Pharmacy

The Louisiana Department of Health’s (LDH) Bureau of Health Services Financing has established a Drug Utilization Review Board to assist the agency in assessing its Drug Utilization Review (DUR) Program. The DUR program assures that prescriptions for outpatient drugs are appropriate, medically necessary, and are not likely to result in adverse medical results. The DUR program is designed to educate physicians and pharmacists to identify and reduce the frequency of patterns of fraud, abuse, gross overuse, or inappropriate or medically unnecessary care among physicians, pharmacists, and patients or associated with specific drugs as well as:

• Potential and actual adverse drug reactions;
• Therapeutic appropriateness;
• Overutilization and underutilization;
• Appropriate use of generic products;
• Therapeutic duplication;
• Drug-disease contraindications;
• Drug-drug interactions;
• Incorrect drug dosage or duration of drug treatment;
• Drug-allergy interactions; and
• Clinical abuse/misuse

The functions of the Drug Utilization Review Board include:

• Make recommendations and approve predetermined criteria established in retrospective DUR and prospective DUR;
• Evaluate the use of predetermined criteria and standards in use, and make recommendations to the Bureau concerning modification or elimination of existing predetermined criteria and standards or the adoption of new ones;
• Identify educational topics to improve prescribing and dispensing practices;
• Make recommendations regarding interventions to improve quality of drug therapy;
• Periodically re-evaluate educational interventions; and
• Be a knowledgeable group, dedicated to assisting the agency in the administration of its Drug Utilization Review Program in an advisory capacity

COMPOSITION

The board shall be composed of at least eleven members (or approved designees).

The membership of the DUR Board shall consist of at least one-third but not more than 51% licensed and actively practicing physicians and at least one-third licensed and actively practicing pharmacists.  New members shall be appointed by LDH. 

The Managed Care Organizations (MCOs) shall recommend one Louisiana MCO Medical Director, one Behavioral Health Medical Director and one Louisiana MCO Pharmacy Director to represent all Louisiana MCOs as voting members on the DUR Board.  The MCO representatives may not be employed by the same MCO plan.

Up to three alternate members may be appointed by LDH.  At the discretion of LDH, alternate members may be called upon to attend meetings and vote in the absence of DUR Board members.

QUALIFICATIONS

The DUR board members shall consist of healthcare professionals who have knowledge, expertise, and experience in:

• Developing or practicing under a PDL;
• Clinically appropriate prescribing of covered outpatient drugs;
• Clinically appropriate dispensing monitoring of covered outpatient drugs;
• Drug use review, evaluation and intervention; and
• Medical quality assurance

Members must also be licensed and in good standing with the Louisiana Medical Board or the Louisiana State Board of Pharmacy and actively provide services to Louisiana Medicaid beneficiaries.

Naloxone, and other opioid antagonists, is a prescription medication indicated for the reversal of respiratory depression or unresponsiveness due to opioid overdose. Given the current public health emergency relative to the misuse and abuse of opioid derivatives, it has been determind that widespread availability of opioid antagonists to addicts and their caregivers, as well as first responders in the community, would serve the public interest. For as long as naloxone, and other such opioid antagonists, remain classified as prescription drugs by the federal Food and Drug Administration, pharmacists must secure a prescription or order from a prescriber with the legal authority to prescribe said drug products in order to dispense or distribute the drug product. Thus, the Lousiana Legislature has adopted a number of laws designed to facilitate the distribution and dispensing of naloxone, or other opioid antagonists, beyond the person who would need the medication on an emergent basis to manage an opioid-related drug overdose; specifically first responders, caregivers and family/ friends of potential patients.

The committee shall be responsible for maintaining a preferred drug list established in conjunction with a prior approval process.

Any new drug approved by the United States Food and Drug Administration may be added to the preferred list when it becomes commerically available and the manufacturer enters into a federal medicaid drug rebate program if the department determines it is in the best interest of the medical assistance program.

The Medicaid Pharmaceutical & Therapeutics Committee shall conduct an evidence based analysis of the drug to determine if the drug shall be maintained on the preferred drug list.  The analysis shall include but is not limited to the medical evidence of clinical effectiveness of the drug, as well as evidence of the cost-effectiveness of the drug in treating illness and disease.

The committee may use contractors to assist with reviewing evidence, such as the state's PBM or an academic institution.