Health.utah.gov2

Dr. W ilhelm Lehmann, DUR Board Chairman
Editors: Tim Morley, R.Ph., Lisa Hulbert, R.Ph.
Jennifer Zeleny, CphT., MPH., Duane Parke, R.Ph.
An “unofficial” publication of the State Medicaid DUR Board Preferred Drug List Update
Prior Authorization Changes
During the 2009 legislative session, the State Legislature approved SB87, which authorizes Utah Medicaid to require a Prior Authorization for Effective July 1, 2009, butalbital-containing compounds for non-preferred drugs. The PA requirement went into effect on May 18, headache treatment will require a PA. Requests will be 2009. To receive a Non-Preferred Authorization (NPA), the prescriber reviewed by the DUR Board on an individual basis.
must provide a detailed explanation of one of the following: Effective July 15, 2009, Chantix will require a PA. Use will belimited to 24 weeks per calendar year. Trial and failure of at least one preferred agent in the class,including name of the preferred product(s) tried, length oftherapy and reason for discontinuation. Prior Authorization criteria can be obtained through the pharmacy Evidence of a potential drug interaction between current medication and the preferred product(s). Medicaid Prior Authorizations at (801)538-6155 or (800) 662-9651.
Evidence of a condition or contraindication that prevents theuse of the preferred product(s). Objective clinical evidence that a patient is at high risk of Influenza Medications Available for H1N1
adverse events due to a therapeutic interchange. Due to the H1N1 pandemic, Medicaid has temporarily suspended Prior Requests for NPA should be faxed to (801) 536-0477. Prescribers Authorization requirements for Tamiflu and Relenza. The Medicaid may provide the information either in the form of chart notes or by Pharmacy Claims system will continue to check the patient’s age and filling out the NPA form that can be downloaded from the Pharmacy pay claims only for the FDA-approved age ranges for these products. Many providers have called Medicaid to ask how reimbursement for the The Medicaid Preferred Drug List continues to expand on a monthly H1N1 Influenza vaccine will be handled once it becomes available. To basis. Watch the Medicaid Pharmacy website at date, there is no reliable information on when the vaccine will become available, how many doses will be required, etc. The decision on how to handle coverage will be made expeditiously once this informationbecomes readily available to Medicaid staff. Free Blood Glucose M eters Still Available
Medicaid clients may call 1-877-229-3777 for a Bayer blood glucose Nicotine Replacem ent Therapy & Counseling
The DUR Board recently reviewed the smoking cessation class andrecommended that Medicaid patients receiving NRT or other generic Medicaid clients may call 1-877-535-7467 and refer to Order Number smoking cessation medications that do not include enrollment in a 417-UTM001 to obtain a Lifescan blood glucose meter. behavioral program be referred to Utah Quitnet to increase theirchances of success in quitting. All preferred drugs and diabetic supplies are NDC specific. Pleaserefer to the Medicaid Pharmacy Website for a list of NDCs. Clients should be referred to the webor to one of the following phone numbers: Please Note: Occasionally, rebate offers from pharmaceutical
companies may make coverage of a brand-name drug more cost
effective than the generic. Medicaid may, in these instances, require that pharmacies dispense the brand-name drug as the preferred Educational letters to clients receiving smoking cessation products will P&T Com m ittee Schedule
The P&T Committee meets on the third Thursday of the month in the Reimbursement Updates
Cannon Health Building at 7:00 A.M. The schedule of upcoming drug State budget shortfalls required a reduction in the Medicaid Pharmacy Drug EAC basis of reimbursement. Effective March 1, 2009, the EACwas reduced to Average Wholesale Price (AWP) minus 17%. This change in the EAC was restored to AWP minus 15% begnning July 1, Aug 2009: Third Generation Cephalosporins Sep 2009: Targeted ImmunomodulatorsOct 2009: Second Generation Antihistamines Medicaid is also continuing to aggressively expand use of the UtahMAC. To dispute a Utah MAC price, please fax the most recent invoice Continue to watch the P&T Committee website for important updates of the product being billed to (801) 538-6099. Pharmacies will need to regarding the P&T Committee schedule, or email Duane Parke, at re-submit claims once pricing adjustments are made. Utah Department of Health
Health Care Financing
Amber Sheeet
Box 143102
Salt Lake City UT 84114-3102
Emergency Supplies of PA Drugs
Is It Safe To Wait?
Drugs requiring Prior Authorization are available to patients on an In April 2008, Utah Medicaid wasone of 20 states awarded a grant to emergency basis 24/7. This is true for both drugs requiring Clinical PA the emergency room for non-emergent care. This project The Pharmacy Prior Authorization Department is available Monday - Friday, 8:00 A.M. to 5:00 P.M., except on holidays.
clients about the appropriate use ofthe emergency room. The project If a patient comes to the pharmacy with an emergency need outside of regular business hours, the pharmacy may dispense a 72-hour supply. to clients: Is it safe to wait? Is itsafe to wait for an appointment with Medicaid will issue a PA for the 72-hour supply on the next business day. Further quantity requests will be subject to all PA
requirements.
day at an urgent care / after hoursclinic? Please Note: If the emergency drug comes in a form that cannot be
readily split into a 72-hour supply (i.e. a rescue inhaler or a vial of Through a series of educationalefforts and interventions, Medicaid insulin), Medicaid will work with the pharmacy to accommodate the their healthcare choices includingthe importance of developing a Vitamin D Coverage
relationship with a PCP. Theproject team also provides clients with information about urgent careproviders available in their area. Preliminary data shows that many Recently, the Utah Medicaid DUR Board met to review osteoporosis clients are unaware of the location of, or the services available from, an drugs. Because available evidence suggests that patients taking bisphosphonates (i.e. Fosamax, Boniva, and Actonel) should also betaking Vitamin D, Utah Medicaid was urged to consider providing If clients continue to use the emergency room for care that could be provided at a lower cost facility, they may be enrolled into the CareCoordination and Restriction program where they will be assigned asingle PCP and pharmacy. For more information about the grant Effective July 1, 2009, the following NDCs for Vitamin D will be activities, please visit our website at http://health.utah.gov/safetowait/.
24385-0655-78 Vitamin D 1,000 iu (OTC strength) Medicaid Communication eSources:
50111-0990-01 Vitamin D 50,000 iu (Rx strength) W ebsite
The Medicaid Pharmacy Services website is available 24/7 for policy
Please also note, clients taking oral bisphosphonates should also be information. It contains information about prior authorization criteria, the taking calcium supplements. Non-oyster shell calcium tablets have DUR Board, Amber Sheets, Medicaid Pharmacy policy manuals, and long been a benefit to clients enrolled in the Traditional and Non- the latest news about Medicaid pharmacy. For more information, log on If a Medicaid client taking bisphosphonates expresses concern about ePocrates
being able to afford Vitamin D or Calcium supplements, they may Medicaid will be providing information on the Preferred Drug List, Prior obtain a prescription for these items and have them paid through their Authorizations, and other pharmacy benefit information through ePocrates. All three Medicaid programs now have pharmacy benefit
information available! r further
information.

Source: http://www.health.utah.gov/medicaid/pharmacy/library/files/Amber%20Sheets/Amber%20Sheets%202009/Amber17.2.pdf