Pursuant to the 2010-11 General Appropriations Act (Article II, Health and Human
Services Commission, Rider 49, S.B. 1, 81st Legislature, Regular Session, 2009), the Health and Human Services Commission (HHSC) is required to submit a report by December 1, 2009, on the strategies implemented by the agency after September 1, 2009, to strengthen the Texas Medicaid Drug Utilization Review (DUR) Program. A follow-up report is due by December 1, 2010.
The Texas Medicaid Vendor Drug Program has administered the DUR Program since it was established in 1992.
Retrospective drug use reviews include an evaluation of therapy and intervention after a prescription has been filled. For fiscal year 2008, the estimated general revenue cost savings resulting from retrospective drug use reviews was $14,589,466. The estimated cost savings for fiscal year 2009 retrospective drug use reviews is not yet available, but will be included in the December 1, 2010 report. The DUR Program has traditionally conducted six retrospective drug use reviews per fiscal year. For fiscal year 2010, the number of retrospective drug use reviews will be increased to eight reviews, pending DUR Board approval. Five of the eight retrospective drug use reviews proposed for fiscal year 2010 are repeats of reviews that were approved by the board in previous years. Based on historical savings for these five interventions, the estimated general revenue savings for fiscal year 2010 exceeds the total estimated general revenue savings for fiscal year 2008.
Clinical prior authorization edits are one type of prospective review used to determine if the prescribed medication is consistent with the patient’s known medical conditions. The DUR Program currently has 28 clinical edits in effect. One clinical prior authorization edit was implemented in fiscal year 2009, and seven clinical edits have been reviewed and approved by the DUR Board for implementation in fiscal year 2010. While a key goal of clinical prior authorizations is to improve clinical efficacy and safety in drug prescribing and usage, clinical prior authorization edits also may provide cost savings by deterring inappropriate or duplicative prescribing of medications.
HHSC will require the DUR Board to incorporate a conflict-of-interest policy into its bylaws. The policy will prevent board members from having contractual relationships or other conflicts of interest with pharmaceutical manufacturers that could call into question board members’ impartiality when recommending that drugs or drug classes be subject to drug use reviews.
HHSC will improve monitoring of the DUR Program in several ways. HHSC will expand the DUR Program’s annual report to include estimated cost savings resulting from the program’s performance of both prospective and retrospective drug use reviews. The annual report has not previously included cost savings from prospective prior authorizations. Inclusion of this information will allow for more accurate evaluation of program effectiveness and the development of program improvements. In addition, the final report will be posted on the HHSC website to increase access to and awareness of program information. Finally, HHSC will post quarterly on its website data regarding the prescription drug classes and individual prescription drugs that are most often prescribed to Medicaid patients or that represent the greatest expenditures.
HHSC will develop and submit a follow-up report by December 1, 2010, to describe continued or additional strategies to strengthen the DUR Program, realized cost savings, and anticipated cost savings for fiscal year 2011.
To read the entire report, please view: http://www.hhsc.state.tx.us/reports/Rider49_MedicaidDrug_1209.pdf
