Title 7 . Health and Social Services

Chapter 43 . Hearings

Section 593. Drug use review

7 AAC 43.593. Drug use review

(a) The purpose of this section is to establish a drug use review program to comply with the requirements of 42 U.S.C. 1396r-8(g). The drug use review program primarily consists of prospective drug use review, retrospective drug use review, and educational outreach. The purpose of drug use review is to screen for potential drug therapy problems, identify and prevent abuse of prescribed drugs, and prevent inappropriate or unnecessary drug use. This section applies only to the prescription and dispensing of a drug provided to a Medicaid recipient who is not a patient in a hospital or nursing facility.

(b) As part of the prospective drug use review required in (a) of this section, and before the division will reimburse an enrolled pharmacy, a pharmacist shall make a reasonable effort to review a recipient's drug therapy before a prescription is delivered to the recipient, including obtaining and maintaining the following information for each Medicaid recipient:

(1) name;

(2) address;

(3) telephone number;

(4) date of birth or age;

(5) gender;

(6) medical history, including any current illness, which the pharmacist considers significant;

(7) allergies;

(8) drug reactions;

(9) medications currently used;

(10) medical devices currently used; and

(11) the pharmacist's comments relating to the recipient's drug therapy.

(c) As part of the prospective drug use review under this section, a pharmacist shall review the prescription, either manually or by computer, against the following criteria:

(1) therapeutic duplication;

(2) drug-disease contraindications;

(3) interactions between the prescription and other drugs being taken;

(4) incorrect dose or duration;

(5) possible allergic reactions; and

(6) potential for clinical abuse or misuse.

(d) To complete the prospective drug use review under this section, a pharmacist shall provide the recipient with patient counseling, as required by 12 AAC 52.800, and shall document in a permanent record the recipient's acceptance or refusal of counseling.

(e) In accordance with 42 C.F.R. 716, the department establishes a drug use review committee to help the department comply with federal drug use review requirements. The drug use review committee will help the department

(1) implement prospective drug use review in accordance with 42 C.F.R. 456.705, including recommending changes to the pharmacist review practices described in this section;

(2) implement retrospective drug use review in accordance with 42 C.F.R. 456.709, including periodic examination of past drug prescription practices;

(3) assess drug use data in accordance with 42 C.F.R. 756.703;

(4) implement an educational program in accordance with 42 C.F.R. 456.711, including recommending changes in prescribing or dispensing practices when appropriate to meet the intent of this section; and

(5) prepare and submit an annual report to the United States Department of Health and Human Services in accordance with 42 C.F.R. 456.712.

(f) Members of the drug use review committee will be nominated by the division and appointed by the commissioner to a three-year term, except that the term length of initial appointments to the committee may be varied by the commissioner to effect staggered expiration dates. A member may not serve more than two consecutive terms. The drug review committee shall consist of at least

(1) one-third, but no more than 51 percent, licensed and actively practicing physicians;

(2) one-third licensed and actively practicing pharmacists;

(3) an employee of the division; and

(4) at the discretion of the commissioner, other health care providers.

(g) For purposes of this section, "pharmacist" includes a person who dispenses prescription drugs for outpatient use.

History: Eff. 7/3/94, Register 130; readopt 8/7/96, Register 139

Authority: AS 47.05.010

AS 47.07.030

AS 47.07.040

Editor's note: Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.593 in its entirety, without change, under AS 47.05 and AS 47.07. Executive Order No. 72 transferred certain rate-setting authority to the department.