Common use of DUR Board and MHQAC Reporting Requirements Clause in Contracts

DUR Board and MHQAC Reporting Requirements. In accordance with IC 00-00-00-00, the DUR Board shall review the prescription drug programs of the Contractor at least one (1) time per year. This review shall include, but is not limited to, review of the following for non-formulary (i.e., non-SUPDL) covered drug list categories: ▪ An analysis of the single source drugs requiring prior authorization in comparison to other contractor’s prescription drug programs in the Hoosier Healthwise program. ▪ A determination and analysis of the number and the type of drugs subject to a restriction. ▪ A review of the rationale for the prior authorization of a drug and a restriction on a drug. The DUR Board review shall include, but is not limited to, review of the following for all categories, including SUPDL drug categories: ▪ A review of the number of requests a Contractor received for prior authorization, including the number of times prior authorization was approved and disapproved. ▪ A review of patient and provider satisfaction survey reports and pharmacy- related grievance data for a twelve (12) month period. The Contractor shall provide OMPP with the information necessary for the DUR Board to conduct this review in the timeframe and format specified by OMPP. OMPP may identify therapeutic drug classes or specific drug products for which the Contractor may be required to bring to the DUR Board for review prior to the implementation of any changes in coverage or utilization management criteria. The Contractor shall comply with any reporting requests required for submission to the DUR Board and the Mental Health Quality Advisory Committee (MHQAC). Please refer to the MCE Reporting Manual for more information on pharmacy reporting requirements. All mental health drugs described in IC 12-15-35.5 are considered preferred and included on the SUPDL. The Contractor shall comply with all SUPDL requirements pertaining to mental health drugs. The Contractor shall provide the DUR Board statistics at the DUR Board’s monthly meetings. These statistics may include information on drug utilization or prior authorization reports as requested by the State.

DUR Board and MHQAC Reporting Requirements. In accordance with IC 00-00-00-00, the DUR Board shall review the prescription drug programs of the Contractor at least one (1) time per year. This review shall include, but is not limited to, review of the following for non-formulary (i.e., non-SUPDL) covered drug list categories: ▪ An analysis of the single source drugs requiring prior authorization in comparison to other contractor’s prescription drug programs in the Hoosier Healthwise HIP program. ▪ A determination and analysis of the number and the type of drugs subject to a restriction. ▪ A review of the rationale for the prior authorization of a drug and a restriction on a drug. The DUR Board review shall include, but is not limited to, review of the following for all categories, including SUPDL drug categories: ▪ A review of the number of requests a Contractor received for prior authorization, including the number of times prior authorization was approved and disapproved. ▪ A review of patient and provider satisfaction survey reports and pharmacy- related grievance data for a twelve (12) month period. The Contractor shall provide OMPP with the information necessary for the DUR Board to conduct this review in the timeframe and format specified by OMPP. OMPP may identify therapeutic drug classes or specific drug products for which the Contractor may be required to bring to the DUR Board for review prior to the implementation of any changes in coverage or utilization management criteria. The Contractor shall comply with any reporting requests required for submission to the DUR Board and the Mental Health Quality Advisory Committee (MHQAC). Please EXHIBIT 1.A SCOPE OF WORK refer to the MCE Reporting Manual for more information on pharmacy reporting requirements. All mental health drugs described in IC 12-15-35.5 are considered preferred and included on the SUPDL. The Contractor shall comply with all SUPDL requirements pertaining to mental health drugs. The Contractor shall provide the DUR Board statistics at the DUR Board’s monthly meetings. These statistics may include information on drug utilization or prior authorization reports as requested by the State.

DUR Board and MHQAC Reporting Requirements. In accordance with IC 00-00-00-00, the DUR Board shall review the prescription drug programs of the Contractor at least one (1) time per year. This review shall include, but is not limited to, review of the following for non-formulary (i.e., non-SUPDL) covered drug list categories: ▪ An analysis of the single source drugs requiring prior authorization in comparison to other contractor’s prescription drug programs in the Hoosier Healthwise HIP program. ▪ A determination and analysis of the number and the type of drugs subject to a restriction. ▪ A review of the rationale for the prior authorization of a drug and a restriction on a drug. The DUR Board review shall include, but is not limited to, review of the following for all categories, including SUPDL drug categories: ▪ A review of the number of requests a Contractor received for prior authorization, including the number of times prior authorization was approved and disapproved. ▪ A review of patient and provider satisfaction survey reports and pharmacy- related grievance data for a twelve (12) month period. The Contractor shall provide OMPP with the information necessary for the DUR Board to conduct this review in the timeframe and format specified by OMPP. OMPP may identify therapeutic drug classes or specific drug products for which the Contractor may be required to bring to the DUR Board for review prior to the implementation of any changes in coverage or utilization management criteria. The Contractor shall comply with any reporting requests required for submission to the DUR Board and the Mental Health Quality Advisory Committee (MHQAC). Please refer to the MCE Reporting Manual for more information on pharmacy reporting requirements. All mental health drugs described in IC 12-15-35.5 are considered preferred and included on the SUPDL. The Contractor shall comply with all SUPDL requirements pertaining to mental health drugs. The Contractor shall provide the DUR Board statistics at the DUR Board’s monthly meetings. These statistics may include information on drug utilization or prior authorization reports as requested by the State.

DUR Board and MHQAC Reporting Requirements. In accordance with IC 00-00-00-00, the DUR Board shall review the prescription drug programs of the Contractor at least one (1) time per year. This review shall include, but is not limited to, review of the following for non-formulary (i.e., non-SUPDL) covered drug list categories: ▪ An analysis of the single source drugs requiring prior authorization in comparison to other contractor’s prescription drug programs in the Hoosier Healthwise HIP program. ▪ A determination and analysis of the number and the type of drugs subject to a restriction. ▪ A review of the rationale for the prior authorization of a drug and a restriction on a drug. The DUR Board review shall include, but is not limited to, review of the following for all categories, including SUPDL drug categories: ▪ A review of the number of requests a Contractor received for prior authorization, including the number of times prior authorization was approved and disapproved. ▪ A review of patient and provider satisfaction survey reports and pharmacy- related grievance data for a twelve (12) month period. The Contractor shall provide OMPP with the information necessary for the DUR Board to conduct this review in the timeframe and format specified by OMPP. OMPP may identify therapeutic drug classes or specific drug products for which the Contractor may be required to bring to the DUR Board for review prior to the implementation of any changes in coverage or utilization management criteria. The Contractor shall comply with any reporting requests required for submission to the DUR Board and the Mental Health Quality Advisory Committee (MHQAC). Please EXHIBIT 1.A SCOPE OF EXHIBIT refer to the MCE Reporting Manual for more information on pharmacy reporting requirements. All mental health drugs described in IC 12-15-35.5 are considered preferred and included on the SUPDL. The Contractor shall comply with all SUPDL requirements pertaining to mental health drugs. The Contractor shall provide the DUR Board statistics at the DUR Board’s monthly meetings. These statistics may include information on drug utilization or prior authorization reports as requested by the State.