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205.5638 Duties and responsibilities of board.

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Page 1 of 2 205.5638 Duties and responsibilities of board. (1) The Drug Management Review Advisory Board shall have at least the following duties and responsibilities: <br>(a) Review and make recommendations to the commissioner or designee on predetermined prospective drug use review standards submitted to the board <br>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 <br>designee concerning modification or elimination of existing standards and the <br>need for additional standards; (c) Make recommendations to the commissioner or the commissioner's designee concerning guidelines governing written predetermined standards that <br>pharmacies must use in conducting prospective drug use review if they do not <br>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 <br>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 <br>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 <br>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; <br>(k) Prepare and submit to the commissioner an annual drug use review report that contains the following information: <br>1. A description of the nature and scope of the retrospective drug <br>utilization program including the identity of the contractor, the <br>frequency of screening of claims data and the criteria and standards <br>used, along with new or revised copies of the clinical criteria, and in <br>subsequent years, a list of revised criteria and deleted criteria; 2. A summary of nonpatient and provider specific educational activities <br>including information on the use of each type of patient and provider <br>specific intervention that indicates the guidelines for use and frequency <br>of use by type of intervention and the effectiveness of each type of <br>intervention on changes in prescribing or dispensing practices; Page 2 of 2 3. An evaluation of the adequacy of prospective drug use review database <br>software; and 4. Details on policy guidelines adopted by the board pertaining to written <br>criteria that pharmacies may use if they do not use a computer <br>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 <br>intensity of the disease, and the economic, clinical, and patient-prospective <br>outcomes, including quality of life. (2) The board shall function in accordance with the Kentucky Open Meetings Law and the Kentucky Open Records Act. The board may designate subcommittees to <br>address specific issues and to report findings to the board. In conducting its <br>business, the board shall utilize distance communication technologies whenever <br>possible. (3) Clerical and administrative support shall be provided the board through the Cabinet for Health and Family Services or by contract. Effective: June 20, 2005 <br>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 <br>ch. 561, sec. 5, effective July 15, 1998.