Drug Utilization Review (DUR) Board Meeting Summary - February 18, 2010

Agenda and Introduction

The Drug Utilization Review Board met on Thursday, February 18, 2010 from 9:00 A.M. to 4:30 P.M., in Meeting Room 6, Concourse, Empire State Plaza, Albany, New York.

A. Background Materials Provided:

The DUR Board members were provided copies of materials submitted by interested parties in advance of the meeting.

B. Public Comment Period:

The following speakers provided comments to the DUR Board:

  1. Korenda, Brian, Medical Scientist, GlaxoSmithKline, Research Triangle Park, NC
  2. Baran, Daniel, MD, Senior Regional Medical Director, Merck & Co. Inc., North Wales, PA
  3. Lehach, Joan, MD, Independent Physician, Bronx, NY

C. Key Issues Presented by Interested Parties and Discussed by the DUR Board during the Public Comment Period:

Montelukast
The DUR Board was asked to consider information regarding montelukast including indications and dosing for non-asthmatic patients with allergic rhinitis. The DUR Board was also presented information related to the effectiveness of treatment for allergic rhinitis as well as financial impact relating to restricting the use of montelukast in the treatment of allergic rhinitis.

Triptans
The DUR Board was asked to consider information regarding Treximet®(sumatriptan 85mg/naproxen sodium 500mg) in the treatment of acute migraines. Information presented included appropriate use, potential for medication overuse headache, package size, place in therapy, efficacy and safety.

D. Presentations and Discussions:

The following speakers presented to the DUR Board:

  1. Figge, James, MD, Medical Director, Office of Health Insurance Programs, New York State Department of Health
  2. Merola, Anthony, RPh, MBA, Medicaid Pharmacy Program, Office of Health Insurance Programs, New York State Department of Health
  3. Naioti, John, RPh, Medicaid Pharmacy Program, Office of Health Insurance Programs, New York State Department of Health
  4. Doloresco, Fred, Pharm D, Clinical Assistant Professor, School of Pharmacy & Pharmaceutical Sciences, State University of New York at Buffalo
  5. Wrobel, Mark, Pharm D, Clinical Assistant Professor, School of Pharmacy & Pharmaceutical Sciences, State University of New York at Buffalo
  6. Coe, Holly, Pharm D, Clinical Assistant Professor, School of Pharmacy & Pharmaceutical Sciences, State University of New York at Buffalo
  7. Catanzaro, Linda, PharmD, Clinical Assistant Professor Director, Pharmacotherapy Information Center Chair, HIV Continuing Education Programs, School of Pharmacy & Pharmaceutical Sciences, State University of New York at Buffalo
  8. Fominaya, Cory, PharmD, School of Pharmacy & Pharmaceutical Sciences, State University of New York at Buffalo
  9. Fahr, Rita, RPh, Medicaid Pharmacy Program, Office of Health Insurance Programs, New York State Department of Health
  10. Probst, Luke, PharmD, BCPS Pediatric Pharmacy Specialist - University Hospital Clinical Assistant Professor - Departments of Pediatrics and Medicine Vice-Chair, SUNY Upstate Medical University

Topical Corticosteroids
Dr. Catanzaro and Dr. Doloresco presented the topical corticosteroid utilization review. The DUR Board was provided with a general overview of the drug class including the indications, acceptable uses and clinical considerations. The Board was also provided with NYS Medicaid claim utilization information, which included the quantity per claim, the frequency of refills, and the incidence of progression, from more cost effective generic products to more costly drug therapies of equal efficacy.

Topical Antifungals
Dr. Catanzaro and Dr. Doloresco presented the topical antifungals utilization review. The DUR Board was provided with a general overview of the drug class including the indications, acceptable uses and clinical considerations. The Board was also provided with NYS Medicaid claim utilization information, which included quantity per claim, frequency of refills, and the incidence of progression, from more cost effective OTC/generic products to more costly drug therapies of equal efficacy.

Ophthalmic Non-Fluoroquinolone Antibiotics
Dr. Wrobel and Dr. Doloresco presented the ophthalmic non-fluoroquinolone antibiotic utilization review. The DUR Board was provided with a general overview of the drug class including the indications, acceptable uses and clinical considerations associated with the incidence of bacterial resistance. The Board was also provided with NYS Medicaid claims utilization information, including quantity, frequency of use, and progression of therapy from more cost effective generic products of equal efficacy to more costly drug therapies.

Ophthalmic Antibiotic/Steroid Combinations
Dr. Wrobel and Dr. Doloresco presented the ophthalmic antibiotic/steroid combination utilization review. The DUR Board was provided with a general overview of the drug class including the indications, acceptable uses and clinical considerations associated with the incidence of bacterial resistance. The Board was also provided with NYS Medicaid claims utilization information, including quantity, frequency of use, and progression of from more cost effective generic products of equal efficacy to more costly drug therapies.

Triptans
Dr. Coe and Dr. Doloresco presented the triptan utilization review. The DUR Board was provided with a general overview of the drug class, including dosing and administration, warnings and precautions, and adverse reactions. The Board was also provided with NYS Medicaid claims utilization information specifically related to quantity dispensed, frequency of dispensing, duration of therapy, and potential over-utilization and misuse.

Montelukast
Dr. Fominaya and Dr. Doloresco presented the montelukast utilization review. The DUR Board was provided with a general overview of products indicated for the treatment of allergic rhinitis. The Board was also provided with NYS Medicaid claim utilization information and the incidence of progression of treating allergic rhinitis, from more cost effective OTC/generic products of equal or superior clinical efficacy to montelukast.

Prescriber Education Program (PEP)
Dr. Probst and Dr. Figge presented the Prescriber Education Program (PEP) update. Dr. Probst discussed the success of the PEP palivizumab module including the prescriber selection process, visit arrangements, and visit overview and nature of interactions. Dr. Figge noted that the PEP has an academic educational component offered as statewide on-site educational programs. PEP is working with Stony Brook University to enhance the PEP web site. Information was provided regarding the PEP hypertension module roll out, mental health module development, and the consideration of therapeutic approaches for type II diabetes as the next PEP module. Dr. Figge also provided information following up on questions related to the High Tech Act, including confidential health information exchange and prospective decision support module for practitioners, reflecting the Medicaid prospective DUR edits.

Medicaid DUR Board Activities Report
Mr. Merola and Mr. Naioti provided the DUR Board activities report. Mr. Merola reviewed Clinical Drug Review Program (CDRP) items that were previously addressed by the DUR Board and referred to the Pharmacy and Therapeutics (P&T) Committee for further evaluation. The DUR Board was provided an overview of the P&T Committee's recommendations, the Commissioner's final determinations and implementation timelines. Mr. Naioti reviewed items previously addressed by the DUR Board for frequency, quantity and duration limits, and step therapy with regard to the implementation timeline.

Medication Therapy Management (MTM)
A Medicaid Medication Therapy Management (MTM) pilot program status report was presented to the DUR Board by Ms. Fahr. The DUR Board was provided with information pertaining to the pharmacy/pharmacist selection process, pharmacist training, and selection criteria to identify patients for invitation to the program. Ms. Fahr responded to questions regarding pharmacy enrollment, and enrollee participation.

E. DUR Board Discussion

The DUR Board discussed utilization of clinically comparable topical corticosteroids including indications for use and the cost effectiveness of generic products of comparable potencies within this class of drugs.

The DUR Board discussed utilization of clinically comparable topical antifungals including indications for use and the cost effectiveness of OTC/generic products in the drug class.

The DUR Board discussed utilization of clinically comparable ophthalmic non-fluoroquinolone antibiotics and ophthalmic antibiotic/steroid combinations including indications for use and the cost effectiveness of generic products in these drug classes.

The DUR Board discussed factors that may be contributing to the increased utilization of triptans.

The DUR Board discussed the use of montelukast in non-asthmatic patients with allergic rhinitis in relation to the initial use of potentially equally effective and more cost effective OTC and prescription antihistamines. Discussion also included more cost effective intranasal corticosteroid products and their efficacy in treating allergic rhinitis in the absence of asthma.

G. DUR Board Action:

No official actions were taken during this meeting.

New York State Medicaid Pharmacy proposals and discussions of intervention pathways were tabled until the next DUR Board meeting when a voting quorum would be available.

The meeting adjourned at 1:00 pm

Meeting Summary Posted 03/16/2010