Mqd prescription drug report act 200 sect 36.pdf

REPORT TO THE TWENTY-THIRD HAWAII STATE
LEGISLATURE, 2005
IN ACCORDANCE WITH ACT 200, PART III, SECTION 36,
SLH 2003, ON PRESCRIPTION DRUGS FOR FEE-FOR-
SERVICE CLIENTS INCLUDING MENTAL HEALTH
TREATMENT
Department of Human Services
Med-QUEST Division
November 2004
REPORT ON PRESCRIPTION DRUGS FOR FEE-FOR-SERVICE CLIENTS
INCLUDING MENTAL HEALTH TREATMENT FOR FY 2004, PURSUANT TO ACT
200, PART III, SECTION 36, SLH 2003
Act 200, Part III, Section 36, SLH 2003 appropriated funds to the Department for prescription drugs for fee-for-service clients. Section 36 requires the Department to submit a report that includes but not limited to, all expenditures made listed by prescription drugs, the number of recipients by type of drug prescribed, and possible cost containment measures for FY 2004. 1) Expenditures Listed by Prescription Drug
Attachment A shows a listing of the Top 100 Drugs by Amount Paid for FY 2004 in
descending order. The expenditure total for the Top 100 drugs was $75,728,702.33.
Expenditures for generic drugs and other drugs not as widely prescribed was $36,847,291.49
The total expenditures for all prescription drugs was $112,575,993.82 (see Attachment D.)

2) Number of Recipients by Type of Drug
Attachment B shows a listing of the Top 100 Drugs by Prescription Count for FY 2004 in descending order. Attachment C shows a Summary Listing of Unique Recipients by Therapeutic Drug Class for FY 2004. This listing provides a count of unique recipients by Drug Class (only counts each recipient once if they received multiple drugs within the same drug class).
3) Additional Reports on Expenditures, Recipient Counts, and Prescriptions

Attachment D shows the number of recipients by type of fee-for-service plan, the total number of prescriptions by plan, and the total amounts paid by plan for the prescriptions. Total expenditures for all prescription drugs: $112,575,993.82 Total number of claims paid: 1,748,937 Average prescription cost: $64.37 ($112,575,994/1,748,937) Total number of recipients unduplicated: 43,189 Attachment E shows the average number of recipients per month and the average number of prescriptions per recipient. Monthly average of utilizing recipients: 27,518 Average number of prescriptions per month: 5.2 4) Drugs Granted Prior Authorization

Attachment F shows a listing of the top drugs on the PDL that were granted prior authorization. Attachment G shows a listing of the top 25 other drugs that are not on the PDL but are granted prior authorization by the Medicaid program. 5) Cost Containment Measures for Fiscal Year 2004

The Department implemented these cost containment measures: a) Mandatory generic prescriptions savings Summary of Mandatory Generic Drug Prescriptions for FY 2004 $1,933,196.45
b) Imposed quantity limits for certain medications that are over-utilized, requiring a prior authorization to justify that large quantities are medically necessary and appropriate. c) Imposed quantity limits to reduce overpayments to providers who bill for overstated quantities, which leads to disputes with drug manufacturers on drug rebate amounts. d) The pharmacy audit contractor audited the pharmacy fiscal agent and more pharmacies The audit reports have shown problem areas that needed to be addressed such as incorrect provider billings, “lost” prescriptions, “lost” drug purchase invoices, etc. Also, the fiscal agent audit covering August 1, 2001 through December 31, 2002 showed deficiencies for which ACS and MQD are finalizing resolution in the clinical services area. ACS prepared a gap analysis to identify deficiencies and remedies and submitted outstanding deliverables on 11/12/04. A letter was submitted by ACS to MQD on 11/15/04 detailing additional services to be provided by Heritage (wholly owned subsidiary of ACS) and ACS will be holding telephone conferences with MQD to explain and validate outstanding clinical services being met. The goal is to have final resolution before November 30, 2004. e) Additional prior authorizations for highly utilized medications or new very expensive drugs were implemented to reduce inappropriate usage. f) Certain outlier prescribers were targeted to receive “report cards” comparing their prescribing practices to their peers. As a result, the utilization patterns for a number of the outliers changed after these report cards were issued. This was a small scale project that involved only prescribers of high dose Zyprexa. g) A preferred drug list (PDL) was initially started in the fall of 2003 through a short-term contract amendment with the current Pharmacy Fiscal Agent, Affiliated Computer Services (ACS). In 2004, a new contractor, First Health Services Corporation, was competitively awarded a 15 month contract with a one year extension provision for the PDL program. Attachment H shows savings of $261,652.47 for the Phase I PDL therapeutic class implementation and the therapeutic classes impacted. The Federal rebates for this period are still being collected. The State supplemental rebate contracts are being finalized and the cost of implementing and maintaining the program was not included in this report. 6) Cost Containment Measures Proposed for Fiscal Year 2005

The MQD plans to implement or continue with the following: a) Expand the preferred drug list with supplemental rebates. b) Conduct audits of pharmacies and the pharmacy fiscal agent. c) Prior authorize high cost, highly utilized medications when appropriate. d) Place limits on various medications to encourage appropriate utilization. e) Consider revising the state maximum allowable cost program to increase savings on f) Increase prescriber profiling to show more outliers how much they differ from their peers. Attachments Top 100 Drugs by Amount Paid for FY 2004 (7/01/2003 - 6/30/2004)
Top 100 Drugs by Rx Count for FY 2004 (7/01/2003 - 6/30/2004)
Summary of Unique Recipients by Therapeutic Drug Class (7/01/03 through 6/30/04)
Specific
Thera
Class
HYPOTENSIVES,ANGIOTENSIN RECEPTOR ANTAGONIST ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATION PULMONARY ANTI-HTN, ENDOTHELIN RECEPTOR ANTAGONIST NON-NARCOTIC ANTITUSSIVE AND EXPECTORANT COMB. HYPOGLYCEMICS, INSULIN-RELEASE STIMULANT TYPE HYPOGLYCEMICS, BIGUANIDE TYPE (NON-SULFONYLUREAS) HYPOGLYCEMICS, ALPHA-GLUCOSIDASE INHIB TYPE (N-S) HYPOGLYCEMICS, INSULIN-RESPONSE ENHANCER (N-S) IV SOLUTIONS: DEXTROSE AND LACTATED RINGERS ORAL MUCOSITIS/STOMATITIS ANTI-INFLAMMATORY AGENT DRUGS TO TX CHRONIC INFLAMM. DISEASE OF COLON IRRITABLE BOWEL SYND. AGENT,5HT-3 ANTAGONIST-TYPE IRRITABLE BOWEL SYND. AGENT,5HT-4 PARTIAL AGONIST DRUG TX-CHRONIC INFLAM. COLON DX,5-AMINOSALICYLAT ALZHEIMER'S THERAPY, NMDA RECEPTOR ANTAGONISTS SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRIS) TRICYCLIC ANTIDEPRESSANTS & REL. NON-SEL. RU-INHIB TX FOR ATTENTION DEFICIT-HYPERACT(ADHD)/NARCOLEPSY TRICYCLIC ANTIDEPRESSANT/PHENOTHIAZINE COMBINATNS TRICYCLIC ANTIDEPRESSANT/BENZODIAZEPINE COMBINATNS ANALGESICS NARCOTIC, ANESTHETIC ADJUNCT AGENTS ALPHA-2 RECEPTOR ANTAGONIST ANTIDEPRESSANTS SEROTONIN-NOREPINEPHRINE REUPTAKE-INHIB (SNRIS) NOREPINEPHRINE AND DOPAMINE REUPTAKE INHIB (NDRIS) SEROTONIN-2 ANTAGONIST/REUPTAKE INHIBITORS (SARIS) MAOIS - NON-SELECTIVE & IRREVERSIBLE ANTIPSYCHOTICS,DOPAMINE ANTAGONISTS,BUTYROPHENONES ANTIPSYCHOTICS,DOPAMINE ANTAGONISTS, THIOXANTHENES ANTIPSYCH,DOPAMINE ANTAG.,DIPHENYLBUTYLPIPERIDINES ANTIPSYCHOTICS,DOPAMINE ANTAGONST,DIHYDROINDOLONES ANTIPSYCHOTICS,ATYPICAL,DOPAMINE,& SEROTONIN ANTAG ANTIPSYCHOTICS, DOPAMINE & SEROTONIN ANTAGONISTS ANTIPSYCHOTICS, ATYP, D2 PARTIAL AGONIST/5HT MIXED TX FOR ATTENTION DEFICIT-HYPERACT.(ADHD), NRI-TYPE SSRI &ANTIPSYCH,ATYP,DOPAMINE&SEROTONIN ANTAG COMB SMOKING DETERRENT AGENTS (GANGLIONIC STIM,OTHERS) ADRENERGICS, AROMATIC, NON-CATECHOLAMINE BETA-ADRENERGICS AND GLUCOCORTICOIDS COMBINATION ANTIHYPERLIP(HMGCOA) & CALCIUM CHANNEL BLOCKER CMB LHRH(GNRH) AGONIST ANALOG PITUITARY SUPPRESSANTS LHRH(GNRH)AGNST PIT.SUP-CENTRAL PRECOCIOUS PUBERTY BONE FORMATION STIM. AGENTS - PARATHYROID HORMONE CALCIMIMETIC,PARATHYROID CALCIUM ENHANCER OCULAR PHOTOACTIVATED VESSEL-OCCLUDING AGENTS OPHTHALMIC ANTI-INFLAMMATORY IMMUNOMODULATOR-TYPE RECTAL/LOWER BOWEL PREP.,GLUCOCORT. (NON-HEMORR) CHRONIC INFLAM. COLON DX, 5-A-SALICYLAT,RECTAL TX TOPICAL ANTINEOPLASTIC & PREMALIGNANT LESION AGNTS TOPICAL ANTIBIOTICS/ANTIINFLAMMATORY,STEROIDAL MIOTICS/OTHER INTRAOC. PRESSURE REDUCERS NOSE PREPARATIONS, VASOCONSTRICTORS(OTC) OTIC PREPARATIONS,ANTI-INFLAMMATORY-ANTIBIOTICS BENIGN PROSTATIC HYPERTROPHY/MICTURITION AGENTS URINARY TRACT ANTISPASMODIC/ANTIINCONTINENCE AGENT POTASSIUM SPARING DIURETICS IN COMBINATION URINARY TRACT ANESTHETIC/ANALGESIC AGNT (AZO-DYE) ANTI-INFLAMMATORY/ANTIARTHRITICS AGENTS, MISC. ANTI-INFLAMMATORY, PYRIMIDINE SYNTHESIS INHIBITOR ANTI-INFLAMMATORY TUMOR NECROSIS FACTOR INHIBITOR ANTI-FLAM. INTERLEUKIN-1 RECEPTOR ANTAGONIST ANTI-ARTHRITIC, FOLATE ANTAGONIST AGENTS NSAID, COX INHIBITOR-TYPE & PROTON PUMP INHIB COMB ANTINEOPLAST EGF RECEPTOR BLOCKER RCMB MC ANTIBODY ANTINEOPLASTICS ANTIBODY/ANTIBODY-DRUG COMPLEXES SELECTIVE RETINOID X RECEPTOR AGONISTS (RXR) ANTINEOPLASTIC LHRH(GNRH) AGONIST,PITUITARY SUPPR. ANTINEOPLASTIC SYSTEMIC ENZYME INHIBITORS SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERM) ANTINEOPLAST EGF RECEPTOR BLOCKER RCMB MC ANTIBODY ANTINEOPLAST HUM VEGF INHIBITOR RECOMB MC ANTIBODY ANAEROBIC ANTIPROTOZOAL-ANTIBACTERIAL AGENTS ANTIVIRALS, HIV-SPECIFIC, PROTEASE INHIBITORS ANTIVIRALS, HIV-SPECIFIC, NUCLEOTIDE ANALOG, RTI ANTIVIRALS, HIV-SPECIFIC, NUCLEOSIDE ANALOG, RTI ANTIVIRALS, HIV-SPECIFIC, NON-NUCLEOSIDE, RTI ANTIVIRALS, HIV-SPEC., NUCLEOSIDE ANALOG, RTI COMB ANTIVIRALS, HIV-SPECIFIC, PROTEASE INHIBITOR COMB ANTIVIRALS, HIV-SPECIFIC, FUSION INHIBITORS TOXIN-PRODUCING BACILLI VACCINES/TOXOIDS VACCINE/TOXOID PREPARATIONS,COMBINATIONS MONOCLONAL ANTIBODIES TO IMMUNOGLOBULIN E(IGE) Hawaii Report Of Unique Utilizers In FY 2004 By Plan

Total Unique Utilizers and Rx Counts for FY 2003

ATTACHMENT E
Average Rxs Per Recipient Per Month For FY 2004
Plans100, 200, 300, 310, 500, & 600
Average:
Top "PDL" Drugs Granted Prior Authorization
Top 25 Other Drugs (not on the PDL) Granted Standing Prior Authorization
$1,584,377.43
PDL Phase I Cost Savings Data
Feb 17 thru June 30, 2004 Comparison of 5 months prior to implementation of Phase I and 5 months after. Cost Savings from Phase I PDL changes
$261,652.47
Please note that this does not include supplemental rebates or federal rebates Drug Classes included in PDL Phase I
HYPOTENSIVES, ACE INHIBITORS
HYPOTENSIVES,ANGIOTENSIN RECEPTOR ANTAGONIST
ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATION
CALCIUM CHANNEL BLOCKING AGENTS
GASTRIC ACID SECRETION REDUCERS
BILE SALT SEQUESTRANTS
ALPHA/BETA-ADRENERGIC BLOCKING AGENTS
BETA-ADRENERGIC BLOCKING AGENTS
LIPOTROPICS
NSAIDS, CYCLOOXYGENASE INHIBITOR - TYPE II

Source: http://lrbhawaii.info/reports/legrpts/dhs/2005/act200_36_slh03.pdf