Prepared by: ACS Government Healthcare Solutions, ACS Rx Services Primary Author: Felice Slaughter, B.S, R.Ph. Report Date: 3-25-2011 State of Indiana Medicaid Drug Utilization Review (DUR) Programs FFY2010 Annual CMS Report TABLE OF CONTENTS Page I. EXECUTIVE SUMMARY .....................................................................................................................................3 II. CMS SURVEY.........................................................................................................................................................4 III. TABLE 1. PROSPECTIVE DUR (PRO-DUR) CRITERIA-INDIANA MEDICAID ...........................10 TABLE 1.A. PRO-DUR CRITERIA – DETAILED.……………………………….........................................11 TABLE 1.B. PRIOR AUTHORIZATION (PA) CRITERIA............................................................................18 TABLE 1.C. MISCELLANEOUS PRIOR AUTHORIZATION PROGRAMS ...............................................32 IV. TABLE 2. RETRO-DUR APPROVED CRITERIA-FFY 2010 ...............................................................33 V. ATTACHMENT 1. PRO-DUR SUMMARY ..............................................................................................34 VI. ATTACHMENT 2. PRO-DUR ACTIVITY FFY 2010…………………………………………………39 ATTACHMENT 2.1.A. PRO-DUR ACTIVITY SUMMARY BY DUR SCREEN REPORT .......................42 ATTACHMENT 2.1.B. PRO-DUR ACTIVITY DETAIL BY THERAPEUTIC CLASS............................. 43 ATTACHMENT 2.1.C. PRO-DUR ACTIVITY DETAIL: DUR SCREEN BY INTERVENTION SUMMARY .............................................................................70 ATTACHMENT 2.1.D. PRO-DUR ACTIVITY DETAIL: DUR SCREEN BY OUTCOME SUMMARY.............................................................................................................71 ATTACHMENT 2.1.E. PRO-DUR REPORT OF PHARMACIST INTERVENTION & OUTCOME OVERRIDES .......................................................................................72 ATTACHMENT 2.2. PA ACTIVITY SUMMARY....................................................................................73 ATTACHMENT 2.2.A. DETAILED PA ACTIVITY BY PA TYPE: REGULAR, MISC. PA & MHQAC ...............................................................................................................74 ATTACHMENT 2.2.B. DETAILED PA ACTIVITY BY PA TYPE: PDL PA ............................................75 VII. ATTACHMENT 3. RETRO-DUR ACTIVITY – FFY 2010 ................................................................77 ATTACHMENT 3.1. INDIANA RETRO-DUR PROCEDURES ..............................................................79 ATTACHMENT 3.2. RETRO-DUR INTERVENTIONS BY PROBLEM CATEGORY...........................80 ATTACHMENT 3.3. RETRO-DUR ACTIVITY BY MONTH ..................................................................80 ATTACHMENT 3.4. RETRO-DUR SCREENING & INTERVENTIONS BY THERAPEUTIC CLASS...................................................81 ATTACHMENT 3.5. RETRO-DUR INTERVENTIONS PERFORMED – DESCRIPTION .....................88 VIII. ATTATCHMENT 4. SUMMARY OF DUR BOARD ACTIVITIES FFY 2010 ..................... 89 ATTACHMENT 4.1. PRO-DUR CRITERIA CHANGES............................................................ 93 ATTACHMENT 4.2. RETRO-DUR CRITERIA CHANGES ..................................................... 94 ATTACHMENT 4.3. INDIANA DUR BOARD MEETING MINUTES ..................................... 95 ATTACHMENT 4.4. DUR BOARD NEWLETTERS ............................................................... 165 IX. ATTACHMENT 5. GENERIC DRUG SUBSTITUTION POLICIES ................................ 183 ATTACHMENT 5.1. GENERIC UTILIZATION....................................................................... 183 ATTACHMENT 5.2. GENERIC SUBSTITUTION LAW ......................................................... 185 ATTACHMENT 5.3. ADMINISTRATIVE CODE 405 IAC 5-24-8.......................................... 188 X. ATTACHMENT 6. COST SAVINGS ESTIMATES FFY 2010........................................... 189 ATTACHMENT 6.1. PRO-DUR SAVINGS SUMMARY......................................................... 194 ATTACHMENT 6.2. ALL RETRO-DUR PROGRAMS SAVINGS SUMMARY .................... 200 ATTACHMENT 7. PROGRAM MONITORING FFY 2010 …………… …………….....202 ATTACHMENT 7.1 FRAUD, WASTE AND ABUSE DETECTION…………………..…….203 ATTACHMENT 7.1.A MEMBER UTILIZATION MONITORING………………………….…203 ATTACHMENT 7.1.B PROVIDERS UTILIZATION REVIEW……………………………..….203 ATTACHMENT 7.1.C. PHARMACY UTILIZATION REVIEW……………………………...…204 © 2011 Affiliated Computer Services, Inc. All rights reserved. May 2011 The preparation of this document was financed under an agreement with Indiana OMPP. Page 2 of 204 Primary Author: Felice Slaughter, B.S., R.Ph. State of Indiana Medicaid Drug Utilization Review (DUR) Programs FFY2010 Annual CMS Report State of Indiana Medicaid DUR Annual Report For Federal Fiscal Year 2010 (October 1, 2009 through September 30, 2010) Executive Summary The State of Indiana is committed to operating a Medicaid DUR program that has a positive impact upon quality of care as well as upon pharmacy and medical expenditures. Prospective DUR (pro-DUR) and retrospective DUR (retro-DUR) each serve a unique purpose in alerting practitioners and pharmacists with specific, focused, and comprehensive drug information available from no other source. Within the FFY 2010, a pharmacy benefit consolidation initiative took place. The Office of Medicaid Policy and Planning (OMPP) assumed the responsibility for the administration of the Hoosier Healthwise (HHW) managed care organizations and Healthy Indiana Plan (HIP) pharmacy benefits claims. The consolidation was implemented on December 31, 2009. For FFY 2010, the DUR programs yielded a return on investment of $56.32 for every dollar spent on the DUR program. This significant drug savings increase was due to an increase in the number of claims due to the pharmacy benefit consolidation. In addition, portions of the retro-DUR program resulted in improved patient drug therapy, as designed. The total estimated net savings for FFY 2010 for pro-DUR and retro-DUR programs for Indiana Medicaid is $35.48 million. In FFY 2010, total drug spend was $566.82 million versus $313.5 million in FFY 2009. The retro-DUR savings for FFY 2010 was -$85,729* while the pro-DUR savings was $36.20 million. The total savings for the retro-DUR program and the pro-DUR program is estimated at $36.11 million. The cost to administer both programs is $0.63 million which results in a net savings of approximately $35.48 million. Costs avoided as a result of Indiana Medicaid Pro-DUR edits were estimated to be $36.20 million in FFY 2010 versus $19.25 million for FFY 2009. The number of claims denied due to pro-DUR was approximately 928,468 (versus the 455,00 in FFY 2009). The pharmacy benefit consolidation accounts for the increase in the number of claims for FFY 2010 compared to the number of claims for FFY 2009. The Indiana Medicaid DUR program has been shown to be beneficial to the State, provider community, and beneficiary population served. OMPP will continue to monitor and improve the retro-DUR and pro-DUR programs. *NOTE: The detail discussion of the retro-DUR interventions begins on page 196. © 2011 Affiliated Computer Services, Inc. All rights reserved. May 2011 The preparation of this document was financed under an agreement with Indiana OMPP. Page 3 of 204 Primary Author: Felice Slaughter, B.S., R.Ph. State of Indiana Medicaid Drug Utilization Review (DUR) Programs FFY2010 Annual CMS Report CMS SURVEY DRUG UTILIZATION REVIEW (DUR) ANNUAL REPORT FEDERAL FISCAL YEAR 2010 I. STATE NAME ABBREVIATION IN II. MEDICAID AGENCY STAFF PERSON RESPONSIBLE FOR DUR ANNUAL REPORT PREPARATION 1. Name Marc Shirley, R.Ph., OMPP Pharmacy Operations Manager Street Address Office of Medicaid Policy & Planning, Room W-382 Indiana Government Center South 402 West Washington Street City/State/ZIP Indianapolis, Indiana 46204-2739 Area Code/Phone Number (317) 232-4343 2. Identify pharmacy POS vendor. ________ ______HP Enterprise Services_______________________ (contractor, State-operated, other) 3. If not State-operated, is the POS vendor also the MMIS Fiscal agent? Yes __X__ No ____ III. PROSPECTIVE DUR 1. Identify prospective DUR (criteria source). __X_ First Data Bank ____ Other (Specify) _______________ 2. Are new prospective DUR criteria approved by the DUR Board? Yes __X_ No ____ If answer above is “No”, please explain _________________________________ 3. When the pharmacist receives prospective DUR messages that deny the claim, does your system require: a) ____ Preauthorization b) ____ Allow the pharmacist to override with the correct “conflict”, “intervention” and “outcome” codes? Yes ___ No ___ c) _X_ a) and/or b) above - depending on the situation © 2011 Affiliated Computer Services, Inc. All rights reserved. May 2011 The preparation of this document was financed under an agreement with Indiana OMPP. Page 4 of 204 Primary Author: Felice Slaughter, B.S., R.Ph. State of Indiana Medicaid Drug Utilization Review (DUR) Programs FFY2010 Annual CMS Report Additional Comments: __________________________________________________________________ __________________________________________________________________
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