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Drug Prior Authorization Committee MeetingDateTimeMarch 17, 202210:00am – 3:00pm (CST)LocationDepartment of Natural Resources1101 Riverside Dr, Jefferson City, MO65101 and WebEx* Click HERE for Meeting Documents *Committee Members Present:Conrad Balcer, DO, ChairJ.K. Sturgeon, PharmD, BCPSLaura Kingsley, PharmDMatthew Stinson, MDMaya Moody, DO, FAAPMorgan Sperry, PharmDCommittee Members Absent:Angeline Stanislaus, MDMO HealthNet Staff Present:Joshua Moore, PharmD, Director of PharmacyMark Roaseau, R.Ph, Clinical PharmacistAngela Wilson, Pharmacy OperationsManagerOlivia Rush, PharmD, Program IntegrityPharmacistElizabeth Sissom, RN, Clinical ManagementNikki Ashley, Pharmacy Program SpecialistCarmen Burton, Administrative AssistantTimothy Kling, MD, Acting Medical DirectorElizabeth Short, Program DevelopmentSpecialistConnie Sutter, Fiscal ManagerAmbra Stotler, CPhT, Benefit Program SeniorSpecialistDrug Prior Authorization Committee Meeting – March 17, 2021Contractors Present:April Ash, PharmD, ConduentBlake Shrout, PharmD, AAHIVP, ConduentJennifer Colozza, PharmD, ConduentAshleigh Holeman, PharmD, ConduentMegan Fast, PharmD, ConduentSerena Barden, PharmD, BCPS, ConduentChelsea Pendleton, RN, BSN, WiproGeri Roling, RN, WiproValerie Schmitz, RN, BSN, WiproAshley Lytton, RN, BSN, Wipro
Others Present:Anabelle KeohaneAndrew RoyerAudrey RattanBill GBrian StricklandCamille KerrChris BrownCindi PearsonDavid HersheyDave MileyDesiree OwenDonald NopperElaine SiegfriedErin HohmanFolger TuggleGCampbellJackie AdamecJennyJessica PetrieJim MaxsonJoshua McNeilKaren FloederKaren PowellKatieKeith GulleyKenneth BerryKurt HendricksonLarry PalmisanoLaurie KrekemyerLila KertzLisa TraczMelissa BasilMichele ShirleyMike ChenNishil PatelNolanRebecca AbtRobert GroeneveldRobert PearceSandySean JonesSelena GonzalezSteven AngelcykSuzanne HensleyTrisha LadymanVinceDrug Prior Authorization Committee Meeting – March 17, 2021
Conrad Balcer, Committee Chair, called the meeting to order.Welcome, Announcements andIntroductionsJoshua Moore, MHD Director of Pharmacy, introduced himself along with Nikki Ashley, MHD’s newPharmacy Program Specialist. Joshua facilitated the meeting on behalf of the MO HealthNetDivision.Morgan Sperry also introduced her DIC fellow, Rebecca Abt, PharmD.Discussion: Minutes were reviewed from the December meeting.Minutes ReviewDecision: The Committee voted to accept these approved minutes with no revisions.Elizabeth Short, Joshua Moore and Angela Wilson presented a brief power point of the PharmacyProgram and Budget Updates. Information presented included:Pharmacy Program and BudgetUpdate-July-Feb 2022 Eligibles by GroupJuly-Feb 2022 Expenditures by Enrollment GroupJuly-Feb 2022 Expenditures by ServiceFY22 Pharmacy Spend vs July-Feb 2022 Total Medicaid SpendJuly 2021 – March 2022 Pharmacy ExpendituresPharmacy Program Top 4 Drug Classes per FYHep C FY 2018 – FYTD 2022Mavyret Expenditures July 2019 – March 2022Synagis Expenditures FY2019 – FYTD2022FY2019 – FYTD2022 Rare Disease Expenditures Per DayAdditional discussions arose around:o The pharmacy spend goals and budget along with comparisons between the otherstate Medicaid programs.o New initiatives and streamlining older edits to help to decrease prior authorization,fax and call volumes to the helpdesk and overall enhanced workflow for all thoseinvolved.o Process of backdating in the expansion population.o June DPAC meeting consisting of only clinical and fiscal edits due to the PDLvendor RFP process. PDL edit reviews are expected to resume at the SeptemberDPAC meeting.Drug Prior Authorization Committee Meeting – March 17, 2021
Old BusinessJoshua Moore discussed the Edit Implementation Schedule and the criteria for PreviouslyApproved Clinical Edits, Step Therapies and Prior Authorizations.Old BusinessThese handouts were also provided to all attendees and will be posted to the Division's web ting.htmNew BusinessNew Drug ReviewDiscussion:- Olivia Rush reviewed the new products identified for the quarter and the recommendedstatus within the pharmacy program.o A listing of products recommended for open access, clinical edit, step therapy,preferred drug list (PDL), or continue prior authorization was emailed to theCommittee for discussion and action.- Questions arose around the liquid formulations for the new drugs and their availability tochildren. It was explained that these liquid formulations are expected to follow the generalrule MHD has set forth that allows children 10 and younger to receive the liquid without astep through the solid dosage formulation.- Questions arose around the dosing limitations for Injectafer and if those would apply acrossthe board to all Injectafer strengths. It was explained that each strength has its own dosagelimits and the one presented today only applies to the 1,000mg vial.- No public comment provided.Decision: The Committee voted to accept the presented new drug recommendations with norevisions.Drug Prior Authorization Committee Meeting – March 17, 2021
Clinical and Fiscal Edit ReviewClinical & Fiscal Edits With NoAnnual ChangesAcne or Rosacea, Select TopicalAgents Step Therapy EditC5 Complement Inhibitors ClinicalEditDiscussion:- Joshua Moore introduced the edits for discussion to the Committee which included:o Imcivree Clinical Edito Megestrol Clinical Edito Nulibry Clinical Edito Oxervate Clinical Edito Oxlumo Clinical Edito Spravato Clinical Edito Zokinvy Clinical Edito Zulresso Clinical Edit- No other discussion.- No public comment provided.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- Questions arose on the Erygel removal from the edit – it was explained that the cost hasdecreased significantly resulting in its removal.- No public comment provided.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- No public comment provided.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Drug Prior Authorization Committee Meeting – March 17, 2021
Cystic Fibrosis TransmembraneConductance Regulator (CFTR)Modulators Clinical EditFabry Disease Clinical EditGivlaari Clinical EditIsturisa Clinical EditScenesse Clinical EditDiscussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- No public comment provided.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- No public comment provided.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- No public comment provided.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- No public comment provided.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- Questions arose on the expected population we would see – it was explained with thisbeing a rare disease that it is very difficult to predict the expected population.- No public comment provided.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Drug Prior Authorization Committee Meeting – March 17, 2021
Sickle Cell Disease Clinical EditSystemic Antifungals Clinical EditTavneos Clinical EditVoxzogo Clinical EditDiscussion:- Joshua Moore introduced the edit for discussion to the Committee.- Public comment provided by:o Susie Moroney with Novartis on Adakveo yielded time back.o Lisa Tracz with Global Blood Therapeutics (GBT) on Oxbryta.- The Committee asked what GBT would recommend as clinical check points/outcomes thatMHD could utilize for continuation of therapy approval criteria.o The Committee was deferred to the MSL to answer that question and would beasked to attend DUR to follow up.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- No public comment provided.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- Public comment provided by:o Larry Palmisano with ChemocentryxDecision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- No public comment provided.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Drug Prior Authorization Committee Meeting – March 17, 2021
Preferred Drug List Edit ReviewPreferred Drug Edits With NoAnnual ChangesDiscussion:- Joshua Moore introduced the edits for discussion to the Committee which included:o Actinic Keratosis Agents, Topicalo Androgenic Agentso Antibiotics, Inhaledo Antifungals, Oralo Antifungals, Topicalo Antihistamines & Antihistamines/Decongestant Combinations, 2nd Generationo Antihistamines, Intranasalo Antivirals, Herpes Oralo Antivirals, Topicalo Benzoyl Peroxide/Antibiotic Combinationso Corticosteroids, Oral Inhaledo Corticosteroids, Topicalo Corticosteroids and Rhinitis Agents, Intranasalo Cough/Cold Preparationso Epinephrine Agents, Self-Injectableo Fluoroquinolones, Ophthalmico Fluoroquinolones, Otico Glaucoma Agentso Mast Cell Stabilizers, Ophthalmico NSAIDs, Ophthalmico Psoriasis Agents, Oralo Psoriasis Agents, Topicalo Retinoids, Topicalo Ulcerative Colitis Agents, Oralo Ulcerative Colitis Agents, Rectal- Public comment provided by:o Dave Miley with Tevao Erin Hohman with AbbVie on Durysta and Lumigan (Glaucoma Agents PDL)yielded time back.Drug Prior Authorization Committee Meeting – March 17, 2021
---Asthma Policy UpdatesBeta Adrenergic Agents,NebulizedQuestions arose from the Committee on the Antifungals, Oral PDLo It was discussed that the NPDL griseofulvin tablets were must safer in pediatricsand teens compared to the PDL terbinafine tabs which also has many PA steps.o Many providers are utilizing the griseofulvin suspension to bypass the terbinafinePA criteria which ALT/AST might not apply to the pediatric population as theygenerally have good functioning livers.o MHD to research more and bring back to the Committee as the cost between themedications greatly differs.Antifungals, Topicalo Nystatin ointments are flagging as non-preferred at the pharmacy – MHD toresearch and bring back to the Committee.Benzoyl Peroxide/Antibiotic Combinationso Questions arose around single ingredient benzoyl peroxide being covered by MHD.Providers may prefer to start participants on the individual 5-10% benzoyl peroxideproducts instead of a combination agent. MHD to research and bring back to theCommittee.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the recommended updates to MHD’s Asthma Policy.- See Beta Adrenergic Agents, Nebulized; Beta Adrenergic Agents, Short Acting; andLeukotriene Receptor Modifiers PDL edits for decisions on the recommendations.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- No public comment provided.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Drug Prior Authorization Committee Meeting – March 17, 2021
Beta Adrenergic Agents, ShortActingLeukotriene Receptor ModifiersAnticholinergics, LABAs/ICSCombinations and PDE4 InhibitorsDiscussion:- Joshua Moore introduced the edit for discussion to the Committee.- Discussion arose around:o Concerns with participants at risk not receiving appropriate therapy, especially inthe pediatric population.o Operationalization at point of sale Helping pharmacies ensure participants receive what they need and educatethem appropriately on when the next refills can be dispensed Soft vs hard edits DUR messages back to the pharmacieso Provider education- After discussion, the following criteria change was proposedo Cumulative quantity exceeds: 3 inhalers per 180 days for participants aged 18 years- Public comment provided by:o Dave Miley with TevaDecision: The Committee voted to accept the recommended criteria with the additional revisionsabove in blue.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- No public comment provided.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- No public comment provided.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Drug Prior Authorization Committee Meeting – March 17, 2021
Anticholinergics, Long ActingInhaledDiscussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- No public comment provided.Anticholinergics, Short Acting andCombinations InhaledDecision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- No public comment provided.Anticholinergics, LABACombinationsDecision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- No public comment provided.Antihistamines, OphthalmicAntiparasitics, TopicalDecision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- No public comment provided.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- No public comment provided.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Drug Prior Authorization Committee Meeting – March 17, 2021
Atopic Dermatitis Agents,ImmunomodulatorsBeta Adrenergic Agents, LongActingCorticosteroids, Ophthalmic SoftHepatitis C AgentsPancreatic EnzymesDiscussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- No public comment provided.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- No public comment provided.Decision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- Discussion on the trial and failure definition- Public comment provided by:o Desiree Owen with Kala Pharmaceuticals on Eysuvis yielded time backo Andrew Royer with Eyecare-Partners on EysuvisDecision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- Public comment provided by:o Erin Hohman with AbbVie on Mavyret yielded time backDecision: The Committee voted to accept the recommended criteria with no additional revisions.Discussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- Public comment provided by:o Erin Hohman with AbbVie on Creon yielded time backDecision: The Committee voted to accept the recommended criteria with no additional revisions.Drug Prior Authorization Committee Meeting – March 17, 2021
Respiratory MonoclonalAntibodiesPreferred Drug ListAnnouncementDiscussion:- Joshua Moore introduced the edit for discussion to the Committee.- No other discussion.- Public comment provided by:o Lila Kertz with Cardinal Glennon Children’s Hospital on Dupixento Elaine Siegfried with Cardinal Glennon Children’s Hospital on Dupixento Nishil Patel with Amgen on TezpireDecision: The Committee voted to accept the recommended criteria with no additional revisions.A handout of therapeutic categories to be reviewed for inclusion on the Preferred Drug List for thenext phase and June 2022 meeting was included in the meeting packet.This handout was also provided to all attendees and will be posted to the Division's web ting.htmJennifer Colozza with Conduent presented the following items for review:Program Utilization Information –Conduent UpdateAdjournment-Top 25 Drugs by Paid Amount 1st Quarter 2022 (July, August. September)Top 25 Drugs by Paid Number 1st Quarter 2022 (July, August. September)Call Center User Statistics November 2021CyberAccess Logging InformationNew Drug Statistics November 2021Morgan Sperry motioned for the meeting to be adjourned. The meeting was adjourned pursuant toSection 610.021 Subsection (14), (5) RSMo for proceedings required pursuant to a disciplinaryorder concerning medical, psychiatric, psychological, or alcoholism or drug dependency diagnosisor treatment of specific licensees. The next meeting of the Drug Prior Authorization Committee isscheduled via hybrid meeting (in person and WebEx) on Thursday, June 16, 2022.NEXT MEETING: Thursday, June 16, 2022615 Howerton Court, Conference Room 202Jefferson City, MO 65109 and WebExDrug Prior Authorization Committee Meeting – March 17, 2021
Roll Call for March 17, 2022Committee MemberAction er 2021 MinutesYYSYYMYYYNew Drug YFabry Disease Clinical EditYSYMYAYYYGivlaari Clinical EditYYSYAMYYYIsturisa Clinical EditYYYAMYSYYScenesse Clinical EditYMYSYAYYYSickle Cell Disease Clinical EditYYYAMYYSYSystemic Antifungals Clinical EditYSYMYAYYYTavneos Clinical EditYYYAMYSYYClinical & Fiscal Edits With NoAnnual ChangesAcne or Rosacea, Select TopicalAgents Clinical EditC5 Complement Inhibitors ClinicalEditCystic Fibrosis TransmembraneConductance Regulator (CFTR)Modulators Clinical EditDrug Prior Authorization Committee Meeting – March 17, 2021
Roll Call for March 17, 2022Committee MemberAction o Clinical EditYYYAMYYSYPreferred Drug Edits With NoAnnual ChangesYYMYASYYYBeta Adrenergic Agents, NebulizedYYSYAMYYYBeta Adrenergic Agents, ShortActingNYYASYYMYLeukotriene Receptor AYYYAntihistamines, OphthalmicYYYAMYYSYAntiparasitics, , LABAs/ICSCombinations and PDE4 InhibitorsAnticholinergics, Long ActingInhaledAnticholinergics, Short Acting andCombinations InhaledAnticholinergics, LABACombinationsAtopic Dermatitis Agents,ImmunomodulatorsBeta Adrenergic Agents, LongActingDrug Prior Authorization Committee Meeting – March 17, 2021
Roll Call for March 17, 2022Committee MemberAction osteroids, Ophthalmic SoftYYYAYSYMYHepatitis C Agents PDL EditYSYYAMYYYPancreatic EnzymesYYYAMYYSYRespiratory Monoclonal AntibodiesYYYAYSYMYMotion to CloseYYMYASYYYAdjournmentYSYYAMYYYRoll Call Abbreviations: A-Absent; AL-Alternate; R-Ratify; M-Motion; S-Second; Y-Yes; N-No; AB-AbstainDrug Prior Authorization Committee Meeting – March 17, 2021
Pharmacy Program Specialist. Joshua facilitated the meeting on behalf of the MO HealthNet Division. Morgan Sperry also introduced her DIC fellow, Rebecca Abt, PharmD. Minutes Review Discussion: Minutes were reviewed from the December meeting. Decision: The Committee voted to accept these approved minutes with no revisions. Pharmacy Program and .
