DRUG UTILIZATION REVIEW BOARD

October 19, 2016

Department of Natural Resources, LaCharrette/Nightengale Conference Rm, Jefferson City MO

DUR BOARD MEMBERS PRESENT / MHD STAFF PRESENT
Susan Abdel-Rahman, PharmD – Board Chair / Mark Roaseau, R.Ph, Clinical Pharmacist
Kenneth Haller, MD / Stephen Calloway, R. Ph, Director of Pharmacy
Randy Beckner, Pharm D / Jenna McTeer, RN, Clinical Management
Sandra Bollinger, PharmD / Angela Wilson, Manager Band I
Kirk Nelson, MD / Timothy Kling, MD, Assistant Medical Director EBU
Jennifer Passanise, FNP / Megan Goldthrite, Administrative Office Support Assistant
Stacey Mangum, Pharm D / Elizabeth Short, Medicaid Specialist
DUR BOARD MEMBERS ABSENT / CONTRACTED STAFF PRESENT
Charlene Heyde, R. Ph / Josh Moore, PharmD, Xerox
Glenn Talboy, MD / Katie Wilbers, PharmD, Xerox
Ginger Nicol, MD / Luke Boehmer, PharmD, Xerox
OTHERS IN ATTENDANCE
Del Deem, Astra-Zeneca
Ashley Polce, Abbvie
Todd Herman, Merck
Steve Naert, Eli Lilly
Evan Rushing, Alkermes
Chelsea Pendleton, Wipro / Jill Nitz, Wipro
Eric Gardner, Vertex
Randi Lewandowski, Teva
Terry McCurren, Otsuka America
Edie Dodson, Genzyme
Jim Bauman, Pfizer
Christina Yuan, KU School of Pharmacy / Phil King, Pfizer
Sign in sheet on file for review.
Welcome, Introductions and Opening Remarks / Susan Abdel-Rahman, PharmD, called the meeting to order. A quorum was established. Stephen Calloway, R.Ph facilitated the meeting on behalf of the MO HealthNet Division (MHD).
Minutes Review and Approval / Minutes of the July2016 DUR Board meeting were reviewed and approved as submitted. (See Roll Call Votes)
Pharmacy Program/Budget Update / Stephen Calloway presented a brief PowerPoint including highlights and details of the Pharmacy Program. 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.The top four drug classes per FY were shared. Pharmacy expenditures were discussed, including Information on the Hepatitis C Expenditures FY 2015 thru FYTD 2017.Other program statistics were shared, along with discussion of pharmaceutical industry trends and observations.Calloway indicated MHD is working with other state agencies as part of the Prescription Drug Misuse Workgroup.
Review of Prior Authorization Meeting / Copies of the agenda and draft minutes, including public hearing, from the September 2016Drug Prior Authorization Committee Meeting were included in the members' meeting packet.
Old Business
Implementation Schedule / An updated copy of the Proposed Implementation Schedule for Edits, including PDL classes and Clinical Edits was included in the Members’ meeting packet and provided as a handout to all attending. Calloway informed the Board that the approvedAnnual Preferred Drug List (PDL) from June/July wasimplemented on October 6, 2016. Renewed Therapeutic Classes approved in Sept/Oct will be implemented January 2017. Upcoming PDL decisions from Dec/Jan will be implemented April 2017. Schedules may be found on the MHD web page at
New Drug Review / Stephen Calloway reviewed the new drug products that were identified for the quarter April, May and 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, along with the Drug Prior Authorization Committee’s actions/decisions.
  • Decision -The listing and recommendations were approved as part of a block vote by the DUR Board (See Roll Call Votes).

Clinical Edits
Short-Acting Narcotics Clinical Edit / ● Discussion – Mr. Calloway reviewed the Clinical Edit proposal, along with information on projected claims and call center impact. Implementation of the edit is not planned until 2017.
● Decision – This edit was accepted and added to the block vote. (See Roll Call Votes)
Short-Acting Combination Narcotics Clinical Edit / ● Discussion – Mr. Calloway reviewed the Clinical Edit proposal, along with information on projected claims and call center impact. Implementation of the edit is not planned until 2017.
● Decision – This edit was accepted and added to the block vote. (See Roll Call Votes)
Opiate Reversal Agents Clinical Edit / ● Discussion –Mr. Calloway reviewed the Clinical Edit proposal, along with stated intent of the edit. It was stated this could become a Preferred Drug List category in the near future.
● Decision – This edit was accepted and added to the block vote. (See Roll Call Votes)
Preferred Drug List (PDL) Annual Review
ACE Inhibitor Agents /  Discussion –– Mr. Calloway presented 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)
ACE Inhibitors/Calcium Channel Blocker Combination Agents /  Discussion – Mr. Calloway presented 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)
ACE Inhibitors/Diuretic Combination Agents /  Discussion – Mr. Calloway presented 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)
Angiotensin Receptor Blocker Agents (ARB’s) /  Discussion – Mr. Calloway presented 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)
Angiotensin Receptor Blocker/Diuretic Combination Agents /  Discussion – Mr. Calloway presented 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)
Angiotensin Receptor/Calcium Channel Blocker Combination Agents /  Discussion – Mr. Calloway presented 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)
Anticoagulant Agents: Oral and Subcutaneous /  Discussion –– Mr. Calloway presented the criteria document, reviewing preferred and non-preferred agents. This category was updated to separate out the Antiplatelet Agents.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Antiplatelet Agents /  Discussion – Mr. Calloway presented the criteria document, reviewing preferred and non-preferred agents. Antiplatelet Agents are now contained in a separate PDL category.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Beta Adrenergic Blockers and Diuretic Combination Agents /  Discussion – Mr. Calloway presented 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)
Calcium Channel Blocker Agents (Dihydropyridines) /  Discussion – Mr. Calloway presented 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)
Calcium Channel Blocker Agents (Non-Dihydropyridines) /  Discussion – Mr. Calloway presented 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)
Direct Renin Inhibitors and Combination Agents /  Discussion – Mr. Calloway presented 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)
Hepatitis C Therapy: Direct-Acting Antiviral Agents /  Discussion – Mr. Calloway presented the criteria document, reviewing preferred and non-preferred agents. It was emphasized that MHD is requesting decision on PDL status, but will continue with F3 criteria.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Homozygous Familial Hypercholesterolemia Products /  Discussion – Mr. Calloway presented 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)
Lipotropic Agents: Niacin and Combination Preparations /  Discussion – Mr. Calloway presented 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)
Lipotropic Agents: Statins (HMG Co-A Reductase Inhibitors) and Statin Combination Products /  Discussion – Mr. Calloway presented 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)
Proton Pump Inhibitor Agents /  Discussion – Mr. Calloway presented 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)
Pulmonary Hypertension Agents: Inhaled/Injectable /  Discussion – Mr. Calloway presented 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)
Pulmonary Hypertension Agents: Oral /  Discussion – Mr. Calloway presented 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)
Sympatholytic Antihypertensive Agents /  Discussion – Mr. Calloway presented the criteria document, reviewing preferred and non-preferred agents. Although the agents in this category are not new, the PDL category is new to MHD.
● Decision – This PDL recommendation was accepted and added to the block vote. (See Roll Call Votes)
Triglyceride Lowering Agents /  Discussion –Mr. Calloway presented 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)
Preferred Drug List Discussion/Therapeutic Classes / A handout of therapeutic categories scheduled for Annual Reviewand Renewal on the Preferred Drug List at the December/January Advisory meetings was included in the meeting packet. This handout was also provided to all attendees and will be posted to the Division's web page.
Xerox Update / Luke Boehmer, Pharm D reviewed clinical edits.
Top 25 Drugs by Cost / Dr. Boehmer reviewed the Top 25 Drugs Summary Reports for the 3rd quarter 2015 through the 2nd quarter 2016.Two versions were presented: one report ranked drug spend by dollars and the other by utilization/claims.
Call Center Statistics
Clinical Edit Summary Report / 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. Board members were also updated on approved, denied, and total Prior Authorizations for New Drugs in August and September 2016, as well as PA transaction counts by PDL and Clinical Edit.
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 DUR Board meeting is scheduled for January 18, 2017.

Roll Call Votes –October 19, 2016

MEMBER / MEETING MINUTES / ALL RECOMMENDATIONS BLOCK VOTE / CLOSED SESSION / ADJOURN
Susan Abdel-Rahman, Pharm D / Y / Y / Y / Y
Charlene Heyde, RPh / - / - / - / -
Sandra Bollinger, Pharm D / 2Y / Y / Y / Y
Kenneth Haller, MD / MY / MY / Y / Y
Glenn Talboy, MD / - / - / - / -
Jennifer Passanise, FNP / Y / 2Y / Y / Y
Stacy Mangum, Pharm D / Y / Y / MY / Y
Kirk Nelson, MD / Y / Y / Y / Y
Ginger Nicol, MD / - / - / - / -
Randy Beckner, Pharm D / Y / Y (3 Triglyceride, Pulmonary, Arterial Hypotension Agents, Beta Adrenergic, Diabetic Combo / 2Y / Y

EXECUTIVE SESSION

October 19, 2016

DUR BOARD MEMBERS PRESENT / MHD STAFF PRESENT
Susan Abdel-Rahman, PharmD / Mark Roaseau, R.Ph, Clinical Pharmacist
Kenneth Haller, MD / Stephen Calloway, R.Ph
Randy Beckner, Pharm D / Jenna McTeer, RN., Clinical Management
Sandra Bollinger, PharmD / Angela Wilson, Manager Band I
Stacy Mangum, Pharm D
Jennifer Passanise, FNP
Kirk Nelson, MD
DUR BOARD MEMBERS ABSENT / CONTRACTED STAFF PRESENT
Charlene Heyde, R.Ph
Glenn Talboy, MD
Ginger Nicol, MD / Josh Moore, Pharm D, Xerox
Katie Wilbers, Pharm D, Xerox
Luke Boehmer, Pharm D, Xerox
Minutes Review / Minutes of the July Executive Session were approved as submitted.
Case Reviews / Jenna McTeer, RN reviewed 1 case.
Adjourn / Executive session adjourned.

1