No. 30198 (Amendment): R414-60A-3. Responsibilities and Functions

DAR File No.: 30198
Filed: 07/16/2007, 01:56
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This amendment clarifies the Department's intent that the Drug Utilization Review (DUR) Board may consider the recommendations of the independent Pharmacy and Therapeutics (P&T) Committee.

Summary of the rule or change:

This amendment clarifies the relationship between the DUR Board and the P&T Committee regarding the preferred drug list (PDL).

State statutory or constitutional authorization for this rule:

Sections 26-18-2, 26-18-2.4, 26-18-3, and 26-1-5; and Title 26, Chapter 18, Part 2

Anticipated cost or savings to:

the state budget:

There is no budget impact because this amendment only clarifies the relationship between the DUR Board and the P&T Committee.

local governments:

There is no budget impact because local governments do not fund the Medicaid drug program.

other persons:

There is no impact to other persons and small businesses because this amendment only clarifies the relationship between the DUR Board and the P&T Committee.

Compliance costs for affected persons:

There is no budget impact because this amendment only clarifies the relationship between the DUR Board and the P&T Committee.

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

There is no expected fiscal impact on business by clarifying that the Drug Utilization Review Board may consider the recommendations of the independent Pharmacy and Therapeutics Committee. David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division 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:

Melissa Frost at the above address, by phone at 801-538-6381, 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:

08/31/2007

Interested persons may attend a public hearing regarding this rule:

8/29/2007 at 3:00 PM, Cannon Health Building, 288 N 1460 W, Room 114, Salt Lake City, UT
(DAR NOTE: Hearing change notice published 08/15/2007)

This rule may become effective on:

09/07/2007

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

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

R414-60A. Drug Utilization Review Board.

R414-60A-3. Responsibilities and Functions.

(1) The DUR Board 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 times per year.

(3) The DUR Board chairperson shall conduct all meetings. The DUR Board 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) The DUR Board manager shall schedule meetings, set agendas, provide meeting materials, keep minutes, record DUR Board business, notify DHCF when vacancies occur, provide meeting notices, and coordinate functions between the DUR Board and DHCF.

(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) The DUR Board [shall]may consider recommendations, criteria, and standards produced by the Pharmacy and Therapeutics (P&T) Committee.[ in matters regarding a preferred drug list. The P&T Committee is established in Rule R414-60B.]

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: 2007

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