TennCare Drug Utilization Review (DUR) Board Minutes - Magellan ...

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generic category comprises 84% of TennCare pharmacy claims verses the brand originator at only 0.34%. o There are 5 classes of drugs in both the top 10 claim volume and top 10 payment amount. Those drugs classes consist of Narcotic Analgesics, Anticonvulsants, ADHD Agents, Sympathomimetics, and Atypical Antipsychotics. o Generic olanzapine (Zyprexa®) became available in Oct 2011. Generic quetiapine (Seroquel®) will be available in March. Perhaps in the next year and half we will see a decline in atypical antipsychotic payment amount. o Antihemophilic agents’ payment amount increased 38% due to increased utilization. There have been 5 additional hemophilic enrollees since 4q10. There has been an increase in the utilization of NovoSeven®. o Simvastatin claims decreased approximately 10%. This is primarily due to the recommendation from the FDA to limit the use of simvastatin 80mg. A DUR activity went out in June 2011 to notify prescribers of the FDA recommendation which included dosage restrictions, a limitation on the use of the 80mg dose, and the addition of new contraindications to simvastatin’s label. o Synagis® payment amount increased 20% PMPM. This increase is secondary to increased utilization this RSV season. o The top ranking ProDUR edits in various categories are similar to their ranking in 4q10. One exception is that the drug causing the highest number of “Geriatric Precaution” alerts was amlodipine besylate, with 2,579 edits. Geriatric patients are more likely to experience a delayed clearance of amlodipine and can be at greater risk for toxicity. This could possibly be a good topic for a DUR activity. • Dr. Alston presented 4 th Quarter RetroDUR and Provider Analysis Activities o Strattera® Cardiovascular Safety--The October activity focused on safety concerns surrounding use of atomoxetine (Strattera®), specifically regarding the potential increase in blood pressure and heart rate. 569 profiles were reviewed, and 89 letters addressing 86 enrollees were sent to prescribers, when the enrollee’s profile contained a paid prescription claim(s) for atomoxetine and a cardiovascular medication. o Antiretroviral Non-compliance-- The December activity concentrated on non-compliance with antiretroviral therapy, and 504 enrollee profiles were reviewed. A letter to the prescriber was generated when the enrollee did not obtain a refill of their antiretroviral medication within 7 days after the medication supply was expected to run out. We tried to avoid sending the letter in situations where it appeared the enrollee was ill or hospitalized or situations where there had been change in therapy. Twenty six providers were lettered addressing 43 patients. o Top Narcotic Prescribers-- Out of the top 200 narcotic prescribers the top 125 was lettered. o Short Acting Narcotic Initiative-- A total of 1,636 prescribers were found to meet the criteria during the Short Acting Narcotic initiative analysis, from that total, 800 prescribers were lettered. o Smoking Cessation-- A communication about smoking cessation was requested by PAC (Pharmacy Advisory Committee) and the resulting notice provided additional information on the quantity limits and 10
exceptions under which smoking cessation products would be covered for all TennCare enrollees. This communication was sent to 764 prescribers. o Buprenorphine Benefit Limit-- A letter was sent to remind providers that beginning March 1, 2012; any adult TennCare recipient who has received 6 months of therapy on Suboxone®, Subutex®, or generic buprenorphine will be limited to a maximum daily dose of 8 mg/day. There were 13,936 providers with patients receiving greater than 8mg per day. These prescribers are being lettered based on the date the patient will reach 6 month mark. 194 letters went out to providers whose patients will reach 6 months of therapy sometime in March. The next round will be sent out this week to physicians with patients will reach the 6 month mark in April. • Dr. Alston presented RetroDUR and Provider Analysis Activity Outcomes o ADHD Stimulants with CNS Depressants-- This activity’s focus was to draw attention to counteractive prescribing with TennCare enrollees taking ADHD products concomitantly with CNS depressants. There was a 19% provider response rate, and 77.9% of the responders found the activity useful. 38.98% of the responders stated that the patients had diagnoses which required both medications (CNS stimulants and depressants). o Use of Topamax® During Pregnancy-- This activity reviewed the risk of orofacial birth defects in children born to mothers taking topiramate (Topamax®). 13.9% of the prescribers who received the letter responded, 69.8% found this activity useful. o Simvastatin Dose Restriction-- This activity reviewed the action that the FDA took on simvastatin, which included dosage restrictions, limitation on the use of the 80mg dose, and the addition of new contraindications to simvastatin’s label. 10.5% of the prescribers who received the letter responded, 76.3% found the activity useful. 30% of the responders planned to adjust treatment based on the information we provided. o Poly-Pharmacy-- Activity focused on patients with > = 14 prescriptions, written by > = 4 different providers, and filled at > = 3 different pharmacies over a 90 day period. 14.4% of the providers responded, of which 75.8% thought the activity was useful. o Strattera Adverse Reaction-- The Strattera® activity focused on safety concerns surrounding the use of Strattera® particularly the increase in blood pressure and heart rate. There was a 19.7% provider response rate, and 64.7% of the responders found the activity useful. o Top Narcotic Prescribers-- Top Narcotic Prescribers had 27.4% response rate of that 64.7% thought this activity was useful. Most of these responses are generally negative. Pain clinics states it’s their job to write pain medication. Suboxone® prescribers don’t understand why they are included since they are running a rehabilitation clinic and not prescribing medication for pain. • Dr. Woods recommended breaking the specialty down further to include a Suboxone® category. • Dr. Gary recommended including a copy of the letter from Center of Substance Research to educate the prescribers that this medication can be abused. o Smoking Cessation in Pregnancy-- Smoking cessation in pregnancy, this activity reviewed TennCare criteria for coverage of smoking cessation products for pregnant women prior to these agents becoming a covered 11
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