(1) The Drug Management Review Advisory Board shall have at least the following duties and responsibilities:
(a) Review and make recommendations to the commissioner or designee on predetermined prospective drug use review standards submitted to the board by the Department for Medicaid Services or its contractor;
(b) Evaluate the use of the predetermined prospective drug use review standards and make recommendations to the commissioner or the commissioner’s designee concerning modification or elimination of existing standards and the need for additional standards;
(c) Make recommendations to the commissioner or the commissioner’s designee concerning guidelines governing written predetermined standards that pharmacies must use in conducting prospective drug use review if they do not use approved software;
(d) Oversee the retrospective drug use review contract and incorporate the results into predetermined retrospective drug use review standards;
(e) Review and make recommendations to the commissioner or the commissioner’s designee on predetermined retrospective drug use standards submitted to the board by the Department for Medicaid Services;
(f) Make recommendations to the commissioner or the commissioner’s designee concerning the modification or elimination of existing predetermined retrospective drug use review standards and the need for additional standards;
(g) Identify and develop educational topics on common drug therapy problems if needed to improve prescribing or dispensing practices of practitioners;
(h) Make recommendations to the commissioner or the commissioner’s designee concerning which mix of interventions would most effectively lead to an improvement in the quality of drug therapy;
(i) Conduct periodic reevaluations to determine the effectiveness of educational effort and, if necessary, modify the interventions;
(j) Recommend standards for the identification of suspected fraud and abuse;
(k) Prepare and submit to the commissioner an annual drug use review report that contains the following information:
1. A description of the nature and scope of the retrospective drug utilization program including the identity of the contractor, the frequency of screening of claims data and the criteria and standards used, along with new or revised copies of the clinical criteria, and in subsequent years, a list of revised criteria and deleted criteria;
2. A summary of nonpatient and provider specific educational activities including information on the use of each type of patient and provider specific intervention that indicates the guidelines for use and frequency of use by type of intervention and the effectiveness of each type of intervention on changes in prescribing or dispensing practices;
3. An evaluation of the adequacy of prospective drug use review database software; and
4. Details on policy guidelines adopted by the board pertaining to written criteria that pharmacies may use if they do not use a computer prospective drug utilization review database; and
(l) In advising the department, the board may consider the effectiveness of all interventions used to manage a particular disease over time, the stage and intensity of the disease, and the economic, clinical, and patient-prospective outcomes, including quality of life.
(2) The board shall function in accordance with the Kentucky Open Meetings Law and the Kentucky Open Records Act. The board may designate subcommittees to address specific issues and to report findings to the board. In conducting its business, the board shall utilize distance communication technologies whenever possible.
(3) Clerical and administrative support shall be provided the board through the Cabinet for Health and Family Services or by contract.
Effective: June 20, 2005
History: Amended 2005 Ky. Acts ch. 99, sec. 239, effective June 20, 2005. — Amended
2002 Ky. Acts ch. 7, sec. 5, effective February 21, 2002. — Created 1998 Ky. Acts ch. 561, sec. 5, effective July 15, 1998.