Idaho Medicaid Drug Utilization Review Program
18 July 2013
1
Follow-up to Previous ReviewsBotulinumtoxin DURHydrocodone/APAP DURNystatin/triamcinolone Combo DUR
2
Botulinumtoxin DUROnly payable on the medical side (not self-
administered and not safe for patient to “brown bag” to physician’s office).
Prior authorization was instituted 7/1/2013.Before June 2013:
Prior authorization requests received were returned to prescriber with a note that prior authorization was not required at this time but would be required starting 7/1/13.
3
Botulinumtoxin DURStarting June 1, 2013:
Prior authorization requests were processed. Approvals were dated 7/1/13 with a note that
prior to July, prior authorization was not required.
Denials were sent back with an explanation of why request was denied. Claims still paid through 6/30/13.
4
Botulinumtoxin DURChronic daily headaches/migraines
New prior authorization form specifically for Botox for chronic daily headaches/migraines was written and posted on the website in June 2013.
Letter was sent in June with a copy of this prior authorization form to the Boise physician that was prescribing and administering the majority of Botox for this indication.
5
Botulinumtoxin DURBotox for indications other than chronic daily
headaches/migrainesAnother prior authorization form was created
for all other indications.
6
Botulinumtoxin DURTherapeutic criteria for chronic daily
headaches/migraines1. At least 15 days per month 2. At least four hours per day (on average)3. Prophylactic medication tried and failed4. Abortive medications (e.g. triptans) filled
monthly for at least 3 months
7
Botulinumtoxin DURDocumentation provided by prescribers has
dramatically improved after feedback from Idaho Medicaid on what information is needed.
Prescriber is now sending us a “Chronic Daily Headache” two page data collection sheet that the patient fills out.
Majority of requests received for this indication have been approved.
For new patients, two injections (12 weeks apart) are approved. This duration was chosen as in the licensing trial, reduction in headache frequency was seen by this length of time.
8
Botulinumtoxin DURFor patients who have already received one
dose prior to 7/1/13, a second dose will be approved if the patient meets the therapeutic criteria.
For patients with a positive response who have already received two or more doses, therapy will be approved for six months.
9
Hydrocodone/APAP DUR
What are the utilization numbers on the various hydrocodone/APAP products?
10
Hydrocodone/APAP DURGCN Seq Number (GSN)
Brand Name Strength Desc
Unique Recipient
s
Total Claims
Avg Qty per Days Supply
Max Qty per Day in System
Cost per tablet or ml (WAC)
60338 HYDROCODONE-ACETAMINOPHEN
5MG-300MG 39 43 4.26 Q06 $1.41
60533 HYDROCODONE-ACETAMINOPHEN
7.5-300MG 20 22 2.85 Q06 $1.55
47430 HYDROCODONE-ACETAMINOPHEN
5MG-325MG 6,149 9,425 3.98 Q06 GAAC=$0.14
47431 HYDROCODONE-ACETAMINOPHEN
7.5-325MG 2,267 4,273 3.75 Q06 GAAC=$0.17
30623 HYDROCODONE-ACETAMINOPHEN
10MG-325MG 4,500 12,591 4.24 Q06 GAAC=$0.15
4202 HYDROCODONE-ACETAMINOPHEN
2.5-500 MG 7 7 1.96 Q06 GAAC=$0.13
4204 HYDROCODONE-ACETAMINOPHEN
5 MG-500MG 2,230 3,291 3.78 Q06 GAAC=$0.05
4205 HYDROCODONE-ACETAMINOPHEN
7.5-500MG 879 1,591 3.65 Q06 GAAC=$0.09
26439 HYDROCODONE-ACETAMINOPHEN
10MG-500MG 198 506 3.74 Q06 GAAC=$0.14
16899 HYDROCODONE-ACETAMINOPHEN
10MG-650MG 12 29 2.99 Q03 GAAC=$0.10
27684 HYDROCODONE-ACETAMINOPHEN
10-660MG 7 19 2.36 Q03 GAAC=$0.16
4207 HYDROCODONE-ACETAMINOPHEN
7.5-750MG 72 110 2.64 Q03 GAAC=$0.58
53582 HYDROCODONE-ACETAMINOPHEN
7.5-325/15 5 5 16.96 Q90 $0.25
53428 HYDROCODONE-ACETAMINOPHEN
7.5-500/15 1,367 1,647 32.80 Q60 GAAC=$0.18
11Idaho Medicaid paid pharmacy claims between 1/1/2013 and 4/30/2013
Nystatin/Triamcinolone Combo DUR
What are the utilization numbers on the various nystatin/triamcinolone combo products?
12
Nystatin/Triamcinolone Combo DUR
Cream Ointment0
20406080
100120140160180200
161
39
175
44
Paid Pharmacy Claims 1/1/2013 through 4/30/2013
RecipientsClaims
13
Nystatin/Triamcinolone Combo DUR
14
0 to 3 4 to 6 7 to 18 19 to 55 56 to 670
20
40
60
80
10080
13
34
60
12
90
13
34
66
16
Paid Pharmacy Claims 1/1/2013 through 4/30/2013
RecipientsClaims
Age of Recipients
Current Interventions/Outcomes StudiesHepatitis C DURDemographics of the Idaho Medicaid Utilizer of
Rx’s PopulationCHIC – Children’s Healthcare Improvement
CollaborationGeo‐Mapping Analysis
Utilization of Narcotic Analgesics (HIC3 = H3A)
15
Current Interventions/Outcomes StudiesP&T Committee Narcotic Analgesic Studies
Narcotic Analgesics in Chronic Non-Malignant Pain 2012 Update
Participants Receiving More Than 1 Long Acting at a Time
Suboxone and Participants Paying Cash for Other Opioids
16
Hepatitis C AgentsIncivek and Victrelis
Review past 6 months of data for usage Are patients that started on therapy continuing
therapy? Will be requesting chart notes to determine why
patients discontinued therapy (e.g. intolerable side effects vs. non-responders to therapy based on viral counts) vs. non-compliance.
Will look for trends in patients that discontinued therapy (e.g. does rate vary between practices or geographically)
Are patients on TRIPLE therapy with ribavirin and interferon? Check for adherence to all three medications.
Audit for checking viral counts at appropriate time intervals
17
Hepatitis C AgentsIncivek and Victrelis
Look at quarterly trends in usage since Incivek/Victrelis were approved by the FDA in May 2011 as patients were not started on double therapy (ribavirin/interferon) as the specialists were waiting for triple therapy to be available.
In the future an all oral regimen is going to be available for treatment of Hepatitis C so there may be patient “warehousing” again.
18
Hepatitis C DUR
2Q20
11
3Q20
11
4Q20
11
1Q20
12
2Q20
12
3Q20
12
4Q20
12
1Q20
13
2Q20
130
10
20
30
40
50
Incivek & Victrelis
Total Paid Claims Unique Prescribers Unique Recipients
19
Hepatitis C DUR
2Q20
11
3Q20
11
4Q20
11
1Q20
12
2Q20
12
3Q20
12
4Q20
12
1Q20
13
2Q20
130
102030405060
Incivek & Victrelis
Total Paid Claims Unique PrescribersUnique Recipients
20
Hepatitis C DUR
2Q20
11
3Q20
11
4Q20
11
1Q20
12
2Q20
12
3Q20
12
4Q20
12
1Q20
13
2Q20
1305
101520253035
Incivek & Victrelis
Total Paid Claims Incivek Total Paid Claims Victrelis
21
Hepatitis C DURReview from 5/1/2012 thru 5/26/2013Total of 53 patients prescribed Incivek or Victrelis36 Incivek17 VictrelisMean age: 47 years (range: 18 – 61)Female: 26Male: 27**All patients had a diagnosis for Hepatitis C (ICD-9 code 070.4 or 070.5)
22
Hepatitis C DUR36 Incivek PatientsMean age: 46 years (range 28 – 61)Female: 16Male: 2029 completed treatment (3 months)5 did not complete treatment1 patient was co-infected with HIV (2
months)2 patients exceeded 3 months 5 months (50 y/o male)4 months (28 y/o male)
23
Hepatitis C DUR
Incivek PaymentTotal payment $1,613,601.00Payment/month $18,000.00
6 months should not have been submitted ($108,000.00)
**All Incivek patients were started on Interferon and Ribavirin
24
Hepatitis C DUR
17 Victrelis patientsMean age: 47 years (range 18 – 60)Female: 10Male: 78 completed treatment Mean # of months: 7 2 did not complete treatment7 active treatment
25
Hepatitis C DUR
Victrelis PaymentTotal payment $355,187.00Payment/month $5074.00
**All Victrelis patients were on Interferon and Ribavirin for 4 weeks prior to Victrelis treatment
26
Hepatitis C DURLetters sent out requesting the following information:HCV GenotypeBaseline Laboratory values (CBC, LFT’s,
SVR)Follow-up Laboratory values while on Incivek
or Victrelis (SVR, LFT’s)Documentation/chart notes of follow-up
treatment and response to treatmentIf documented: Co-infection of HIVIf applicable: reason why therapy was
discontinued (side effects, inadequate response, etc) 27
Demographics of the Idaho Medicaid Utilizer of Rx’s Population
0 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80 to 89 90 to 99 100 to 109
-
5,000
10,000
15,000
20,000
25,000 Paid Pharmacy Claims 1/1/2013 through 4/30/2013
Male FemaleAge in Years
Uni
que
Rec
ipie
nts
28
Demographics of the Idaho Medicaid Utilizer of Rx’s Population
0 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80 to 89 90 to 99 100 to 109
- 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 90,000
Paid Pharmacy Claims 1/1/2013 through 4/30/2013
Male FemaleAge in Years
Tota
l Cla
ims
29
Demographics of the Idaho Medicaid Utilizer of Rx’s Population
0 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80 to 89 90 to 99 100 to 109
$-
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
$8,000,000
$9,000,000 Paid Pharmacy Claims 1/1/2013 through 4/30/2013
Male FemaleAge in Years
Tota
l Pay
men
t A
mou
nt
30
Demographics of the Idaho Medicaid Utilizer of Rx’s Population
Unique Recipients Total Claims Total Payment Amount 10,000
100,000
1,000,000
10,000,000
100,000,000
46,096
260,503
23,059,720
61,189
445,347
26,968,052
107,285
705,850
50,027,771 Paid Pharmacy Claims 1/1/2013 through 4/30/2013
Male Female Combined31
CHIC – Children’s Healthcare Improvement Collaboration
Mental Health Learning Collaborative – Depression Screening in Adolescent
Patients
32
CHICTarget Prescribers: Pediatricians and
Family PracticeGoal: Increase screening for depression in
adolescent patients with appropriate follow-up for those patients with positive screeningsPsychosocial support including counselingMedications (e.g. SSRIs)
Target Dates: Learning session for enrolled providers in
August 2013. Sessions to be held in Boise, Twin Falls, and Pocatello
Start tracking screenings and follow-up in October 2013
Duration of project: 6 months
33
CHICBaseline Data for 2012
3265 unique patients age 12-17 years with at least one paid claim for an SSRI
18,063 total paid claims for SSRIs$265,842
4604 unique patients age 12-17 with at least one paid claim for any antidepressant
30,198 total paid claims for all antidepressants$467,419
34
Geo Mapping Analysis‐Utilization of Narcotic Analgesics (HIC3 = H3A)
Prepared by MMA 6/13/2013Please refer to handout in Packet
35
P&T Committee Narcotic Analgesic StudiesNarcotic Analgesics in Chronic Non-
Malignant Pain 2012 UpdateParticipants Receiving More Than 1 Long
Acting at a Time
36
Narcotic Patterns of Use in Chronic Non-Malignant Pain
Follow-Up from 2011 Study
37
Profile ReviewGenerated profiles for the top 150 recipients by
total narcotic claim count from the recipients who had at least one narcotic claim in each of the 24 months of the period ending March 2013
Time Period: October 1, 2012 through March 31, 2013
Original study: May 1, 2011 through December 31, 2011
Evaluated 142 Cancer Diagnosis found in 8All profiles were hand reviewed by Idaho
Medicaid Pharmacists38
Review FocusYears of opioid use Number of different opioids usedDaily morphine equivalentsNumber of different prescribersOther concurrent central acting/ potentially addictive
drugsDiagnosis or indication for chronic opioid useAverage days between refillsHistory of abuse diagnosisCurrently in lock-in program?Additional opioid use paid outside of Medicaid
39
Length of Time for Continuous Opioid Use
40
Number of Different Opioids
41
Includes different drugs or dosage formsMay or may not be concurrent, but over course of therapy
Daily Morphine Equivalents
42
Lowest = 14 mgHighest = 1340 mg
Number of Prescribers per Participant
43
44
Diagnosis/IndicationsDiagnosis Number of Participants
(incidence)
lubago: unspecified disorder of back; back pain 92
chronic pain; chronic pain syndrome; other chronic pain 73
intevertebral disc disorder; lumbar disc degeneration; cervical disc degeneration; cervicalgia; sciatica; disc degeneration; spondylosis
30
knee injury; shoulder injury; pain in limb; lower leg pain; neck injury; hip and thigh injury; wrist injury
20
hand joint pain; osteoarthritis; rheumatoid arthritis; pain in joint of ankle and foot; ankylosing spondylitis; other disorders of synovium tendon and bursa
37
headache; migraine 9
disorders of muscle ligament and fascia; other disease of bone and cartilage; myalgia 2
abdominal pain, generalized pain 12
multiple sclerosis 1
peripheral neuropathy; diabetic peripheral neuropathy 1chronic pancreatitis 4
Unknown 2
Most patients had multiples diagnoses
45
Average Days Prior to Refill
46
Other Information GatheredNumber on Medicaid Pharmacy Lock-In
5 currently on lock-inNon-Medicaid Opioid Fills
From Board of Pharmacy Reports Many gaps in Board of Pharmacy Reports
34 of the 142 patients ( 24%) had fills not paid for by Medicaid
Concurrent Drug Abuse Diagnosis 66 (46%)
47
Comparison of Original and Follow-up Data2011 Current
Number with Cancer DX 6 8Average # of Years on Opioids
8.2 (Range 3-14) 9 (Range 2-13)
Average # of Different Opioids
2.9 ( Range 1-10) 3 (Range 1-7)
Average Daily Morphine Equivalents
256 (Range 10 mg -2421mg)
208 (Range 14 mg- ) Does not include non-Medicaid paid
Average # of Prescribers/Participant
4 ( Range 1-12) 1 (Range 1-8)
Average Days Prior to Refill
27 25
Lock-in Patients 3 5Patients with Prescriptions Paid Outside of Medicaid
30% 24%
Concurrent Drug Abuse Diagnosis
39% 46%48
Evaluation of Participants Receiving More than One
Long-Acting Narcotic Analgesic Concurrently
49
Long-Acting Narcotic EvaluationGoal: To evaluate impact of planned change
that would only allow one long-acting and one short-acting narcotic analgesic per participant without further prior authorization
Report was run and profiles generated for participants who had a claim for more than one unique long-acting narcotic analgesic between 12/1/2012 and 5/31/2013
N = 65
50
EvaluationProfiles were reviewed and all eliminated for
further review that did not meet the following criteria:Two or more consecutive months of receiving
two or more long-acting agents. Must include most recently evaluated month
(May 2013)Participants meeting criteria = 6Refer to attached table for characteristics of
use for these 6 participants
51
Buprenorphine DURSuboxone and Participants Paying Cash for
Other Opioids(includes Suboxone film, Suboxone tablets, buprenorphine/naloxone tablets, buprenorphine
tablets)
52
Buprenorphine DUR Identified all participants with at least one paid claim by
Idaho Medicaid between 2/1/13 and 4/30/13.
Ran Board of Pharmacy report for all of these participants to identify anyone who had received any other opioid with overlapping days of service and noted payment method (cash, Idaho Medicaid, other insurance). This DUR includes opioid claims from January 2013 that would overlap into February (e.g. paid cash for hydrocodone tablets 1/31/13 and had Idaho Medicaid pay for Suboxone 2/1/13). As the Board of Pharmacy only reports number of tablets and not days of service, we assumed a reasonable number of tablets used per day (e.g. six for hydrocodone/acetaminophen, two for OxyContin). Idaho Medicaid has a manual system for entering a block from paying for opioids for patients on Suboxone therapy but an occasional participant is overlooked allowing Idaho Medicaid to pay for opioids for patients also on Suboxone.
53
Buprenorphine DURData Collected
1. Sex (M/F)2. Age as of 4/30/13 (years)3. Overlapping paid claims for opioids (Y/N)4. What is opioid in addition to Suboxone ?5. Quantity of paid claims6. Duration of therapy of Suboxone7. Concomitant benzodiazepine usage8. Cost of therapy ($ and percentage) for patients paying cash
for opioids
54
Buprenorphine DURFor those patients identified who had paid
claims for other opioids that overlapped with days of service for Suboxone, a letter was sent to prescribers of both Suboxone and any other opioid. The Board of Pharmacy report was included as an attachment to these letters. (See packet for copy of letter)
One week after the letter was sent, payment for Suboxone was blocked by Idaho Medicaid and the lock on paying for other opioids was removed.
55
Buprenorphine DUR
Paid Cash26
13%
Did not pay cash17487%
Patients identified who paid cash for opioids while Idaho Medicaid was paying for Suboxone during time period 2/1/13 -
4/30/13
5666 letters sent out between June 3-10, 2013 to 56 unique prescribers. Gave prescribers one week to respond prior to initiating Suboxone payment block.
Buprenorphine DUR
Paid Cash Didn't pay cash0
20406080
100120140
7
42
19
132Sex
Male Female
# o
f pat
ient
s
57
Buprenorphine DUR
Male Female0
20406080
100120140160
49/200, 24.5%
151/200, 75.5%
Percentage in DUR study
58
Buprenorphine DUR
Male Female02468
101214161820
7/26, 27%
19/26, 73%
Paid Cash
59
Buprenorphine DUR
60
50
45
40
35
30
25
20
15
10
5
0Paid Cash Didn’t Pay Cash All Patients in DUR
Average Age: 38.3Standard Deviation: 10.8
Average Age: 30.8Standard Deviation: 5.0
Average Age: 33.8Standard Deviation: 9.7
Buprenorphine DUR
60/200, 30%
140/200, 70%
All patients in DUR
benzo use no benzo use
10/26, 38%
16/26, 62%
Patients who paid cash for opioids and who were also on benzo's
on benzo not on benzo
61
Buprenorphine DUR: Analysis of Prescribers
One prescriber for both Sub-
oxone and other opioid
Two pre-scribers (one for Suboxone and one for
other opioid)
Two pre-scribers (one for buprenor-
phine and Oxycontin, second pre-
scriber for hy-drocodone)
Three pre-scribers (one for Suboxone and two for
other opioids)
Three pre-scribers (two
prescribers for buprenorphine, third prescriber
for hy-drocodone)
Four pre-scribers (one for Suboxone and three for other opioids)
Ten prescribers (one for subox-one and nine for other opi-
oids)
0
2
4
6
8
10
12
14
16
3
14
1
4
12
1
# o
f pat
ient
s
62
Buprenorphine DUR
Suboxone paid for patients paying cash;
$25,889
Suboxone paid for pa-tients not paying cash;
$202,230
Three Month Time Period
63
11.3% of total expenditure - potential cost savings: $103,557 annually
Buprenorphine DUR
1 2 3 4 5 9 10 1202468
101214 12
5
2 2 1 2 1 1
# of opioid prescriptions paid cash for by patients during 3 month time period
# of opioid prescriptions
# o
f pat
ient
s
64
Buprenorphine DUR
73
2
Of 12 patients with one cash paid opioid prescription during the three month DUR
study had paid for addi-tional opioids be-fore/after study periodwere patients recently started on Suboxonehad been on Subox-one for a while with only the one paid opioid claim
65
Buprenorphine DUR
60
15
3 2 1
Opioids paid cash for
hydrocodoneoxycodonehydromorphonemethadonemorphine
66
Buprenorphine DUR
Feb - A
pr 20
13
Oct 20
12 -Ja
n ...
Jan - S
ep 20
1220
1120
1020
0920
0820
0720
0620
0520
0420
0305
101520253035404550
paid cash
did not take other opioids
Suboxone Therapy Initiated
# o
f pat
ient
s
67
Buprenorphine DURBottom Line: Patients were found to be
paying cash for opioid therapy even after many years on Suboxone therapy.
Example – Patient who has been on Suboxone since 2006 paid cash 9 times for opioids during the 3 months of this DUR and 52 times total in the last two years (42 fills for oxycodone and 10 fills for hydrocodone).
68
Buprenorphine DURFeedback from week 1
One physician called and left message. Pharmacist called back and spoke to his nurse to explain what was happening. The physician never called back.
One participant called to complain, Pharmacist called and spoke to physician and re-authorized payment for Suboxone (second chance).
69
Buprenorphine DURFeedback from week 2
Participant called to state that Norco was not filled by her. Pharmacist called prescriber of both Suboxone and Norco. Giving her a second chance.
Physician called and stated that patient had knee surgery and was “off” Suboxone immediately post-op but plan is to stop other opioid and restart Suboxone.
Physician called and stated that patient had one fill of hydrocodone for dental surgery and would like patient to continue on Suboxone.
70
Buprenorphine DURContinued feedback
Patient’s Suboxone discontinued by prescriber due to other opioid use: 2 patients
Prescriber requested (and was granted) re-authorization for Suboxone after fill of other opioid s/p surgery: 2 patients
71
Buprenorphine DURFuture Plans
The department plans on running routine Board of Pharmacy reports every 3-6 months on all Suboxone patients.
Questions/Comments ?
72
Proposed Studies for Next Quarter:SynagisP&T Committee Narcotic Analgesic
Studies – Next StepsUse of Psychotropic Medications in Foster
Children – Next Steps2012 Data Analysis UpdateThree (3) or more concomitant mood stabilizer
medicationsIVIG
73
Proposed Studies for Next Quarter:LevofloxacinAntipsychotic Indication Evaluation- Hold
for Future
74
Synagis DUR
75http://healthandwelfare.idaho.gov/Portals/0/Health/Epi/RSV/RSV%20graph.pdf
Synagis DUR
76
What should the focus be for the DUR project for the concluded 2012-2013 RSV season?
P&T Committee Narcotic Analgesic Studies – Next Steps
77
Use of Psychotropic Medications in Foster Children The U.S. Government Accountability Office
released the results from a study that they performed examining the rates of psychotropic medications for foster and nonfoster children in 2008.
It was determined that HHS Guidance Could Help States Improve Oversight of Psychotropic Prescriptions.
78
Foster Children Psychotropic Drugs Red Flags
7/18/2013
79
Red FlagsFive (5) or more psychotropic medications prescribed
concomitantly (reviewed August 2012)Two (2) or more concomitant antidepressants
(reviewed October 2013)Two (2) or more concomitant antipsychotic
medications (current)Two(2) or more concomitant stimulant medications
long-acting plus short-acting okThree (3) or more concomitant mood stabilizer
medicationsPsychotropic polypharmacy (2 or more agents) for a
given mental disorder prescribed before utilizing psychotropic monotherapy 80
81
Implementation of Red Flags
Retroacti
ve Evaluatio
n
Identify outliers
Profile
Review
DUR Board Intervention• Targ
eted education
Re-evaluation• indi
viduals
• overall
Further
Action
Point of service edits• Informa
tional (soft) – pharmacist override
• Hard Stop
ADHD Drugs Anti-depressants Mood Stabilizers Atypical Antipsychotics0%
5%
10%
15%
20%
25%
30%
35%
40%
36%
23%
13%
21%
9%
6%
0%
4%
Percent of Foster and Non-Foster Children Psychotropics by Drug Class
Calendar Year 2011
% Foster Children% Non-foster Children
Total foster =2785Total Non-Foster = 106,024
82
Use of Psychotropic Medications in Foster Children: Next Steps2012 Data Analysis UpdateThree (3) or more concomitant mood
stabilizer medications
83
IVIGIVIG follow-up as implemented prior
authorization criteria 1-1-13. Will look at cost of therapy (pharmacy and medical) January – June 2012 vs. same dates 2013 as well as some comments on prior authorization requests received.
84
LevofloxacinLevofloxacin – changed minimum age from 16
down to zero 11-1-12 so look at usage Jan – June 2012 vs. same dates 2013 for children and compare utilization.
85
Antipsychotic Indication Evaluation- Hold for Future
86
Prospective DUR ReportHistory Errors:
• DD – drug-to-drug• PG – drug to pregnancy• TD – therapeutic
duplication• ER – early refill• MC – drug-to-disease
Non-History Errors:• PA – drug-to-age• HD – high dose• LD – low dose• SX – drug-to-gender
87
Prospective DUR ReportIdaho Medicaid ProgramProDUR Message Report
June-13
ProDUR ProDUR Message MessageMessage Severity Count Amount
Drug To Drug 1 1,381 $373,620.15 2 13,026 $2,521,971.05 3 67,204 $12,025,994.08Drug To Gender 1 146 $34,461.03 2 2,195 $265,410.63Drug To Known Disease 1 65,499 $9,849,442.93 2 229,816 $42,448,043.20 3 291,920 $54,632,417.89Drug To Pregnancy 1 23 $301.97 2 15 $483.73 A 4 $39.35 B 70 $10,458.15 C 126 $12,492.54 D 7 $130.78 X 10 $844.76Duplicate Therapy 0 108,162 $24,283,884.93Min Max 0 29,517 $4,838,004.04Too Soon Clinical 0 19,545 $3,632,514.43ALL 828,666 $154,930,515.64 Total Number of Claims with Messages 200,209 Average ProDUR Message Per Claim 4.14
88
DUR Summer NewsletterCopy of Spring Newsletter in packetBrainstorm for new topics
89
Medicaid Update
90