DRUG UTILIZATION REVIEW BOARD
July 20, 2016
Department of Natural Resources, LaCharrette/Nightengale Conference Rm, Jefferson City MO
DUR BOARD MEMBERS PRESENT / MHD STAFF PRESENTSusan Abdel-Rahman, Pharm D / Mark Roaseau, R.Ph, Clinical Pharmacist
Charlene Heyde, RPh / Stephen Calloway, R. Ph
Randy Beckner, Pharm D / Jenna McTeer, RN
Sandra Bollinger, PharmD / Christine Thompson, Fiscal Manager
Ginger Nicol / Angela Wilson, Manager Band I
Jennifer Passanise, FNP / Lisa Smith, DUR Coordinator
Kenneth Haller, MD / Megan Goldthrite, Administrative Assistant
Elizabeth Short
Dr. Timothy Kling
DUR BOARD MEMBERS ABSENT / CONTRACTED STAFF PRESENT
Kirk Nelson, MD / Josh Moore, Clinical Pharmacist, Xerox
Glenn Talboy / Katie Wilbers, Clinical Pharmacist, Xerox
Luke Boehmer, Xerox
OTHERS IN ATTENDANCE
John Kirby, Sanoti / Ken Ludwig, The Medicine Co. / Aimee Redhair, UCB
Jeff Knappen, Allergan / Tyler Craddok, The Medicine Co. / Randi Lewandowski, Teva
Ashley Pelce, Abbvie / Evan Rushing, Alkermes / Terry McCurren, Obuka America
Mike Lafond, Abbvie / Shefali Patel, Wipro / Melissa Laurie, BMS
Todd Herman, Merck / Phil King, Pfizer / Lisa Tootle, BMS
Marc Welborn, Intercept / Sara Schenkelberg, Pfizer / Dan Keeney, Tris
Jim Baumann, Pfizer / Christina Soltmli, Amgen / Casey Johnson, Viiv
*Many names on the sign in sheet were illegible. Sign in sheet on file for review.
Welcome, Introductions and Opening Remarks / Susan Abdel-Rahman, Pharm D, called the meeting to order. A quorum was established. Stephen Calloway, R.Ph facilitated the meeting on behalf of the MO HealthNet Division (MHD). Stephen Calloway introduced Christine Thompson.
Minutes Approval / Minutes of the April 2016 meeting were reviewed and approved as submitted.
Pharmacy Program/Budget Update / Stephen Calloway presented a brief PowerPoint. The presentation contained graphs representing an expenditure amount per member for all eligible participants, disabled participants, elderly participants, and other; a pie chart of participants; and expenditures by participants. Information on the Blind Pension was also presented, with support from Angela Wilson and Lisa Smith. Generic dispensing rates were shared with the Committee. Mr. Calloway also mentioned that MO HealthNet is working to implement expansion of Medicaid Managed Care and Telehealth, while continuing to manage expenses. Mark Roaseau spoke about what is going on with ICD-10 and October 1st official start date.
Review of Prior Authorization Meeting / Copies of the agenda and draft minutes, including public hearing, from the June 2016 Drug Prior Authorization Committee Meeting were included in the members' meeting packet.
Implementation Schedule / An updated copy of the Proposed Implementation Schedule for Edits, including PDL classes was included in the Members’ meeting packet and provided as a handout to all attending. The schedule included the therapeutic classes will be implemented October 2016. PDL decisions from June/July will be implemented October 2016. Schedules may be found on the MHD web page at http://dss.missouri.gov/mhd/cs/pharmacy/impsched.pdf
New Drug Review / Stephen Calloway reviewed the new drug products that were identified for the quarter April, May, June 2016 and the recommended status within the clinical program.
· Discussion – A listing of products recommended for open access, clinical edit, preferred drug list (PDL) product, or continued prior authorization was provided in the Members’ meeting packet for discussion and action. This listing was also provided as a handout to all attending.
· Decision – This was accepted and added to the block vote. (See Roll Call Votes)
Old Business / Stephen Calloway informed the Board that the approved Preferred Drug List (PDL) from June/July will be implemented in October 2016.
Clinical Edits
Entresto Clinical Edit / ● Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This edit was accepted and added to the block vote. (See Roll Call Votes)
PCSK9 Inhibitors (Praluent/Repatha) Clinical Edit / ● Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This edit was accepted and added to the block vote. (See Roll Call Votes)
Xolair/Nucala Clinical Edit / ● Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This was voted on separately to say that it will be revisited. (See Roll Call Votes)
Preferred Drug List (PDL) Annual Review
Amylin Analogs / · Discussion – Mr. Calloway stated there are no changes recommended for this class.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Antihyperuricemic Agents / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Bile Salts Agents / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Targeted Immune Modulators (formerly Biologics – Disease Modifying Anti-Rheumatic Drugs- DMARDs) / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Bone Deossification Suppression Agents (including Calcitonin) / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
BPH Agents (formerly Androgen Hormone Inhibitors) / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents..
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Cryopyrin-Associated Periodic / · Discussion – Mr. Calloway stated there are no changes recommended for this class.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Syndrome (CAPS) Agents / · Discussion – Mr. Calloway stated there are no changes recommended for this class.agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
DPP-IV (Dipeptidyl Peptidase-4) Inhibitors / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Electrolyte Depleters (Phosphate Binders) / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Fluoroquinolones – Oral / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
GLP-1 Receptor Agonists (Anti-Diabetic Mimetics) / · Discussion – Mr. Calloway stated there are no changes recommended for this class.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Growth Hormones / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents..
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Hematopoietic Agents / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Ribavirins / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Insulins / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Insulins – Long Acting / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Insulins- Mix / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Insulins – Rapid Acting / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Intravaginal Antibiotics / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Macrolides – Adult / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Macrolides – Pediatric / · Discussion – Mr. Calloway stated there are no changes recommended for this class.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Multiple Sclerosis (MS) Agents
Pancreatic Enzymes / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Oral Anti-Diabetics: Alpha-Glucosidase Inhibitors / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Oral Anti-Diabetics: Biguanides / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Oral Anti-Diabetics: Combinations / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Oral Anti-Diabetics: Meglitinides / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Oral Anti-Diabetics: Sulfonylureas 2nd Generation / · Discussion – Mr. Calloway stated there are no changes recommended for this class.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Oral Anti-Diabetics: Thiazolidinediones / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Tetracyclines / · Discussion – Mr. Calloway stated there are no changes recommended for this class.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Urinary Tract Antispasmodics / · Discussion – Mr. Calloway reviewed the criteria document, reviewing preferred and non-preferred agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Xerox Update / Luke Boehmer, PharmD reviewed clinical edits, utilization data and trends for ADHD. Also, spoke about the different reasons for denials.
Preferred Drug List Discussion/Therapeutic Classes / A handout of therapeutic categories to be reviewed for inclusion on the Preferred Drug List for the next phase and meeting was included in the meeting packet. This handout was also provided to all attendees and will be posted to the Division's web page.
Top 25 Drugs by Cost / Dr. Boehmer reviewed the Top 25 Drugs Summary Reports for the 4th quarter 2015 and the 1st quarter 2016. Two versions were presented: one report ranked drug spend by dollars and the other by utilization/claims.
Call Center Statistics / A handout detailing pharmacy help desk call center activity was provided for all attending. Cyber Access Active User Counts and Logging Information reports detailing activity were shared. Dr. Boehmer reviewed how many sites/physical locations are trained and have access to CyberAccess. Reports also detailed the number and type of prescribers and active users on CyberAccess.
Adjourn / The DUR Board went into Executive Session for the sole purpose of discussing individual participant specific medical information. At the conclusion of these discussions the group adjourned entertaining no further business, actions or motions. (See attached roll call vote). The next meeting is scheduled for
October 19, 2019.
Roll Call Votes – July 20, 2016
MEMBER / MEETING MINUTES / ALL RECOMMENDATIONS BLOCK VOTE / CLOSED SESSION / ADJOURNSusan AbdelRahman / Y / Y / Y / Y
Charlene Heyde / Y / Y / Y / 2Y
Sandra Bollinger / MY / 2Y / Y / MY
Kenneth Haller / Y / Y / 2Y / Y
Glenn Talboy / - / - / - / -
Jennifer Passanise / Y / Y / Y / Y
Stacy Mangum / Y / Y / Y / Y
Kirk Nelson / - / - / - / -
Ginger Nicol / 2Y / MY / MY / Y
Randy Beckner / Y / Y (Abstained from Xonair/Nucala, Bone Deossification, BPH, GLP-1, Oral Anti-Diabetics, Oran Combinations, Oral Anti-Diabetics Thiazolidinediones, SGLT2, Urinary Tract Atispasmodics) / Y / Y
EXECUTIVE SESSION
July 20, 2016
DUR BOARD MEMBERS PRESENT / MHD STAFF PRESENTSusan Abdel-Rahman, Pharm D / Mark Roaseau, R.Ph, Clinical Pharmacist
Charlene Heyde, RPh / Stephen Calloway, R. Ph
Randy Beckner, Pharm D / Jenna McTeer, RN
Sandra Bollinger, PharmD / Andrew Haslag, Fiscal Manager
Ginger Nicol / Angela Wilson, Manager Band I
Jennifer Passanise / Lisa Smith, DUR Coordinator
Megan Goldthrite, Administrative Assistant
Elizabeth Short
DUR BOARD MEMBERS ABSENT / CONTRACTED STAFF PRESENT
Kirk Nelson, MD / Josh Moore, Clinical Pharmacist, Xerox
Stacy Mangum / Katie Wilbers, Clinical Pharmacist, Xerox
Glenn Talboy / Luke Boehmer, Xerox
Kenneth Haller, MD / 1 Student
Minutes Review / Minutes of the January Executive Session were approved as submitted.
Case Reviews / Jenna McTeer, RN reviewed 2 case.
Adjourn / Executive session adjourned.
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