KRS § 205.5638 — KY Code / Title XVII / Chapter 205 / Section 205.5638
205.5638 Duties and responsibilities of board
Status: in_force

205.5638 Duties and responsibilities of board.

(1) The Drug Management Review Advisory Board shall have at least the following

duties and responsibilities:

(a) Review and make recommendations to the commissioner or designee on

predetermined prospective drug use review standards submitted to the board

by the Department for Medicaid Services or its contractor;

(b) Evaluate the use of the predetermined prospective drug use review standards

and make recommendations to the commissioner or the commissioner's

designee concerning modification or elimination of existing standards and the

need for additional standards;

(c) Make recommendations to the commissioner or the commissioner's designee

concerning guidelines governing written predetermined standards that

pharmacies must use in conducting prospective drug use review if they do not

use approved software;

(d) Oversee the retrospective drug use review contract and incorporate the results

into predetermined retrospective drug use review standards;

(e) Review and make recommendations to the commissioner or the

commissioner's designee on predetermined retrospective drug use standards

submitted to the board by the Department for Medicaid Services;

(f) Make recommendations to the commissioner or the commissioner's designee

concerning the modification or elimination of existing predetermined

retrospective drug use review standards and the need for additional standards;

(g) Identify and develop educational topics on common drug therapy problems if

needed to improve prescribing or dispensing practices of practitioners;

(h) Make recommendations to the commissioner or the commissioner's designee

concerning which mix of interventions would most effectively lead to an

improvement in the quality of drug therapy;

(i) Conduct periodic reevaluations to determine the effectiveness of educational

effort and, if necessary, modify the interventions;

(j) Recommend standards for the identification of suspected fraud and abuse;

(k) Prepare and submit to the commissioner an annual drug use review report that

contains the following information:

1. A description of the nature and scope of the retrospective drug

utilization program including the identity of the contractor, the

frequency of screening of claims data and the criteria and standards

used, along with new or revised copies of the clinical criteria, and in

subsequent years, a list of revised criteria and deleted criteria;

2. A summary of nonpatient and provider specific educational activities

including information on the use of each type of patient and provider

specific intervention that indicates the guidelines for use and frequency

of use by type of intervention and the effectiveness of each type of

intervention on changes in prescribing or dispensing practices;

3. An evaluation of the adequacy of prospective drug use review database

software; and

4. Details on policy guidelines adopted by the board pertaining to written

criteria that pharmacies may use if they do not use a computer

prospective drug utilization review database; and

(l) In advising the department, the board may consider the effectiveness of all

interventions used to manage a particular disease over time, the stage and

intensity of the disease, and the economic, clinical, and patient-prospective

outcomes, including quality of life.

(2) The board shall function in accordance with the Kentucky Open Meetings Law and

the Kentucky Open Records Act. The board may designate subcommittees to

address specific issues and to report findings to the board. In conducting its

business, the board shall utilize distance communication technologies whenever

possible.

(3) Clerical and administrative support shall be provided the board through the Cabinet

for Health and Family Services or by contract.