Oklahoma § 63-5030.4 - Drug utilization review program

§ 63-5030.4. Drug utilization review program

1. The Medicaid Drug Utilization Review Board shall develop and

recommend to the Oklahoma Health Care Authority Board a

Oklahoma Statutes - Title 63. Public Health and Safety

retrospective and prospective drug utilization review program for

medical outpatient drugs to ensure that prescriptions are

appropriate, medically necessary, and not likely to result in

adverse medical outcomes.

2. The retrospective and prospective drug utilization review

program shall be operated under guidelines established by the

Medicaid Drug Utilization Review Board as follows:

a.

The retrospective drug utilization review program

shall be based on guidelines established by the

Medicaid Drug Utilization Review Board using the

mechanized drug claims processing and information

retrieval system to analyze claims data in order to:

(1) identify patterns of fraud, abuse, gross overuse

or underuse, and inappropriate or medically

unnecessary care,

(2) assess data on drug use against explicit

predetermined standards that are based on the

compendia and other sources for the purpose of

monitoring:

(a) therapeutic appropriateness,

(b) overutilization or underutilization,

(c) appropriate use of generic drugs,

(d) therapeutic duplication,

(e) drug-disease contraindications

(f) drug-drug interactions,

(g) incorrect drug dosage,

(h) duration of drug treatment, and

(i) clinical abuse or misuse, and

(3) introduce remedial strategies in order to improve

the quality of care and to conserve program funds

or personal expenditures.

b.

(1) The prospective drug utilization review program

shall be based on guidelines established by the

Medicaid Drug Utilization Review Board and shall

provide that, before a prescription is filled or

delivered, a review will be conducted by the

pharmacist at the point of sale to screen for

potential drug therapy problems resulting from:

(a) therapeutic duplication,

(b) drug-drug interactions,

(c) incorrect drug dosage or duration of drug

treatment,

(d) drug-allergy interactions, and

(e) clinical abuse or misuse.

(2) In conducting the prospective drug utilization

review, a pharmacist may not alter the prescribed

Oklahoma Statutes - Title 63. Public Health and Safety

outpatient drug therapy without the consent of

the prescribing physician or purchaser.

Added by Laws 1999, c. 201, § 4, eff. July 1, 1999.

§63-5030.4A. Disease state management programs – Feasibility study.

A. The Oklahoma Health Care Authority shall study the

feasibility of implementing one or more disease state management

programs.

B. The components of the study shall include, but not be

limited to:

1. A description and assessment of the findings, costs of the

program, savings incurred and estimated costs and savings of an

expansion of the pilot program for asthma disease state management

developed by the Authority;

2. An overview of disease state management programs for

enrollees of health management organizations contracting with the

Authority pursuant to the Sooner Care Plus Program;

3. An assessment of the adaptability of such disease state

management programs for the Medicaid fee-for-service population;

4. An overview of representative vendors of the disease state

management programs, including their characteristics, capabilities

and charges for products and services;

5. An overview and assessment of the disease state management

pilot project developed by the Oklahoma State Education Employees

Government Insurance Board; and

6. A record, if available, of the savings generated by disease

state management programs in other states by pharmaceutical

manufacturers for Medicaid fee-for-service recipients.

C. The study shall be under the joint direction of the Disease

State Management Director and the Pharmacy Director of the Oklahoma

Health Care Authority. The Directors shall consult with the

following entities as they deem necessary:

1. Medical, pharmacy, and nursing professionals who are

experienced in disease state management programs;

2. Appropriate pharmaceutical manufacturers in connection with

study components outlined in paragraphs 4 and 5 of subsection B of

this section;

3. Disease state management vendors; and

4. Other resources as necessary including, but not limited to,

health care advocates.

D. The Oklahoma Health Care Authority shall submit periodic

progress reports to the Joint Legislative Oversight Committee. The

Oklahoma Health Care Authority shall publish and submit a final

report by December 1, 2002, to the Speaker of the Oklahoma House of

Representatives, the President Pro Tempore of the Senate, the

Governor, and the chair of the Health and Social Services

Subcommittee of the Appropriation and Budget Committee of the

Oklahoma Statutes - Title 63. Public Health and Safety

Oklahoma House of Representatives and of the Health and Social

Services Subcommittee of the Committee on Appropriations of the

Oklahoma State Senate.

E. As used in this section, "disease state management program"

means an integrated system of interventions, measurements and

refinements of health care delivery that include:

1. Patient education and involvement in self-care techniques;

2. Clinical policies/best practices that extend across the

entire continuum of care;

3. Outpatient drug management;

4. Clinical information systems with the capacity to identify,

classify, and track defined patient populations;

5. Informed support of physicians;

6. Team-oriented multidisciplinary approach; and

7. Feedback or continuous review.

Added by Laws 2002, c. 411, § 1, emerg. eff. June 5, 2002.