If you answered yes to ether of these questions please send an email with "PES" in the subject line to: idahommis@dhw.idaho.gov immediately. these processes will change in February 2010 and we need to discuss the options that will be available to you.
(added October 2009)
P&T Committee Sets 2010 Schedule
The following dates have been set for Pharmacy and
Therapeutics Committee meetings in 2010: January 15, February 19, July 16, and August 20, 2010.
Unless otherwise posted in the agenda, meetings start at 9 a.m., with public testimony received from 9:30 to 10:30 a.m. All meetings are held at Idaho Medicaid, 3232 Elder Street, Boise.
Professional letters regarding a drug under P&T review must be received 7 days prior to the meeting.
CNS/Eli Lilly Mental Health Prescribing Initiative Ends
Idaho Medicaid’s initiative through Comprehensive NeuroSciences (CNS) and Eli Lilly to monitor safe and appropriate us of mental health medications ended March 31, 2009. The initiative, referred to as the Mental Health Pharmacy Management Initiative (MHPMI), began in late 2004, and was scaled back in 2007 due to a severe decrease in funding.
Efforts to improve best-practice prescribing of mental health medications will continue through the academic detailing program described in the story below.
Idaho Medicaid thanks prescribers for their time and effort spent on MHPMI. Thanks also to those who guided the effort through their involvement with MHPMI Stakeholder and Steering Committees.
(added 4/10/09)
Idaho Medicaid Awarded Academic Detailing Grant
The Idaho Medicaid pharmacy program has been awarded a $50,000 grant to fund an academic detailing pilot program. The program, which will operate during the 2009 calendar year in southwest and south central Idaho, will provide targeted educational outreach to prescribers of mental health medications.
Pew Charitable Trust is providing grant funding through Community Catalyst, a Massachusetts nonprofit agency that works with state and local organizations and policy makers to build quality, affordable healthcare programs. Idaho and its neighbor state Oregon were the only states nationwide selected for the program.
A factor driving the need for this program is verifiable patterns of inappropriate use and overuse of mental health medications that result in actual or potential adverse drug events. Also, from a cost standpoint, it is important to eliminate expense due to over prescribing and unnecessary prescribing as well as decrease associated costs resulting from inappropriate medication use.
“This program will provide a service to busy practitioners on up-to-date, non-biased information,” said Tami Eide, PharmD, supervisor of the Idaho Medicaid Pharmacy Unit. “It will also supply tools for patient care that they might not otherwise have time to access.”
Through the academic detailing program, Medicaid pharmacists will seek to strengthen evidence-based prescribing through one-to-one consultations with selected medical practitioners. Detailer visits will take place in the practitioner’s office, with a minimum of 85 visits expected by December 2009.
The program will focus on the appropriate use of drugs to treat ADHD, depression, bipolar disorder, psychosis, and insomnia. Appropriate use is defined as proper diagnosis, dose, avoidance of adverse events, and avoidance of duplicative therapy.
Objectives for the academic detailing program include:
- Improving patient care
- Improving the overall health status of Idaho Medicaid participants
- Decreasing Idaho Medicaid drug costs
- Improving communication between the Department of Health and Welfare and health care practitioners
- Educating pharmacists within the outreach area about the need for, and goals of, the academic detailing program
For more information contact Tami Eide, Medicaid Pharmacy Supervisor, PharmD at (208) 364-1821, or Bob Faller, Medical Program Specialist at (208) 364-1850.
(added 12/8/08)
New Policy for Fluoxetine Prescribing
Currently the 20 mg fluoxetine tablet is 20 times the cost of the 20 mg capsule. The 40 mg capsule is 9 times the cost of using two, 20 mg capsules and fluoxetine solution is 13 times the cost using 5 ml for a 20 mg dose.
Idaho Medicaid is requesting that all participants currently using the more expensive dosage forms convert to fluoxetine 10 and/or 20 mg capsules. Idaho Medicaid allows up to three, 10 mg capsules and/or four, 20 mg capsules per day.
As of March 1, 2009, the 20 mg tablet, 40 mg capsule and 20 mg/5 ml solution will require prior authorization. An Exception: Children 9 years of age and younger, will not require prior authorization to use fluoxetine 20 mg/5 ml solution up to 20 mg/day.
As of March 1, 2009, the 20 mg tablet, 40 mg capsule and 20 mg/5 ml solution will require prior authorization. An Exception: Children 9 years of age and younger, will not require prior authorization to use fluoxetine 20 mg/5 ml solution up to 20 mg/day.
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Please review your Idaho Medicaid participants listed on the enclosed page to determine if these patients would be able to use the 10 or 20 mg fluoxetine capsules in place of their current fluoxetine dosage forms. If the participant is unable to use the more cost effective 10 or 20 mg capsules, please submit documentation to support the use of their current fluoxetine therapy using the universal prior authorization form.
Your cooperation is appreciated and will be of great value to the state without any participant needing to change therapy.
(added 2/17/09)
Tamper-Resistant Prescription Forms
Are Generic Drugs Always Cheaper?
Not necessarily.
Idaho Medicaid covers the least expensive AB-rated product—which, on occasion, is the brand name product.
When a drug first becomes available as generic, the generic price is sometimes higher than a brand name product which has a federal and/or supplemental rebate. Therefore, it is more cost effective for Idaho Medicaid to continue paying for the branded drug until the price of the generic becomes more competitive.
The government is the largest pharmaceutical payor in the country. As such, it has established relationships with pharmaceutical manufacturers to allow their products into the Medicaid program as long as rebates are provided. These rebates allow the government to obtain the lowest contract price.
An example of a brand name drug being cheaper than generic can be found in the Long-Acting Narcotic Analgesic drug group. The weighted average unit cost for the brand name Duragesic patch is $12.65, while the generic fentanyl patch is $28.88.
(added 10-23-07)
72-Hour Emergency Supplies
Medicaid will pay for point-of-sale (POS) pharmacy claims for a 72-hour emergency supply of medications requiring prior authorization (PA) if the pharmacist in his/her professional judgment believes a participant has an immediate need. The appropriate prior authorization process must be used during regular business hours. All the following conditions must be met for an emergency supply:
- The participant is Medicaid eligible on the date of service
- The prescription is new to the pharmacy
- The medication requires prior authorization.
- The supply for the emergency period does not exceed three days
The override codes for billing for a 72-hour emergency supply are:
- Reason for Service Code: TP (Payer/Processor Question)
- Professional Service Code: MR (Medication Review)
- Result of Services Code: 1F (Filled, with different quantity)
A completed PA request must be faxed to the Medicaid Pharmacy at (208) 364-1864.
Information noted in Idaho Medicaid Provider Handbook, Pharmacy Guidelines, Section 3.4.2
(added 6/25/07)
Information on the DUR Site
See the Idaho Drug Utilization Review (DUR) link listed under Resources in the right column of this page for a variety of information reports. Patient educational leaflets on asthma and hypertension are available. There are also more than 20 leaflets for healthcare professionals on subjects ranging from trends in gestational diabetes to appropriate treatment of allergic rhinitis.
Idaho State University’s DUR program was created in 1990 to improve patient care and reduce drug costs in the state. DUR’s accomplishments include:
- Creating drug-use criteria for 14 drug classes.
- Developing educational interventions for physicians and pharmacists.
- Establishing a clinical database for Idaho Medicaid to determine prescribing patterns that are unnecessary, too expensive, and/or potentially dangerous.