Crosswalk

MEDICAID DRUG UTILIZATION REVIEW

ANNUAL REVIEW REPORT CROSSWALK

Renumbering Changes:

Current Amended Version

1. State Abbreviation I. Demographic Information

2. Medicaid Agency Information II. Prospective DUR

3. Prospective DUR III. Retrospective DUR

4. Retrospective DUR IV. DUR Board Activity

5. Physician Administered Drugs V. Physician Administered Drugs

6. DUR Board Activity VI. Generic Policy and Data Utilization

7. Generic Policy and Utilization Data VII. Program Evaluation/Cost

Savings/Cost Avoidance

8. Program Evaluation / Cost Savings VIII. Fraud, Waste and Abuse Detection

9. Fraud, Waste, and Abuse Detection IX. Innovative Practices

10. Innovative Practices X. E-Prescribing

11. E-Prescribing XI. Managed Care Organizations (MCO)

12. Null XII. Executive Summary

ATTACHMENT 1 – PRODUR REVIEW SUMMARY – Deleted due to duplicity

ATTACHMENT 2 – PROSPECTIVE DUR PHARMACY COMPLIANCE REPORT – renumbered as ATTACHMENT 1

ATTACHMENT 3 – RETROSPECTIVE DUR SCREENING AND INTERVENTION SUMMARY REPORT – renumbered and renamed – ATTACHMENT 2 - RETROSPECTIVE EDUCATIONAL OUTREACH SUMMARY

ATTACHMENT 4 - SUMMARY OF DUR BOARD ACTIVITIES – renumbered ATTACHMENT 3

ATTACHMENT 5 - GENERIC DRUG SUBSTITUTION POLICIES renumbered ATTACHMENT 4

ATTACHMENT 6 - COST SAVINGS ESTIMATES – renamed as COST SAVINGS/COST AVOIDANCE METHODOLOGY and renumbered ATTACHMENT 5

ATTACHMENT 7 - PRESCRIPTION DRUG MONITORING PROGRAM deleted as the survey questions are sufficient.

ATTACHMENT 8 - INNOVATIVE PRACTICES – renumbered ATTACHMENT 6

ATTACHMENT 9 - E-PRESCRIBING ACTIVITY SUMMARY –renumbered Attachment 7

ATTACHMENT 8 – EXECUTIVE SUMMARY - new

Clarifications:

TABLE 1 -TOP 10 Prospective DUR Criteria Reviewed by DUR BOARD – This Table combines two previous data requests ( ATT 1 ProDUR Review Summary and Table 1- ProDUR Criteria reviewed by DUR Board and reduces the data being requested by specifying that only the TOP 10 problems should be reported as opposed to all problems during the previous fiscal year.)

II. MEDICAID AGENCY INFORMATION - #2. and #3. moved to new Section II. Prospective DUR

Deletions from Current version:

II. Medicaid Agency Information - Street Address, City/State/Zip Code –not necessary

III. Prospective DUR – Therapeutic Duplication questions removed as not providing useful information back to states

ATTACHMENT 1 –ProDUR Review Summary- duplicative, information captured in new Table 1.

III. Prospective DUR – Deleted Therapeutic Duplication questions in #5

IV. Retro DUR- deleted #3- due to duplication of information requested.

ATTACHMENT 7- deleted survey questions are sufficient.

Additions to the amended survey submission:

I. Medicaid Agency Information - email address added

II. Prospective DUR- added questions 3, 4, 5, 6, 8,9,11 to clarify the state’s processing of data.

III. RetroDUR – Decreased the quantity of data states are to submit for TOP 20 to TOP 10 problems

IV. DUR Board Activity – slightly reworded questions 1, 2 & 3.

VI. Generic policy and Utilization Data –revised wording of question 1, added new question 2 for details regarding “Brand Medically Necessary” practices, renumbered #2 to #3, 3 to 4 and added question 5 asking the states to provide policies that would impact the responses to the previous questions.

VII. Program Evaluation/ Cost Savings – renamed Program Evaluation/ Cost Savings/Cost Avoidance, deleted question 3 as Attachment 6 was eliminated and added chart to capture monetary figures requested and renumbered question 5 to question 3.

VIII. Fraud, Waste and Abuse Detection – Created subsections A- E as listed below-

1. Lock-IN or Patient Review and Restrictive Program-this is refinement of questions 1-4 in the current survey, and have added 2 new questions 5 and 6 to gather further details on how the states operate these programs.

2. Prescription Drug Monitoring Programs- previously there was only question # 4, in the survey on this topic. The new question 1 asks for details on how the state program operates, question 2 inquires if the state faces barriers.

3. Pain Management Controls – is a new section with 4 questions allowing the states to detail if they have a pain management program in place and to detail how it operates.

4. Opioids – new section with 2 questions regarding screening and limitations on prescribing of this drug category.

5. Morphine Equivalent Daily Dose – is a new sections with 3 questions to determine if states have implemented practices to better monitor prescribing of this additive drug category and/to educate prescribers.

6. Buprenorphine – a new section with 5 questions to monitor the prescribing restrictions states have in place for this drug category.

7. Psychotropic Drugs/Stimulants- a new section with 2 questions added to obtain further insight as to how the state is monitoring prescribing of drugs in these categories.

XI. Managed Care Organizations (MCOs) – This is new sections added to better understand the ways state agencies oversee the MCO pharmacy drug programs. Currently MCOs are not required to submit DUR report to CMS. With the movement of large portions of Medicaid populations into MCOs, CMS is interested in having a better understanding of state oversight in this area.

XII. Executive Summary - this a new section however, in the past, states have generally provide a summary report of overall activities during the preceding year, therefore this is not an additional burden but we are providing a specific place to be include it in the report.

INSTRUCTIONS: Nomenclature format for attachments and tables – to provide a standardized format for naming documents when uploading files to the survey tool.

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