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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
(2)
(3)
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.
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.
Clerical and administrative support shall be provided the board through the
Cabinet for Health and Family Services or by contract.
Effective:June 20, 2005
History: Amended 2005 Ky. Acts ch. 99, sec. 239, effective June 20, 2005. -Amended 2002 Ky. Acts ch. 7, sec. 5, effective February 21, 2002. -- Created
1998 Ky. Acts ch. 561, sec. 5, effective July 15, 1998.
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