205.5638 Duties and responsibilities of board.
546 words·~2 min read·
/ky/chapter-205/205-5638A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(1)The Drug Management Review Advisory Board shall have at least the following
duties and responsibilities:
(a)Review and make recommendations to the commissioner or designee on
predetermined prospective drug use review standards submitted to the board
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
designee concerning modification or elimination of existing standards and the
need for additional standards;
(c)Make recommendations to the commissioner or the commissioner's designee
concerning guidelines governing written predetermined standards that
pharmacies must use in conducting prospective drug use review if they do not
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
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
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
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;
(k)Prepare and submit to the commissioner an annual drug use review report that
contains the following information:
1. A description of the nature and scope of the retrospective drug
utilization program including the identity of the contractor, the
frequency of screening of claims data and the criteria and standards
used, along with new or revised copies of the clinical criteria, and in
subsequent years, a list of revised criteria and deleted criteria;
2. A summary of nonpatient and provider specific educational activities
including information on the use of each type of patient and provider
specific intervention that indicates the guidelines for use and frequency
of use by type of intervention and the effectiveness of each type of
intervention on changes in prescribing or dispensing practices;
3. An evaluation of the adequacy of prospective drug use review database
software; and
4. Details on policy guidelines adopted by the board pertaining to written
criteria that pharmacies may use if they do not use a computer
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
intensity of the disease, and the economic, clinical, and patient-prospective
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
address specific issues and to report findings to the board. In conducting its
business, the board shall utilize distance communication technologies whenever
possible.
(3)Clerical and administrative support shall be provided the board through the Cabinet
for Health and Family Services or by contract.