(L3) Managed Medicaid Update: Annual Drug Use Review Results

The 2016 CMS Medicaid Managed Care Final Rule imposed certain requirements on states contracting with Medicaid managed care (MMC) plans, including requirements relating to Drug Utilization Review (DUR) data. With the implementation of the SUPPORT Act in late 2018, CMS required MMC plans to collect and report DUR information to their affiliated state and provide these data to CMS. The SUPPORT Act requirements relate primarily to the use of opioids in the Medicaid population. CMS has now gathered the DUR survey data from MMC plans for the first time.

This session will provide background on the regulatory requirements for drug use review reporting in Medicaid programs and will then share results of the first CMS-conducted national survey of DUR programs using data reported by managed Medicaid plans. The audience will hear the perspective of the CMS Medicaid Pharmacy Director, a state Medicaid pharmacy director, and a managed Medicaid pharmacy director. The speakers will address the challenges of implementing the novel DUR requirements, the method for collecting and processing the data, and reactions to the survey findings. The data will be presented in aggregate, yet this session will provide a glimpse of how your program compares to MMC programs across the country in fulfilling new federal standards for drug use review.