Why does Alaska Medicaid have a Drug Utilization Review program?
Alaska Medicaid’s Drug Utilization Review, (DUR), program was developed in order to comply with the federal requirements set forth in the Omnibus Budget Reconciliation Act of 1990. Prospective and retrospective DUR are required by both federal and state law. The State of Alaska contracts with Conduent State Healthcare , to conduct the DUR program.
Prospective DUR (ProDUR) is performed by all Alaska pharmacists before filling any prescription. Proprietary software developed by the pharmacy claims processor, Magellan Health Services, is used to check for potential problems with a Medicaid patient’s medication therapy. This software will bring the pharmacists attention to such matters as drug-drug interactions, therapeutic duplications, early refills, pregnancy cautions, as well as other potential problems.
In response to actual or potential medication utilization issues the Department may implement strategies to address safety, fraud, waste, abuse, misuse or medically unnecessary care. Some of the ProDUR interventions currently used are prior authorizations, step-edits, therapeutic duplication edits and quantity limits. A list of the medications impacted by ProDUR edits can be found at the Medication Prior Authorization webpage.
Retrospective DUR is performed by the state’s DUR Committee some time after a prescription is filled. The committee consists of physicians, pharmacists, and other healthcare providers who are actively practicing in the community, as well as 1 pharmacist who is a state employee and coordinates the committee’s activities. The committee meets at least quarterly to review the use of medications by Medicaid recipients, and identify regimens that do not meet predetermined clinical criteria. When an aberrant pattern of prescribing and/or utilization is identified, an educational letter is sent to the prescriber and/or dispensing pharmacist informing them of the potential problem and requesting a reply which explains how the issue will be addressed.
DUR Committee Members
- Ryan Ruggles, Pharm. D.
- Maggie Rader, ANP
- Jenny Love, MD, MPH
- Charles Semling, Pharm.D.
- John Pappenheim, M.D.
- Heath McAnally, MD, MPH
* If you are interested in serving on the DUR Committee please contact the committee coordinator
Prospective DUR: The following ProDUR interventions have recently been implemented to address actual or potential issues of safety, fraud, waste, abuse, misuse, or medically unnecessary care:
- New Prescription Medication now require prior authorization for at least 6 months following the availability to the market.
- Prior authorization criteria were implemented for Adcirca, Ampyra, Fentora, Onsolis, Revatio, Serostim, Suboxone and Subutex.
- Quantity limits have been implemented for Provigil, Nuvigil, Suboxone, Subutex, Revatio, Adcirca, Fentora, and Onsolis.
Additional prior authorizations, therapeutic duplications edits, quantity limits and step-edits have been approved by the DUR committee and will be implemented in Federal Fiscal Year 2011.
Retrospective DUR: The state of Alaska has a successful DUR program. During Federal Fiscal Year 2009, the committee reviewed an average of 77 profiles each meeting and generated 908 letters to prescribers addressing one or more of the following twelve therapeutic classes:
- Anti-Ulcer Preparations
- Ataractics – Tranquilizers
- Muscle Relaxants
- CNS Stimulants
- Bronchial Dilators
- Narcotic Analgesics
- Antinausea Agents
During Federal Fiscal Year 2009, cooperation between Medicaid providers and the DUR Committee resulted in improved patient safety, and allowed the state of Alaska to reduce drug expenditures by over $115,000 or over $119 per intervention.