CMS Releases New Information About State Medicaid Drug Utilization Review Practices

On July 30, 2013, the Centers for Medicare & Medicaid Services (“CMS”) posted state annual Medicaid DUR reports for fiscal year 2012.  States are required to complete annual Medicaid drug utilization review (“DUR”) surveys outlining prescribing habits, and describing cost savings generated from state Medicaid DUR programs and their Medicaid program’s operations (including adoption of new innovative DUR practices).  The survey results are compiled annually by CMS in published reports.  In addition, and “in an effort to share useful information on the activities states are performing to improve the quality of care and prudent delivery of their programs”, CMS posted examples of state Medicaid “innovative” DUR practices, drawn from the fiscal year 2011 annual reports. 

Increased prior authorization requirements, including electronic systems and protocols intended to enhance existing programs, topped CMS’s outline of 2011 “innovative” DUR practices.  Additionally, CMS noted that antipsychotic drug use was being actively monitored by each state Medicaid program, except where restricted by state law.  In this regard, CMS highlighted initiatives in CA, NV, PA, VA and WV.  CMS also highlighted efforts by Utah to use case management for hemophilia patients.  CMS further provided information regarding prescriber education efforts by states, as well as anti-fraud, waste, misuse, and abuse tools, such as fraud hotlines (CT), corrective case management (MD) and chronic pain management (DE, MT and NJ). 

The FY2012 annual Medicaid DUR reports (as well as previous years’ annual reports) can be viewed by going to CMS’s Medicaid Drug Programs Data & Resources page, selecting “Drug Utilization Report” under the “Filter by Data Report” option, and then selecting the state under “Filter by State”.  These reports contain detailed information that drug manufacturers, as well as prescribers and pharmacies may find useful in evaluating the DUR programs and controls used by the various Medicaid programs.

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