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Idaho Medicaid Drug Utilization Review Program

Idaho Medicaid Drug Utilization Review Program . 10 October 2013. Follow-up to Previous Reviews. Nystatin/Triamcinolone Combo DUR (re-run summer months to compare to previous, as well as potent steroid combos – these fall in combo rule so no claims)

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Idaho Medicaid Drug Utilization Review Program

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  1. Idaho Medicaid Drug Utilization Review Program 10 October 2013

  2. Follow-up to Previous Reviews • Nystatin/Triamcinolone Combo DUR (re-run summer months to compare to previous, as well as potent steroid combos – these fall in combo rule so no claims) • Suboxone and Participants Paying Cash for Other Opioids • Hepatitis C DUR • Geo‐Mapping Analysis • Utilization of Narcotic Analgesics (HIC3 = H3A) 16YO+

  3. Nystatin/Triamcinolone Combo DUR • What are the utilization numbers on the various nystatin/triamcinolone combo products?

  4. Nystatin/Triamcinolone Combo DUR

  5. Nystatin/Triamcinolone Combo DUR

  6. Nystatin/Triamcinolone Combo DUR • Questions/Comments ???

  7. Buprenorphine DUR Suboxone and Participants Paying Cash for Other Opioids (includes Suboxone film, Suboxone tablets, buprenorphine/naloxone tablets, buprenorphine tablets)

  8. Buprenorphine DUR Follow-Up • Identified all participants with at least one claim paid for oral buprenorphine by Idaho Medicaid between 6/1/13 and 8/31/13. n=201 • 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).

  9. Buprenorphine DUR Follow-Up

  10. Buprenorphine DUR Follow-Up Note: Adds up to more than 27 as some patients paid cash for multiple opioids.

  11. Buprenorphine DUR Follow-Up • 2 patients had both Suboxone and another opioid prescribed by the same doctor. The other 25 patients had different prescriber(s) for the other opioids.

  12. Buprenorphine DUR Follow-Up

  13. Buprenorphine DUR Follow-Up • Case Study: • Patient identified during DUR done the previous quarter and payment was blocked for Suboxone after it was filled in June. Between June through August 2013, patient filled hydrocodone 18 times, oxycodone 4 times, and codeine once. This patient obtained prescriptions from 9 different prescribers and used 9 different pharmacies during this three month period. Letters were sent to all 9 prescribers and she is in the process of being enrolled into the lock-in program. Prescribers included two ER physicians, 2 internal medicine physicians, 2 family medicine physicians, an orthopedic surgeon, an otolaryngologist, and a physician’s assistant. At this time, Idaho Medicaid has blocked payment for Suboxone as well as other opioids. She is paying cash for all of these drugs and is getting medication filled every several days.

  14. Buprenorphine DUR Follow-Up • Called Suboxone Prescribers • Was prescriber aware of other opioids paid for with cash? • What was the consequence to the patient?

  15. Buprenorphine DUR Follow-Up

  16. Buprenorphine DUR Follow-Up

  17. Buprenorphine DUR Follow-Up

  18. Buprenorphine DUR Follow-Up

  19. Buprenorphine DUR Follow-Up • Unable to contact one prescriber (n=2) • Left three voicemail messages and sent letters on two of his patients that had paid fills for hydrocodone as well as Suboxone. Blocking payment to Suboxone one week after letters sent.

  20. Buprenorphine DUR Follow-Up • All prescribers were appreciative of the information Idaho Medicaid provided to them. • Future Plans • The department plans on running routine board of pharmacy reports every 3 to 6 months on all Suboxone patients.

  21. Hepatitis C DUR • Total Medicaid patients who received HepC treatment: • 53 (36 Incivek, 17 Victrelis) • Letters were sent to prescribers in June 2013 and for those who did not respond sent again August 2013 • Requested information returned from prescribers: • 46 (29 Incivek, 17 Victrelis) (13% no response from provider)

  22. Hepatitis C DUR 1A-10, 1B-10, Type 1 unspecified-9 1A-10, 1B-3, Type 1 unspecified-4

  23. Hepatitis C DUR

  24. Hepatitis C DUR • All patients from both groups who reported back underwent triple therapy with Pegylated Interferon and Ribavirin • No patients who reported back had an HIV co-infection • Initial Viral Loads • Lowest – 18,029, Highest – 69,000,000, Average – 5,777,694 • Info not received for 5 patients (11%)

  25. Hepatitis C DUR

  26. Hepatitis C DUR

  27. Hepatitis C DUR Yes-9, No- 6 d/t SEs & 1 d/t Non-response, In progress-9, Info not provided-4 Yes-3, No-3 d/t SEs & 1 d/t infection, In progress-4, Info not provided-6

  28. Hepatitis C DUR

  29. Hepatitis C DUR Non-responder-1, Side effects-6, Co-Morbid Condition-0 Non-responder-0, Side effects-3, Co-Morbid Condition-1

  30. Hepatitis C DUR • Question/comments ???

  31. Geo‐Mapping AnalysisUtilization of Narcotic Analgesics (HIC3 = H3A) 16 YO+ Prepared by MMA 6/13/2013 originally Age specific prepared by MMA 8/5/2013 Please refer to handout in Packet

  32. Current Interventions/Outcomes Studies • Use of Psychotropic Medications in Foster Children – Next Steps • 2012 Data Analysis Update • Immune Globulin (IV and SQ) Follow-up to 2012 DUR Project

  33. Current Interventions/Outcomes Studies • Non-Preferred Growth Hormone • Levofloxacin • Oral ketoconazole • Imitrex Pens

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