Dr. W ilhelm Lehmann, DUR Board Chairman Editors: Tim Morley, R.Ph., Lisa Hulbert, R.Ph. Jennifer Zeleny, CphT., MPH., Duane Parke, R.Ph.
An “unofficial” publication of the State Medicaid DUR Board
Preferred Drug List Update Prior Authorization Changes
During the 2009 legislative session, the State Legislature approved SB87, which authorizes Utah Medicaid to require a Prior Authorization for
Effective July 1, 2009, butalbital-containing compounds for
non-preferred drugs. The PA requirement went into effect on May 18,
headache treatment will require a PA. Requests will be
2009. To receive a Non-Preferred Authorization (NPA), the prescriber
reviewed by the DUR Board on an individual basis.
must provide a detailed explanation of one of the following:
Effective July 15, 2009, Chantix will require a PA. Use will belimited to 24 weeks per calendar year.
Trial and failure of at least one preferred agent in the class,including name of the preferred product(s) tried, length oftherapy and reason for discontinuation.
Prior Authorization criteria can be obtained through the pharmacy
Evidence of a potential drug interaction between current
medication and the preferred product(s).
Medicaid Prior Authorizations at (801)538-6155 or (800) 662-9651.
Evidence of a condition or contraindication that prevents theuse of the preferred product(s).
Objective clinical evidence that a patient is at high risk of
Influenza Medications Available for H1N1
adverse events due to a therapeutic interchange.
Due to the H1N1 pandemic, Medicaid has temporarily suspended Prior
Requests for NPA should be faxed to (801) 536-0477. Prescribers
Authorization requirements for Tamiflu and Relenza. The Medicaid
may provide the information either in the form of chart notes or by
Pharmacy Claims system will continue to check the patient’s age and
filling out the NPA form that can be downloaded from the Pharmacy
pay claims only for the FDA-approved age ranges for these products.
Many providers have called Medicaid to ask how reimbursement for the
The Medicaid Preferred Drug List continues to expand on a monthly
H1N1 Influenza vaccine will be handled once it becomes available. To
basis. Watch the Medicaid Pharmacy website at
date, there is no reliable information on when the vaccine will become
available, how many doses will be required, etc. The decision on how
to handle coverage will be made expeditiouslyonce this informationbecomes readily available to Medicaid staff.
Free Blood Glucose M eters Still Available
Medicaid clients may call 1-877-229-3777 for a Bayer blood glucose
Nicotine Replacem ent Therapy & Counseling
The DUR Board recently reviewed the smoking cessation class andrecommended that Medicaid patients receiving NRT or other generic
Medicaid clients may call 1-877-535-7467 and refer to Order Number
smoking cessation medications that do not include enrollment in a
417-UTM001 to obtain a Lifescan blood glucose meter.
behavioral program be referred to Utah Quitnet to increase theirchances of success in quitting.
All preferred drugs and diabetic supplies are NDC specific. Pleaserefer to the Medicaid Pharmacy Website for a list of NDCs.
Clients should be referred to the webor to one of the following phone numbers:
Please Note: Occasionally, rebate offers from pharmaceutical companies may make coverage of a brand-name drug more cost
effective than the generic. Medicaid may, in these instances, require
that pharmacies dispense the brand-name drug as the preferred
Educational letters to clients receiving smoking cessation products will
P&T Com m ittee Schedule
The P&T Committee meets on the third Thursday of the month in the
Cannon Health Building at 7:00 A.M. The schedule of upcoming drug
State budget shortfalls required a reduction in the Medicaid Pharmacy
Drug EAC basis of reimbursement. Effective March 1, 2009, the EACwas reduced to Average Wholesale Price (AWP) minus 17%. This
change in the EAC was restored to AWP minus 15% begnning July 1,
Aug 2009: Third Generation Cephalosporins
Sep 2009: Targeted ImmunomodulatorsOct 2009: Second Generation Antihistamines
Medicaid is also continuing to aggressively expand use of the UtahMAC. To dispute a Utah MAC price, please fax the most recent invoice
Continue to watch the P&T Committee website for important updates
of the product being billed to (801) 538-6099. Pharmacies will need to
regarding the P&T Committee schedule, or email Duane Parke, at
re-submit claims once pricing adjustments are made.
Utah Department of Health Health Care Financing Amber Sheeet Box 143102 Salt Lake City UT 84114-3102 Emergency Supplies of PA Drugs Is It Safe To Wait?
Drugs requiring Prior Authorization are available to patients on an
In April 2008, Utah Medicaid wasone of 20 states awarded a grant to
emergency basis 24/7. This is true for both drugs requiring Clinical PA
the emergency room for non-emergent care. This project
The Pharmacy Prior Authorization Department is available Monday -
Friday, 8:00 A.M. to 5:00 P.M., except on holidays.
clients about the appropriate use ofthe emergency room. The project
If a patient comes to the pharmacy with an emergency need outside of
regular business hours, the pharmacy may dispense a 72-hour supply.
to clients: Is it safe to wait? Is itsafe to wait for an appointment with
Medicaid will issue a PA for the 72-hour supply on the next business
day. Further quantity requests will be subject to all PA requirements.
day at an urgent care / after hoursclinic?
Please Note: If the emergency drug comes in a form that cannot be
readily split into a 72-hour supply (i.e. a rescue inhaler or a vial of
Through a series of educationalefforts and interventions, Medicaid
insulin), Medicaid will work with the pharmacy to accommodate the
their healthcare choices includingthe importance of developing a
Vitamin D Coverage
relationship with a PCP. Theproject team also provides clients with information about urgent careproviders available in their area. Preliminary data shows that many
Recently, the Utah Medicaid DUR Board met to review osteoporosis
clients are unaware of the location of, or the services available from, an
drugs. Because available evidence suggests that patients taking
bisphosphonates (i.e. Fosamax, Boniva, and Actonel) should also betaking Vitamin D, Utah Medicaid was urged to consider providing
If clients continue to use the emergency room for care that could be
provided at a lower cost facility, they may be enrolled into the CareCoordination and Restriction program where they will be assigned asingle PCP and pharmacy. For more information about the grant
Effective July 1, 2009, the following NDCs for Vitamin D will be
activities, please visit our website at http://health.utah.gov/safetowait/.
24385-0655-78 Vitamin D 1,000 iu (OTC strength)
Medicaid Communication eSources:
50111-0990-01 Vitamin D 50,000 iu (Rx strength)
W ebsite The Medicaid Pharmacy Services website is available 24/7 for policy
Please also note, clients taking oral bisphosphonates should also be
information. It contains information about prior authorization criteria, the
taking calcium supplements. Non-oyster shell calcium tablets have
DUR Board, Amber Sheets, Medicaid Pharmacy policy manuals, and
long been a benefit to clients enrolled in the Traditional and Non-
the latest news about Medicaid pharmacy. For more information, log on
If a Medicaid client taking bisphosphonates expresses concern about
being able to afford Vitamin D or Calcium supplements, they may
Medicaid will be providing information on the Preferred Drug List, Prior
obtain a prescription for these items and have them paid through their
Authorizations, and other pharmacy benefit information through
ePocrates. All three Medicaid programs now have pharmacy benefit information available! r further information.
UNIVERSIDAD SALESIANA DE BOLIVIA GABINETE DE AUDITORÍA EL INFORME DEL AUDITOR INDEPENDIENTE Concepto El dictamen del auditor es el medio mediante el cual emite un juicio técnico sobre los estadosfinancieros que ha examinado. Mediante este documento el auditor expresa:Que ha examinado los estados financieros de un ente, identificandolos. ¿ Cómo llevo a cabo su examen ?, generalmen