Rational Drug Therapy Program WVBMS Drug Utilization Board
Rational Drug Therapy Program WVBMS Drug Utilization Board November 13, 2018 Presented by Stephen A. Small, M. S. , R. Ph. West Virginia University School of Pharmacy
September 2018 Program Summary EO/PA Status APPROVED CALLTRACK CANCEL CLOSED DENIED INPROCESS MEDREVIEW PENDING Total Program # Member ID# s EO Count % EO Total PA Count % of PA Total 6322 71. 35% 4964 50. 78% 0 0. 00% 128 1. 31% 0 0. 00% 26 0. 27% 444 5. 01% 179 1. 83% 1385 15. 63% 3138 32. 10% 1 4. 16% 106 1. 08% 369 3. 83% 624 6. 38% 339 3. 83% 610 6. 24% 8860 45. 37% 9775 50. 05% 8390 1. 06 9493 1. 03 Total Count 11286 128 26 623 4523 107 993 949 18635 17696 % of Total 60. 56% 0. 69% 0. 14% 3. 34% 24. 27% 0. 57% 5. 33% 5. 09% 95. 42% 1. 05
October 2018 Program Summary EO/PA Status APPROVED CALLTRACK CANCEL CLOSED DENIED INPROCESS MEDREVIEW PENDING Total Program # Member ID# s EO Count % of EO Total PA Count % of PA Total Count % of Total 5987 72. 51% 4893 52. 51% 10880 61. 90% 0 0. 00% 173 1. 86% 173 0. 98% 0 0. 00% 17 0. 18% 17 0. 10% 356 4. 31% 180 1. 93% 536 3. 05% 1175 14. 23% 2718 29. 17% 3893 22. 15% 3 4. 49% 133 1. 43% 136 0. 77% 371 4. 42% 626 6. 72% 997 5. 67% 365 4. 42% 579 6. 21% 944 5. 37% 8257 44. 81% 9319 50. 57% 17576 95. 38% 7815 1. 06 9008 1. 03 16690 1. 05
September 2018 Edit Overrides (EO) EO Status APPROVED CLOSED DENIED INPROCESS MEDREVIEW PENDING Total EO's 7069 Ther. Dup 79. 73% 1. 48% 11. 54% 0. 00% 2. 51% 4. 74% 3586 EO Status APPROVED CLOSED DENIED INPROCESS MEDREVIEW PENDING Total EO's 7187 User Max Units Limit 71. 00% 7. 79% 11. 26% 0. 00% 3. 46% 6. 49% 231 7073 Early Refill 73. 13% 7. 95% 13. 47% 0. 00% 2. 50% 2. 96% 1522 7026 Disp > 7511 Morphine 7155 Max Rx Exceeds Max Equiv. Exceeded Days 56. 12% 57. 38% 92. 27% 1. 15% 27. 07% 0. 34% 35. 68% 6. 22% 3. 36% 0. 12% 0. 00% 3. 23% 5. 57% 1. 34% 3. 70% 3. 76% 2. 69% 866 772 595 7071 Ingred. Duplication 84. 19% 0. 93% 8. 84% 0. 00% 1. 86% 4. 19% 215 7502 CII 7196 Missing Invalid Quant/Time RX 7514 MD not on Type limit file-Opioids 91. 94% 28. 04% 1. 15% 4. 74% 5. 61% 0. 00% 2. 37% 54. 21% 90. 80% 0. 00% 0. 47% 8. 41% 8. 05% 0. 47% 3. 74% 0. 00% 211 107 87
September 2018 Edit Overrides (EO)
October 2018 Edit Overrides (EO) Edit Override Status 7069 Ther. Dup 7073 Early Refill 7155 Max Rx Days 7511 Morphine Equiv. Exceeded 7026 Disp > Exceeds Max APPROVED 80. 33% 72. 90% 92. 48% 54. 77% 61. 21% CLOSED 1. 51% 6. 79% 0. 65% 27. 14% 1. 85% DENIED 10. 17% 15. 83% 2. 12% 5. 03% 25. 46% INPROCESS 0. 03% 0. 00% 0. 33% 0. 00% MEDREVIEW 2. 73% 1. 89% 1. 47% 5. 36% 5. 73% PENDING 5. 23% 2. 59% 2. 94% 7. 71% 5. 73% Total EO's 3442 1428 612 597 593 Edit Override Status 7071 Ingred. Duplication 7187 User Max 7502 CII Missing 7091 Prescriber not 7196 Quant/Time Units Limit Invalid Type on file RX limit APPROVED 85. 77% 77. 35% 97. 22% 14. 39% 30. 77% CLOSED 2. 69% 0. 43% 2. 22% 1. 52% 5. 98% DENIED 7. 69% 10. 26% 0. 56% 75. 00% 42. 74% INPROCESS 0. 00% MEDREVIEW 0. 77% 4. 70% 0. 00% 9. 09% 17. 09% PENDING 3. 08% 7. 26% 0. 00% 3. 42% Total EO's 261 234 180 132 117
October 2018 Edit Overrides (EO) Chart
September 2018 Prior Approvals PA Status APPROVED CALLTRACK CANCEL CLOSED DENIED INPROCESS MEDREVIEW PENDING Totals Atypical Antipsychotics 69. 21% 0. 44% 0. 00% 4. 37% 13. 97% 0. 55% 2. 51% 8. 95% 916 PA Status APPROVED CALLTRACK CANCEL CLOSED DENIED INPROCESS MEDREVIEW PENDING Totals Proton Pump Inhibitors 28. 21% 0. 85% 0. 00% 0. 43% 59. 40% 1. 28% 5. 98% 3. 85% 234 ADD Agents 46. 01% 1. 31% 0. 00% 1. 79% 38. 97% 0. 00% 10. 01% 1. 91% 839 SGLT-2 42. 67% 0. 86% 0. 00% 0. 43% 42. 24% 0. 43% 2. 16% 11. 21% 232 Amphetamines 78. 97% 1. 49% 0. 00% 1. 90% 8. 14% 0. 00% 6. 78% 2. 71% 737 Insulins 42. 67% 1. 78% 0. 00% 0. 44% 41. 33% 0. 00% 5. 33% 8. 44% 225 Anti-convulsants 57. 69% 1. 07% 0. 21% 1. 50% 27. 35% 0. 00% 5. 13% 7. 05% 468 GPL-1 Recept Agonist 41. 37% 0. 25% 0. 00% 1. 02% 46. 95% 0. 51% 1. 78% 8. 12% 394 Heparin Products 86. 25% 0. 00% 5. 00% 1. 25% 0. 00% 7. 50% 160 Vitamin-A Derivatives 66. 00% 0. 67% 0. 00% 1. 33% 20. 00% 11. 33% 0. 67% 150
September 2018 PA Status Graph
October 2018 Prior Approvals Status APPROVED CALLTRACK CANCEL CLOSED DENIED INPROCESS MEDREVIEW PENDING Totals Atypical Antipsychotics 69. 19% 0. 97% 0. 11% 3. 57% 14. 81% 0. 43% 3. 78% 7. 14% 925 Amphetamines 74. 74% 2. 11% 0. 15% 3. 91% 10. 53% 0. 15% 5. 71% 2. 71% 665 ADD Agents 50. 76% 2. 66% 0. 00% 1. 90% 27. 57% 0. 38% 14. 64% 2. 09% 526 GPL-1 Recept Agonist Anti-convulsants 54. 19% 45. 53% 0. 99% 0. 26% 0. 00% 0. 26% 0. 99% 0. 53% 33. 00% 38. 68% 0. 00% 1. 32% 4. 19% 1. 84% 6. 65% 11. 58% 406 380 Status APPROVED CALLTRACK CANCEL CLOSED DENIED INPROCESS MEDREVIEW PENDING Totals Proton Pump Inhibitors 50. 80% 0. 64% 0. 32% 40. 58% 0. 32% 4. 15% 2. 88% 313 SGLT-2 42. 54% 0. 00% 22. 01% 0. 37% 1. 12% 11. 94% 268 Insulins 37. 17% 2. 21% 0. 44% 43. 36% 0. 44% 6. 19% 9. 73% 226 ADHD NRI Type TNF Inhibitors 91. 48% 64. 61% 0. 45% 2. 25% 0. 00% 3. 14% 0. 56% 1. 79% 21. 91% 0. 00% 1. 12% 1. 35% 1. 69% 1. 79% 7. 87% 223 178
October 2018 PA Chart
September 2018 Therapeutic Dups HIC 3 H 2 S H 7 C H 2 V J 5 B S 2 B A 4 F A 4 D H 3 U H 3 A D 4 J C 4 G Definition SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRIS) SEROTONIN-NOREPINEPHRINE REUPTAKE-INHIB (SNRIS) TX FOR ATTENTION DEFICIT-HYPERACT(ADHD)/NARCOLEPSY ADRENERGICS, AROMATIC, NON-CATECHOLAMINE NSAIDS, CYCLOOXYGENASE INHIBITOR TYPE HYPOTENSIVES, ANGIOTENSIN RECEPTOR ANTAGONIST HYPOTENSIVES, ACE INHIBITORS NARCOTIC ANALGESIC & NON-SALICYLATE ANALGESIC COMB ANALGESICS, NARCOTICS PROTON-PUMP INHIBITORS INSULINS GCN Seqno 57892 57893 46214 46404 46229 46215 46403 46228 50760 50712 Drug Name duloxetine HCl fluoxetine HCl venlafaxine HCl sertraline HCl escitalopram oxalate Drug Strength 30 MG 60 MG 20 MG 75 MG 100 MG 40 MG 37. 5 MG 50 MG 20 MG 10 MG Count 639 438 316 272 193 141 126 113 100 93 92 Count 114 100 87 74 66 61 58 55 49 Percent 17. 82% 12. 21% 8. 81% 7. 59% 5. 38% 3. 93% 3. 51% 3. 15% 2. 79% 2. 57% Percent 1. 29% 1. 17% 1. 13% 0. 98% 0. 84% 0. 74% 0. 69% 0. 65% 0. 62% 0. 55%
October 2018 Therapeutic Dups HIC 3 H 2 S H 7 C H 2 V J 5 B S 2 B H 3 U A 4 D A 4 F D 4 J H 3 A C 4 G Definition SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRIS) SEROTONIN-NOREPINEPHRINE REUPTAKE-INHIB (SNRIS) TX FOR ATTENTION DEFICIT-HYPERACT(ADHD)/NARCOLEPSY ADRENERGICS, AROMATIC, NON-CATECHOLAMINE NSAIDS, CYCLOOXYGENASE INHIBITOR TYPE NARCOTIC ANALGESIC & NON-SALICYLATE ANALGESIC COMB HYPOTENSIVES, ACE INHIBITORS HYPOTENSIVES, ANGIOTENSIN RECEPTOR ANTAGONIST PROTON-PUMP INHIBITORS ANALGESICS, NARCOTICS INSULINS GCN Seqno 046214 057892 057893 046404 046228 046229 046215 050712 046403 050760 Drug Name fluoxetine HCl duloxetine HCl venlafaxine HCl sertraline HCl fluoxetine HCl escitalopram oxalate venlafaxine HCl escitalopram oxalate Drug Strength 20 MG 30 MG 60 MG 75 MG 50 MG 100 MG 40 MG 10 MG 37. 5 MG 20 MG Count 666 465 330 285 173 125 109 97 93 90 77 Count 114 110 109 95 83 65 62 57 57 55 Percent 19. 35% 13. 51% 9. 59% 8. 28% 5. 03% 3. 63% 3. 17% 2. 82% 2. 70% 2. 61% 2. 24% Percent 3. 31% 3. 20% 3. 17% 2. 76% 2. 41% 1. 89% 1. 80% 1. 66% 1. 60%
September 2018 Early Refills GCN Seqno Drug Name Drug Strength Count 300 MG 43 21414 gabapentin 62867 insulin glargine, hum. rec. anlog 100/ML (3) 40 66636 buprenorphine HCl/naloxone HCl 8 MG-2 MG 39 00346 clonidine HCl 0. 1 MG 38 06373 blood sugar diagnostic 11672 ranitidine HCl 28090 albuterol sulfate 57439 46229 29 15 MG/ML 24 90 MCG 20 insulin detemir 100/ML (3) 20 sertraline HCl 100 MG 19
October 2018 Early Refills GCN Seqno Drug Name Drug Strength Count 100/ML (3) 44 0. 1 MG 41 8 MG-2 MG 35 62867 insulin glargine, hum. rec. anlog 00346 clonidine HCl 66636 buprenorphine HCl/naloxone HCl 21414 gabapentin 300 MG 33 28090 albuterol sulfate 90 MCG 24 27462 pantoprazole sodium 40 MG 24 11672 ranitidine HCl 15 MG/ML 23 44341 insulin aspart 100/ML 22 06373 blood sugar diagnostic 46229 sertraline HCl 20 100 MG 19
Issues Any Questions?
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