Committee to advise and make recommendations on drug utilization review standards and interventions
- • preferred drug list
- • rules
(1) The Pharmacy and Therapeutics Committee shall advise the Oregon Health Authority on:
(a) Adoption of rules to implement ORS 414.351 (Definitions for ORS 414.351 to 414.414) to 414.414 (Use and disclosure of confidential information) in accordance with ORS chapter 183.
(b) Implementation of the medical assistance program retrospective and prospective programs as described in ORS 414.351 (Definitions for ORS 414.351 to 414.414) to 414.414 (Use and disclosure of confidential information), including the type of software programs to be used by the pharmacist for prospective drug use review and the provisions of the contractual agreement between the state and any entity involved in the retrospective program.
(c) Development of and application of the criteria and standards to be used in retrospective and prospective drug use review in a manner that ensures that such criteria and standards are based on compendia, relevant guidelines obtained from professional groups through consensus-driven processes, the experience of practitioners with expertise in drug therapy, data and experience obtained from drug utilization review program operations. The committee shall have an open professional consensus process for establishing and revising criteria and standards. Criteria and standards shall be available to the public. In developing recommendations for criteria and standards, the committee shall establish an explicit ongoing process for soliciting and considering input from interested parties. The committee shall make timely revisions to the criteria and standards based upon this input in addition to revisions based upon scheduled review of the criteria and standards. Further, the drug utilization review standards shall reflect the local practices of prescribers in order to monitor:
(A) Therapeutic appropriateness.
(B) Overutilization or underutilization.
(C) Therapeutic duplication.
(D) Drug-disease contraindications.
(E) Drug-drug interactions.
(F) Incorrect drug dosage or drug treatment duration.
(G) Clinical abuse or misuse.
(H) Drug allergies.
(d) Development, selection and application of and assessment for interventions that are educational and not punitive in nature for medical assistance program prescribers, dispensers and patients.
(2) In reviewing retrospective and prospective drug use, the committee may consider only drugs that have received final approval from the federal Food and Drug Administration.
(3) The committee shall make recommendations to the authority, subject to approval by the Director of the Oregon Health Authority or the director’s designee, for drugs to be included on any preferred drug list adopted by the authority and on the Practitioner-Managed Prescription Drug Plan. The committee shall also recommend all utilization controls, prior authorization requirements or other conditions for the inclusion of a drug on a preferred drug list.
(4) In making recommendations under subsection (3) of this section, the committee may use any information the committee deems appropriate. The recommendations must be based upon the following factors in order of priority:
(a) Safety and efficacy of the drug.
(b) The ability of Oregonians to access effective prescription drugs that are appropriate for their clinical conditions.
(c) Substantial differences in the costs of drugs within the same therapeutic class.
(5) The committee shall post a recommendation to the website of the authority no later than 30 days after the date the committee approves the recommendation. The director shall approve, disapprove or modify any recommendation of the committee as soon as practicable, shall publish the decision on the website and shall notify persons who have requested notification of the decision. A recommendation adopted by the director, in whole or in part, with respect to the inclusion of a drug on a preferred drug list or the Practitioner-Managed Prescription Drug Plan may not become effective less than 60 days after the date that the director’s decision is published.
(6) The director shall reconsider any decision to adopt or modify a recommendation of the committee with respect to the inclusion of a particular drug on a preferred drug list or the Practitioner-Managed Prescription Drug Plan, upon the request of any interested person filed no later than 30 days after the director’s decision is published on the website. The decision on reconsideration shall be sent to the requester and posted to the website without undue delay. [2011 c.720 §4]
Note: See note under 414.351 (Definitions for ORS 414.351 to 414.414).
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent.