Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 20 - Pharmacy Program › Section 13 CSR 70-20.300 - Retrospective Drug Use Review Process

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: The purpose of this amendment is to
				  incorporate the current functions of the Drug Prior Authorization Committee
				  into the Drug Utilization Review (DUR) Board.
PURPOSE: This rule establishes the division process
				  by which the Drug Utilization Review Board will be established as required by
				  Section
				  4401 of
				  P.L.
				  101-508 (Omnibus Budget Reconciliation Act of
				  1990) and by section
				  208.175,
				  RSMo.
(1) Drug Utilization
				Review (DUR) Board. This rule establishes a MO HealthNet DUR Board in the
				Department of Social Services, MO HealthNet Division. The board shall be
				composed as specified in section
				208.175,
				RSMo.
(2) A chairperson shall be
				elected by the board members.
(3)
				The DUR Board shall meet at least once every ninety (90) days. A quorum of
				two-thirds (2/3) of the total members, including no fewer than three (3)
				physicians or three (3) pharmacists, is required for the board to act in its
				official capacity.
(4) Members
				shall serve four- (4-) year terms, except the terms of the original members,
				two (2) shall be appointed for a term of two (2) years, three (3) shall be
				appointed for a term of three (3) years, and three (3) shall be appointed for a
				term of four (4) years. Members may be reappointed, provided that minimum
				qualifications for membership continue to be met. Nominations shall be referred
				for final appointment by the governor subject to advice and consent of the
				senate. As vacancies occur, the DUR Board shall solicit and select a slate of
				nominees.
(5) The members of the
				DUR Board shall receive no compensation for their services other than
				reasonable expenses actually incurred in the performance of their official
				duties.
(6) The DUR Board shall
				hold a public hearing during which the MO HealthNet Division shall make
				recommendations to the board. The hearing shall be prior to any final decision
				by the division to require prior authorization for that pharmaceutical product,
				class, or category.
(7) The
				tentative meeting agenda of the DUR Board with the therapeutic classes to be
				discussed shall be posted on the MO HealthNet Division website (
www.dss.mo.gov/mhd
) approximately
				fourteen (14) days prior but no less than seven (7) days prior to the meeting.
(A) The specific therapeutic class or classes
				to be considered at the next regularly scheduled DUR Board meeting shall be
				placed on the current agenda or posted on the website approximately thirty (30)
				days prior to the scheduled meeting.
(B) Any interested party shall be granted the
				opportunity for clinically relevant public comment for up to five (5) minutes
				per medication under review by the DUR Board. The responsibility of scheduling
				the presentation shall rest with the interested party. Interested parties
				representing a manufacturer shall be granted five (5) minutes in the aggregate
				per medication under review by the DUR Board.
(C) Following the consideration of all
				presented information, the DUR Board may accept or alter the recommendations
				from the MO HealthNet Division. The board shall make their final recommendation
				to the MO HealthNet Division by a majority vote of the members of the committee
				present thereto in a recorded roll call vote.
(D) The specific therapeutic class or classes
				recommended for restriction by means of step therapy, clinical edit, fiscal
				edit, or preferred drug list shall be available on the division website at
www.dss.mo.gov/mhd
approximately
				fifteen (15) calendar days after the meeting.