Common use of SCOPE OF WORK – HOOSIER HEALTHWISE Clause in Contracts

SCOPE OF WORK – HOOSIER HEALTHWISE. ▪ 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. ▪ 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. In addition to the DUR Board approval, the Contractor shall also seek the advice of the Mental Health Medicaid Quality Advisory Committee, as required in IC 12-15-35.5, prior to implementing a restriction on a mental health drug described in IC 12-15-35.5-3(b). The Contractor shall supply, on a quarterly basis, a report to the Office and the DUR Board of the number of member days of missed therapy due to prior authorization. The format of this report will be agreed upon by the Contractor, the Office and the DUR Board. In addition, the Contractor shall comply with any additional reporting requests required for submission to the DUR Board. Please refer to the Hoosier Healthwise MCE Reporting Manual for more information on pharmacy reporting requirements. 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.

SCOPE OF WORK – HOOSIER HEALTHWISE. ▪ 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. ▪ 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. In addition to the DUR Board approval, the Contractor shall also seek the advice of the Mental Health Medicaid Quality Advisory Committee, as required in IC 12-15-35.5, prior to implementing a restriction on a mental health drug described in IC 12-15-35.5-3(b). The Contractor shall supply, on a quarterly basis, a report to the Office and the DUR Board of the number of member days of missed therapy due to prior authorization. The format of this report will be agreed upon by the Contractor, the Office and the DUR Board. In addition, the Contractor shall comply with any additional reporting requests required for submission to the DUR Board. Please refer to the Hoosier Healthwise MCE Reporting Manual for more information on pharmacy reporting requirements. The Contractor shall provide the DUR Board statistics at the DUR Board’s monthly meetings. These statistics may include information on drug utilization utilizat ion or prior authorization reports as requested by the State.