Texas DUR Board Proposed Retrospective- DUR Interventions - Prepared by Luke Boehmer, PharmD, MCMP-II - Texas Health and Human Services
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July 23, 2021 Texas DUR Board Proposed Retrospective- DUR Interventions Prepared by Luke Boehmer, PharmD, MCMP-II
Agenda
Recent Interventions
• Benzodiazepine Anxiolytics and/or Controlled Sedative Hypnotics
• Major Depressive Disorder (MDD) Management
Recent Outcome Reports
• Asthma
• Pharmacotherapy of Post-Traumatic Stress Disorder
• Gabapentinoid Drug Use Evaluation
• Overutilization of Antibiotics
Potential RetroDUR Interventions
• Bipolar Disorder
• Hypertension
2Recent RetroDUR Interventions
Provider
Intervention Date Mailed Patients
Letters
Benzodiazepine Anxiolytics and/or
06/15/2021 38 43
Controlled Sedative Hypnotics
Major Depressive Disorder (MDD) July 2021
645 736
Management TBD
3Recent Outcome Reports
12-Month State
Intervention Date Mailed
Savings
Asthma 8/20/20 $27,736.71
Pharmacotherapy of Post-Traumatic Stress
9/15/20 $3,667.67
Disorder
Gabapentinoid DUE 10/23/20 $32,929.45
Overutilization of Antibiotics 11/17/20 $91,408.89
4Recent Outcome Reports:
Asthma
Clinical Indicators Baseline Mar-2021 % Change
Overutilization of short-acting beta2-agonist (SABA)
4 2 -50%
inhalers in patients with asthma
Use of long-acting beta-agonist (LABA) inhaler
without SABA inhaler and/or ICS in patients with 3 2 -33.3%
asthma
Identify the underutilization of asthma therapy 2 1 -50%
Identify patients who may be at risk of experiencing
53 38 -28.3%
an adverse drug event
Encourage medication adherence with asthma
28 21 -25%
therapy
Identify asthmatic patients with a history of smoking 31 22 -29.0%
Total 121 86 -28.9% 5Recent Outcome Reports:
Post-Traumatic Stress Disorder Management
Clinical Indicators Baseline Mar-2021 % Change
Use of benzodiazepines in PTSD 3 2 -33.3%
Use of antidepressants other than SSRIs or
51 32 -37.3%
venlafaxine in PTSD
Use of sedative-hypnotics in PTSD 1 0 -100%
Use of an antipsychotic without an SSRI or
venlafaxine in PTSD unless there is a history of 11 7 -36.4%
schizophrenia or bipolar disorder
Total 66 41 -37.9%
6Recent Outcome Reports:
Gabapentinoid DUE
Clinical Indicators Baseline May-2021 % Change
Multiple prescribers of gabapentinoids and opioids 1 1 -0%
Multiple prescribers of gabapentinoids and CNS
6 3 -50%
depressants
Gabapentinoid use with CNS Depressants 21 14 -33.3%
Gabapentinoid use with 1st generation
1 1 -0%
antihistamines
Gabapentinoid use in patients with respiratory
25 18 -28%
impairment
Use of a gabapentinoid without an approved
207 164 -20.8%
indication
Total 261 201 -23.0%
7Recent Outcome Reports:
Overutilization of Antibiotics
Clinical Indicators Baseline May-2021 % Change
Promote prudent use of antibiotics through the
use of narrow-spectrum or no antibiotics and
1,023 784 -23.4%
provide education regarding antibiotic use and
common infections
Total 1,023 784 -23.4%
8Potential RetroDUR Intervention:
Bipolar Disorder Management
Purpose:
• To promote safe and effective drug therapy in patients with Bipolar Disorder (BD). The National Institute
for Health and Care Excellence (NICE) clinical guideline1, the Canadian Network for Mood and Anxiety
Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative guidelines2,
and the British Association for Psychopharmacology (BAP) guideline for the management of bipolar
disorder3 provide the foundation for this proposal. These guidelines, along with recently published major
studies, provide performance indicators to evaluate the medication management of BD.
Why Issue was Selected:
• BD has an estimated lifetime prevalence of 4.4% for adults in the US and is associated with
significant psychosocial impairment and disability along with a reduced quality of life
• Pharmacotherapy is the mainstay of treatment for BD, and treatment guidelines recommend
such regimens be built around adequate dosing of a mood stabilizer. Additional medication
classes commonly employed include atypical antipsychotic agents, antidepressants, and
stimulants
• The principles to effectively employ and combine these different medication groups to obtain
optimal outcomes with minimal risks are the focus of this intervention
9Potential RetroDUR Intervention:
Bipolar Disorder Management
Setting and Population:
• All patients with a history of bipolar disorder in the past 2 years and have
pharmacy claims in the past 90 days
Type of Intervention:
• Cover letter and modified patient profiles
Outcome Measures:
• Results of this intervention will be measured when six months of post-initiative
data are available.
10Potential RetroDUR Intervention:
Bipolar Disorder Management
Performance Indicators Exceptions
(< 18 Years) FFS (< 18 Years) MCO
Use of an antidepressant in the absence of a mood stabilizer/atypical
(7) 193 (1,357) 8,511
antipsychotic
Use of multiple atypical antipsychotics simultaneously as mood stabilizers (0) 1 (68) 400
Use of a stimulant medication (9) 11 (2,470) 2,030
Lithium monitoring: serum levels, renal function, and thyroid function (6) 50 (784) 3,567
Atypical antipsychotic monitoring: blood glucose/hemoglobin A1C and lipid
(68) 212 (5,572) 13,835
levels
Anticonvulsant monitoring: complete blood count, hepatic function, and renal
(9) 50 (1,316) 3,442
function
Medication nonadherence with an atypical antipsychotic or mood stabilizer (16) 63 (1,759) 9,862 11Potential RetroDUR Intervention: Hypertension Management Purpose: • To determine opportunities for improving the safety and efficacy of drug therapy for patients with hypertension, following the 2017 Hypertension Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines1 and the Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents.2 Where evidence is in agreement with the previous guidance, the 2020 International Society of Hypertension Global Hypertension Practice Guidelines will also be utilized. Why Issue was Selected: • According to the American Heart Association (AHA), almost 50% of adults in the United States, equating to over 121.5 million people, have high blood pressure or hypertension and almost 40% of these adults are unaware of their condition • Data indicates an increase in the prevalence of high blood pressure in childhood and this correlates with higher blood pressure in adulthood and earlier onset of hypertension • Hypertension is associated with significant morbidity and mortality if not detected and treated appropriately • Globally,, elevated blood pressure remains the leading cause of death and accounts for over 10 million deaths 12 per year
Potential RetroDUR Intervention:
Hypertension Management
Setting and Population:
• All patients with a history of hypertension in the last 2 years will be included
Type of Intervention:
• Cover letter and individual patient profiles
Outcome Measures:
• Results of this intervention will be measured when six months of post-initiative
data are available.
13Potential RetroDUR Intervention:
Hypertension Management
Performance Indicators Exceptions
(< 18 Years) FFS (< 18 Years) MCO
Encourage use of recommended first-line treatment of hypertension:
thiazide diuretics, Angiotensin-Converting Enzyme Inhibitors (ACEIs),
(14) 232 (1,001) 11,910
Angiotensin Receptor Blockers (ARBs), and Calcium Channel Blockers
(CCBs)
Encourage use of angiotensin-modulating agents (ACEIs or ARBs) and
(6) 562 (262) 22,717
beta-blockers with the presence of a compelling indication
Enhance adherence with antihypertensive drug therapy and recognize
(24) 590 (1,804) 32,395
when therapy discontinuation may be contributing to treatment failure
Promote safe and effective use of antihypertensive drug therapy
through identification of potential adverse events and increased (14) 519 (658) 6,776
monitoring
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