No. 42787 (Amendment): Rule R414-60A. Drug Utilization Review Board

(Amendment)

DAR File No.: 42787
Filed: 04/11/2018 09:33:31 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to clarify requirements, responsibilities, and functions for the Drug Utilization Review Board (DURB) members.

Summary of the rule or change:

This amendment clarifies terms of appointment and meeting requirements for DURB members. It also removes language already spelled out in the Utah Code and makes other technical changes.

Statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because this change only clarifies requirements for DURB membership. It neither affects Medicaid member services nor provider reimbursement.

local governments:

There is no impact to local governments because they neither fund the DURB nor make administrative decisions regarding its membership.

small businesses:

There is no impact to small businesses because this change only clarifies requirements for DURB membership. It neither affects Medicaid member services nor provider reimbursement.

persons other than small businesses, businesses, or local governmental entities:

There is no impact to Medicaid providers or to Medicaid members because this change only clarifies requirements for DURB membership. It neither affects Medicaid member services nor provider reimbursement.

Compliance costs for affected persons:

There is no impact to a single Medicaid provider or to a Medicaid member because this change only clarifies requirements for DURB membership. It neither affects Medicaid member services nor provider reimbursement.

Comments by the department head on the fiscal impact the rule may have on businesses:

After conducting a thorough analysis, it was determined that this proposed rule change will not result in a fiscal impact to businesses.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

05/31/2018

This rule may become effective on:

06/07/2018

Authorized by:

Joseph Miner, Executive Director

RULE TEXT

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs

FY 2018

FY 2019

FY 2020

State Government

$0

$0

$0

Local Government

$0

$0

$0

Small Businesses

$0

$0

$0

Non-Small Businesses

$0

$0

$0

Other Person

$0

$0

$0

Total Fiscal Costs:

$0

$0

$0

Fiscal Benefits

State Government

$0

$0

$0

Local Government

$0

$0

$0

Small Businesses

$0

$0

$0

Non-Small Businesses

$0

$0

$0

Other Persons

$0

$0

$0

Total Fiscal Benefits:

$0

$0

$0

Net Fiscal Benefits:

$0

$0

$0

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described above. Inestimable impacts for Non - Small Businesses are described below.

 

Appendix 2: Regulatory Impact to Non - Small Businesses

None of the 735 providers of pharmacy services will see a fiscal impact because this rule only clarifies membership requirements for the Drug Utilization Review Board, and does not affect provider reimbursement.

 

 

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-60A. Drug Utilization Review Board.

R414-60A-1. Introduction and Authority.

(1) The Drug Utilization Review Board (DURB) [Board ]aids in pharmacy policy oversight and drug utilization.

(2) The [DUR Board]DURB is authorized under 42 CFR 456.716 and Sections 26-18-2, 3, and 102.

 

R414-60A-2. [ DUR Board ] DURB Composition and Membership Requirements.

(1) The Director of the Division of Medicaid and Health Financing (DMHF) shall act on behalf of the Executive Director of the Utah Department of Health regarding all [DUR Board]DURB issues, and shall appoint [the following groups of individuals to four-year terms on the DUR Board:]membership to the DURB in accordance with Section 26-18-102. In addition, the Director shall appoint one pharmacist from recommendations received from the Accountable Care Organizations (ACOs).

[(a) Four physicians from recommendations received from the Utah Medical Association.

(b) One physician engaged in Academic Medicine.

(c) Three pharmacists from recommendations received from the Utah Pharmacy Association.

(d) One pharmacist engaged in Academic Pharmacy.

(e) One dentist from recommendations received from the Utah Dental Association.

(f) One individual from recommendations received from the Pharmaceutical Manufacturers Association (PhRMA).

(g) One consumer representative.

(h) One pharmacist from recommendations received from the Accountable Care Organizations (ACOs).]

(2) Membership Requirements.

(a) An appointee may not serve more than two consecutive terms in one of the [12 ]board positions listed in Section 26-18-102.[Subsection R414-60A-2(1).] Terms separated by an interruption of more than [an interruption of ]two months are not consecutive.

(b) If DMHF does not receive recommendations to fill a vacant position within 30 days of a request, DMHF may appoint a qualified individual to fill the vacancy.

(c) If there are no willing nominees for appointment when an appointed term has expired, the DMHF Director may reappoint members on the board to additional non-consecutive terms as needed.

[(3) Notwithstanding the requirements in Subsection R414-60A-2(1), the Director shall adjust the length of terms upon appointment so that one-half of the DUR Board is appointed every two years.

(4) The DUR Board shall elect a chairperson to a one-year term from among its members. The chairperson may serve consecutive terms if reelected by the board.]

([5]3) When a vacancy occurs on the board, the Director shall appoint a replacement for the unexpired term of the vacating member.

(4) DURB members serve at the discretion of the DMHF Director.

([6]5) The DURB [Board ]shall be managed by a non-voting board manager appointed from the pharmacy group within DMHF.

([7]6) Other individuals of the DMHF pharmacy [group]team are non-voting ex-officio advisory members of the DURB.[Board.]

 

R414-60A-3. Responsibilities and Functions.

(1) The [DUR Board]DURB shall meet [monthly ]in a public forum, except when meeting in executive session or in petitions subcommittee.

(2) [The board may elect to not meet in a given month if circumstances do not require a meeting. ]The board shall meet at least [ten]four times per year.

(3) The [DUR Board]DURB chairperson shall conduct all meetings. The [DUR Board]DURB manager shall conduct meetings if the chairperson is not present.

[(4) In accordance with Section 26-18-105, notice shall be given for a DUR Board meeting in which prior authorization criteria is considered.]

([5]4) The [DUR Board]DURB manager shall schedule meetings, set agendas, provide meeting materials, keep minutes, record [DUR Board]DURB business, notify [DHCF]DMHF when vacancies occur, provide meeting notices, and coordinate functions between the [DUR Board]DURB and [DHCF]DMHF.

[(6) DHCF shall rely upon the DUR Board to carry out the Division's federal and state responsibilities for the Medicaid drug program to address the following issues:

(a) Adverse reactions to drugs.

(b) Therapeutic appropriateness.

(c) Overutilization and underutilization.

(d) Appropriate use of generic drugs.

(e) Therapeutic duplication.

(f) Drug-disease contraindications.

(g) Drug-drug interactions.

(h) Incorrect drug dosage and duration of treatment.

(i) Drug allergy interactions.

(j) Clinical abuse and misuse.

(k) Identification and reduction of the frequency of patterns of fraud, abuse, and gross overuse.

(l) Inappropriate or medically unnecessary care among physicians, pharmacists, and recipients.

(m) Prior Authorization criteria.]

([7]5) The [DUR Board]DURB may consider recommendations, criteria, and standards produced by the Pharmacy and Therapeutics (P [and ]&T) Committee.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [April 1, 2017]2018

Notice of Continuation: June 13, 2017

Authorizing, and Implemented or Interpreted Law: 26-18-3; 26-1-5; 26-18 Part 2

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