20 January 2011
Follow-up to Previous Reviews
 Type II Diabetes
 Treatment Guidelines
 Metformin Non-adherence
 Suboxone/Subutex Utilization
 Narcotics
 Long acting
 Short acting
2
Type II Diabetes Treatment
Guidelines – Update
Letters sent if patient was on a second generation
hypoglycemic without metformin
Results
 243 letters were sent on 9/13-14/2010.
 54 responses have been received as of 1/11/2011 (22.2%
response rate).
3
Type II Diabetes Treatment Guidelines:
Metformin Non-adherence - Update
Patients were selected for evaluation if they had at least one refill
of metformin that was at least 5 days late within the previous 3
month period that ended on 5/31/2010.
Patients were also tagged for an intervention if their daily dose of
metformin was < 500 mg/day for the 6 month evaluation period
Results:
 Letters were sent to 73 prescribers for 69 patients on 9/15/2010
(10.9% lettering rate.)
 As of 1/1/2011, 20 responses have been received (27.4% response
rate.)
4
Suboxone®/Subutex®
Drug Utilization Review – Update
Letters sent to prescribers of patients receiving
Suboxone®/Subutex® and opioids or benzodiazepines
within the same timeframe.
Results:
 567 letters sent for 124 patients on 9/15/2010
 Letters were sent to ALL prescribers, not just those
prescribing Suboxone®/Subutex®, to ensure all were
aware the patient was on Suboxone®/Subutex®
 83 responses have been received as of 1/11/2011 (14.6%
response rate)
5
Suboxone®/Subutex® - Update –
Pharmacy letters
 Letters were sent to pharmacies who had dispensed
Suboxone®/Subutex® within the six month DUR evaluation period.
 Notification that therapeutic criteria would be implemented requiring
a diagnosis of opioid dependency.
 Information on federal requirement that prescriber has a DEA-X
number to prescribe Suboxone/Subutex for opioid dependency
 Concomitant opioid therapy is contra-indicated for patients receiving
Suboxone/Subutex
Results:
 92 letters were sent on 9/20/2010. 10 responses have been received as
of 1/1/2011 (10.8% response rate.)
6
Suboxone®/Subutex® Clinical
Criteria
 As of 01-03-2011, therapeutic criteria is in effect for
Suboxone®/Subutex®.
 Diagnosis of Opioid Dependency or Opioid Abuse is
required
 If diagnosis is in electronic profile, claim will pay at
pharmacy without written prior authorization as long as
the following are met:
 Maximum Quantity Limit – 3 per day
 Age Requirement – 16 years or older
 Patients will not be authorized for payment of any other
opioid while receiving Suboxone®/Subutex®.
7
Long Acting Narcotic Use: Update
Patients using multiple long acting narcotics were
identified
Results:
 28 letters were sent on 9/13/2010 on 17 patients. 17
responses have been received as of 10/19/2010 (60.7%
response rate.)
8
Short Acting Narcotic Use - Update
Patients using multiple short acting narcotics and those
receiving chronic pain treatment with no long-acting
narcotics were identified
Results:
 587 letters were sent on 9/13/2010 on 87 patients. 112
responses have been received as of 1/11/2011 (19.1%
response rate.)
9
Current Intervention/Outcome
Studies
 Long Acting Beta Agonist Inhalers
Lack of Prior Controller Use
 Duration of Therapy
 Long Acting Beta Agonist Inhalers with
high rescue inhaler use
 Fentanyl patch frequency interval < 72
hours

10
FDA Warning: LABAs
 Increased risk of severe exacerbation of asthma, leading
to hospitalizations and, in some cases, death
 To ensure safe use:
 Contraindicated without use of controller
 Should not be used in patients controlled on low or
medium dose ICS
 Long term use only in patients with asthma uncontrolled by
controller
 Use for shortest duration required to achieve control, then
discontinue and maintain controller
 Pediatric and adolescent patients who require LABA should
use ICS/LABA combination product to ensure compliance
(recommended for all patients)
11
Long Acting Beta Agonists Inhalers
 Patients were selected for evaluation if they had at
least one fill of a LABA during the 3 month period that
ended on 9/30/2010. History was evaluated for long
term, continuous use of a LABA and lack of a
controller medication, if applicable.
 150 patient profiles were evaluated.
 Letters were sent to 32 prescribers about 30 patients on
12/16/2010 (21.3% lettering rate.)
 As of 1/1/2011, 5 responses have been received (15.6%
response rate.)
 See packet for copy of the letter.
12
Long Acting Beta Agonist Inhalers
Criteria Paragraph
 During a recent review, it was noted that your patient, Member Name, is taking
a Long Acting Beta Agonist (LABA) and has 3 or less fills over the 6 month
review period noting little or no use of an inhaled corticosteroid (ICS). FDA
warnings for long acting beta agonists (LABA's) including combinations with
corticosteroids (LABA/ICS) note that prolonged use of these agents has been
associated with the increased risk of severe exacerbation of asthma, leading to
hospitalizations and, in some cases, deaths. To ensure the safe use of these
products their use is contraindicated without the use of an asthma controller
agent, should not be used in patients controlled on low or medium dose
inhaled corticosteroids (ICS), and should be used long term only in patients
with asthma uncontrolled by a controller agent. Controller agents are
medications taken daily on a long-term basis to keep asthma under clinical
control and include inhaled and systemic glucocorticosteroids, leukotriene
modifiers, inhaled long-acting inhaled B2 agonists with inhaled
glucocorticosteroids, sustained release theophylline, cromones (e.g. sodium
cromoglycate and nedocromil sodium) and anti-IgE (e.g. omalizumab).
13
LABA Long Term Use: Response
detail as of 1/1/2011:
 Note that providers may choose more than one selection per response.
 Reviewed and do not believe adjustment is needed
 Reviewed and have or will modify the treatment
 Information clinically useful: plan to monitor
 I will use this information in the care of future pts
 My patient, but I did not prescribe this
 Somewhat useful to my practice
 Not useful to my practice
 Information appears to be correct
2
1
1
1
1
2
1
1
14
LABA Long Term Use: Comments
of Interest*
 Profile ID: 10090000044: Patient appears to be
noncompliant. She is also managed by a
pulmonologist.
 Profile ID: 10090000245: I have never prescribed a
LABA alone for this patient. In the records the medical
history you provided I see no LABA prescription so I
am not sure why you have this recorded this way.
* Profiles are in member packets for your review
15
Overuse of Short Acting Beta
Agonist Inhaler
 Patients were selected for evaluation if they had at
least one fill of a LABA during the 6 month period and
at least 2 fills for a SABA in the period that ended on
10/30/2010.
 208 patient profiles were evaluated.
 Letters were sent to 399 prescribers about 102 patients
on 12/28/2010 (192% lettering rate.)
 As of 1/1/2011, 63 responses have been received (16%
response rate.)
 See packet for copy of the letter.
16
Overuse of Short Acting Beta Agonist
Inhaler
Criteria Paragraph
 During a recent review, it was noted that your patient, Member Name, is taking
a long acting beta agonist (LABA) and also has 5 or more fills for a short acting
beta agonist (SABA) over the 6 month review periods. While SABAs are the
drug of choice for treating acute asthma symptoms and exacerbations, use of
SABAs for more than 2 days a week generally indicates inadequate control of
asthma and the need for initiating or intensifying anti-inflammatory therapy.
Regularly scheduled, daily or chronic use of SABAs is not recommended.1 Use
of more than one SABA canister every 1-2 months is associated with an
increased risk of an acute exacerbation that requires an emergency department
visit or hospitalization.2
1
National Heart, Lung and Blood Institute, Expert Panel report 3 (EPR3): Guidelines for
the Diagnosis and Management of Asthma. 2007.
2 Crystal-Peters J, Neslusan C, Crown WH, Torres A. Treating allergic rhinitis in
patients with comorbid asthma: the risk of asthma-related hospitalizations and
emergency department visits. J Allergy Clin Immunol 2002;109(1):57-62.
17
SABA overuse in LABA patients:
Response detail as of 1/1/2011:
 Note that providers may choose more than one selection per response.
 Reviewed and do not believe adjustment is needed
14
 Reviewed and have or will modify the treatment
9
 Attempted to modify therapy unsuccessfully
5
 Information clinically useful: plan to monitor
13
 I will use this information in the care of future pts
6
 Previously saw this pt, but no longer in my care
6
 My patient, but I did not prescribe this
15
 Not my patient, never under my care
6
 Under my care, but have not seen recently
6
 Extremely useful to my practice
2
 Very useful to my practice
10
 Somewhat useful to my practice
5
 Not useful to my practice
1
 Information appears to be correct
2
 Will change dose
1
18
SABA Overuse: Comments of
Interest*
 Profile ID: 10100000077: X does not have the insight I would
desire for a patient regarding their disease despite being a bright
kid. He can’t qualify in detail his usage of his inhalers. He lives
in an environment that has allergens which could increase his
asthma. Xolair will be offered in the future as a possible option to
get off steroids.
 Profile ID: 10090000185: Monitor use of both LABA and SABA
carefully, provide better family instructions. Poor patient
compliance with LABA leads to exacerbation and need for SABA.
Parental confusion also leads to misuse of SABA.
* Profiles are in member patients for your review
19
Fentanyl Topical Patch (Duragesic®)
Frequency of Administration
 Patients were selected for evaluation if they received
more than 10 patches in a 30 day period during the 3
month period that ended on 11/30/2010.
 291 patient profiles were evaluated.
 Letters were sent to 60 prescribers about 44 patients
on 12/28/2010 (21% lettering rate.)
 As of 1/1/2011, 16 responses have been received (27%
response rate.)
 See packet for copy of the letter.
20
Fentanyl Topical Patch Frequency of
Administration
Criteria Paragraph
 During a retrospective drug utilization review, it was noted that 31% of
Idaho Medicaid patients who were prescribed fentanyl patches were
replacing them every 48 hours instead of 72 hours. According to the
FDA approved labeling information, an increase in the mcg/hr dose
should be evaluated before shortening the dosing interval from 72
hours to 48 hours. The package insert for fentanyl patches also states
that the majority of patients should maintain pain relief with replacing
the patch every 72 hours. On a monthly basis, utilizing 15 patches (one
patch every 48 hours) rather than 10 patches (one patch every 72
hours) is a 50% increase in drug cost. During a recent review, it was
noted that your patient, Member Name, was receiving patches in
quantities greater than 10 patches per 30 days. Please review the
attached profile for Member Name and evaluate if this Idaho Medicaid
participant would be a candidate to switch to an every 72 hour regimen.
21
Fentanyl Patch Frequency of Administration:
Response detail as of 1/1/2011:
 Note that providers may choose more than one selection per
response.
 Reviewed and do not believe adjustment is needed
 Reviewed and have or will modify the treatment
 Attempted to modify therapy unsuccessfully
 Information clinically useful: plan to monitor
 Previously saw this pt, but no longer in my care
 Very useful to my practice
 Somewhat useful to my practice
12
2
2
1
2
1
2
22
Fentanyl Patch Frequency of Administration:
Comments of Interest*
 Profile ID: 10110000208: Will refer to pain management
specialist.
* Profile is in member patients for your review
23
Proposed Studies for Next Quarter:
 Auto Refill Practices
 Atypical Antipsychotics
 Colchicine Usage
 High Dose Utilization
 Oxycodone
 Atypical Antipsychotics
 Injectable Antipsychotics
 Proton Pump Inhibitors – Long Term Use
 Thiazolidinedione Safety
 Tramadol with SSRI’s or SNRI’s
All information based on Idaho Medicaid Pharmacy Data 4th Quarter 2010 (10/1/10-12/31/10) unless
otherwise indicated.
24
Auto Refill Practices
Some pharmacies are instituting Auto Refill policies
which allow them to automatically dispense refills
based on days since last fill
 Issues
 Potential for stockpiling
 Potential for continued fill of discontinued medications
 Increase cost/waste
25
Atypical Antipsychotics
P&T Recommendations
 Approved for diagnosis per FDA indications or off-label indications





with supporting evidence-based literature.
All patients receiving at least 90 days of therapy for the past 120 days as
of implementation date will be grandfathered. No criteria for diagnosis
required.
No PDL requirements for patients with schizophrenia and related
psychosis.
Bipolar, major depression adjunctive, autism and other designated
acceptable diagnoses will require failure of a preferred agent for
designated non-preferred agents.
Age, dose and quantity per labeling information on all drugs.
If the medical diagnosis and required drug history have been
submitted as prior claims then the prescription will auto-approve at
point of sale. i.e. No written PA required.
26
Atypical Antipsychotics
P&T Recommendations
Agent
Diagnoses/Criteria
Abilify®
Schizophrenia and Related Psychoses; Bipolar
Disease; Autism; Adjunctive Therapy in Major
Depression with continuous antidepressant therapy
within the last eight weeks with trials of a minimum
of two different antidepressants with a minimum
trial of two weeks each.
Abilify® Injectable
Schizophrenia and Related Psychoses with Acute
Agitation; Bipolar Disease with Acute Agitation
Clozapine
Resistant Schizophrenia and Related Psychoses
Fanapt®
Schizophrenia and Related Psychoses
Geodon®
Schizophrenia and Related Psychoses; Bipolar
Disease – Mania and Mixed State
Geodon® Injectable
Schizophrenia and Related Psychoses with Acute
Agitation
27
Atypical Antipsychotics
P&T Recommendations (continued)
Agent
Invega®
 Adherence
Diagnoses/Criteria
RatesSchizophrenia and Related Psychoses
Invega Sustenna®
Schizophrenia and Related Psychoses AND
History of Oral Invega® or Risperidone within
the past 2 years AND
Failure of Risperdal Consta®
Risperidone
Schizophrenia and Related Psychoses; Bipolar
Disease – Mania and Mixed State; Autism; Disruptive
Behavioral Disorders; Obsessive Compulsive
Disorder
*Brand name will deny for brand/generic rule
Risperdal Consta®
Schizophrenia and Related Psychoses
Saphris®
Schizophrenia and Related Psychoses; Bipolar
Disease – Mania and Mixed State
28
Atypical Antipsychotics
P&T Recommendations (continued)
Agent
Seroquel®
 Adherence
Diagnoses/Criteria
RatesSchizophrenia and Related Psychoses ; Bipolar
Disease – Mania and Mixed State; Bipolar
Depression; Obsessive Compulsive Disorder
Seroquel XR®
Schizophrenia and Related Psychoses ; Bipolar
Disease – Mania and Mixed State; Bipolar
Depression; Adjunctive Major
DepressionContinuous - antidepressant therapy
within the last eight weeks with trials of a minimum
of two different antidepressants with a minimum
trial of two weeks each.
Symbyax®
Treatment Resistant Depression - Continuous
antidepressant therapy within the last eight weeks
with trials of a minimum of two different
antidepressants with a minimum trial of two weeks
each.
29
Atypical Antipsychotics
P&T Recommendations (continued)
Agent
Zyprexa®
 Adherence
Diagnoses/Criteria
RatesSchizophrenia and Related Psychoses, Acute
Agitation; Bipolar, Acute Agitation
Zyprexa Injection®
Schizophrenia and Related Psychoses; Bipolar
Disease, Acute Agitation
Zyprexa Relprevv®
Reimbursed as Medical Benefit Only; Schizophrenia
and Related Psychoses
30
Atypical Antipsychotics
P&T Recommendations
Patients Receiving Atypical Antipsychotics
41%
59%
With Approvable
Diagnosis
Without Approvable
Diagnosis
31
Gout Treatment
Colchicine’s Place in Therapy

Acute Gout Attacks –
 NSAIDS and/or corticosteroids are the drugs of choice for the
management of an acute gout attack.
 Management of Chronic Gout –
 Allopurinol is the drug of choice to lower serum uric acid and does not
require prior authorization.
 Uloric® will be approved for payment only after (1) continuation of gout
attacks after three months of allopurinol therapy at a therapeutic dose, (2)
serum urate levels > 6mg/dl after three months of allopurinol therapy at a
therapeutic dose, or (3) documented intolerance to allopurinol. To
prevent an acute attack as a result of starting allopurinol, low dose NSAID
(e.g. naproxen 250mg twice daily) or prophylactic Colcrys® can be used if
there are no contra-indications.
 Probenecid increases uric acid excretion and does not require prior
authorization.
32
Gout Treatment
Colchicine’s Place in Therapy
 Utilization Overview
Number of
Recipients
Number of
Claims
Average
Cost/Claim
Allopurinol
170
407
$6.59
Colchicine
46
63
$24.31
Colcrys®
10
12
$299.43
Probenecid
4
8
$27.28
Uloric®
8
20
$156.77
33
High Dose Oxycodone Long Acting
Nine recipients received more than one strength of LA Oxycodone during Oct,
Nov, and Dec 2010.
3
3
40mg + 10mg
60mg + 15mg
80mg + 30mg
2
1
80mg + 40mg
34
High Dose Atypical Antipsychotics
395 recipients received multiple doses of the same atypical antipsychotic
during Oct, Nov, and Dec 2010
Product Distribution by Number of Recipients
Multiple Doses of Same Agent
1
1 1 15
FANAPT
SAPHRIS
23
SYMBYAX
72
197
INVEGA
57
CLOZAPINE
ZYPREXA
98
67
GEODON
ABILIFY
RISPERIDONE
SEROQUEL
35
Injectable Atypical Antipsychotics
Invega® Sustenna® and Risperdal® Consta®
 Indications
Agent
Indication
Invega® Sustenna®
Acute and Maintenance Treatment of Schizophrenia
Risperdal® Consta®
Treatment of Schizophrenia
Risperdal® Consta®
Mono or Adjunct therapy to Lithium or Valproate in
Bipolar I Disorder
 Utilization Overview
Agent
Recipients
Invega® Sustenna®
93
Risperdal® Consta®
149
Oral Agents
6719
Patients Receiving Both Oral and Injectable – 4th Quarter 2010
140
*Idaho Medicaid Data 4th Quarter 2010 (10/1/2010-12/31/2010)
36
Injectable Atypical Antipsychotics
Invega® Sustenna® and Risperdal® Consta®
 Goal 1:
Evaluate Adherence Rates




 Goal 2:


Oral use prior
Current adherence
For Invega Sustenna – previous adherence on Risperdal
Consta
Ensure not receiving oral therapy in addition to injectable
Program Integrity
Ensure doses dispensed by the pharmacy are actually
administered
Compare drug profiles, medication administration records
and time period
37
Injectable Atypical Antipsychotics
Study Responsibilities
 MMA:



Program Integrity:



Request and obtain the medication administration records and
the progress notes
Take action on any identified fraud or billing irregularities
Medicaid Pharmacy Staff



Patient list
Pharmacy and Prescriber identification
Compile and analyze treatment for each patient
Present an analysis of the data to DUR Board and P&T Committee
DUR Board and P&T Committee


Review and interpret results
Make Conclusions and Recommendations
38
Injectable Atypical Antipsychotics
Invega® Sustenna® and Risperdal® Consta®
 Adherence Rates
Agent
Adherence Rate
Oral Therapy
66%
Risperdal® Consta®
71%
Invega® Sustenna®
76%
Adherence calculated by evaluating claims for patients receiving
multiple claims for the same agent and comparing difference
between days’ supply and days between refills.
*Idaho Medicaid Data 3rd Quarter 2010 (7/1/2010-9/30/2010)
39
Proton Pump Inhibitors
Long Term Use
 High doses or long-term use of PPI’s may increase the
risk for hip, wrist, and spine fractures.
 Utilization Data – Patients receiving 4 or more claims
for a PPI between 7/1/2010 and 12/31/2010 were
identified.
Number of Recipients
Number of Claims
3819
21,285
40
Proton Pump Inhibitors
Long Term Use
 Product Distribution
ACIPHEX
20
114 178
DEXILANT
1196
LANSOPRAZOLE
28
1037
2670
NEXIUM
OMEPRAZOLE/
PRILOSEC
PANTOPRAZOLE/
PROTONIX
PREVACID
Idaho Medicaid claims data 7/1/10 – 12/31/10
41
Thiazolidinediones (TZDs)
 Safety issues with Avandia® related to increased risk for
Cardiovascular Events
 “The U.S. Food and Drug Administration announced that it
will significantly restrict the use of the diabetes drug
Avandia® (rosiglitazone) to patients with Type 2 diabetes
who cannot control their diabetes on other medications.
These new restrictions are in response to data that suggest
an elevated risk of cardiovascular events, such as heart
attack and stroke, in patients treated with Avandia®.”
http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm226956.htm
42
Thiazolidinediones
Product Distribution 4th Qtr 2010
Product Distribution 4th Qtr 2009
1
69
44
109
340
356
ActoPlus Met
Actos
Avandia
ActoPlus Met XR
40
ActoPlus Met
Actos
Avandia
43
Tramadol with SSRI’s or SNRI’s
Increased risk for serotonin syndrome
 150 profiles selected on 1/12/2011
 Profiles will be reviewed by DHW Pharmacy
staff
 Focus is on patients with more than one
tramadol fill and at least a 30 day overlap with
the SSRI or SNRI
 Letter will include educational information
about serotonin syndrome
44
Antiemetics
Ondansetron Expenditure
$700,000
$600,000
$500,000
$400,000
$300,000
$200,000
$100,000
$-
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Generic Preferred
Over Brand
PA Removed < 15
Generic Ondansetron
Available
PA Criteria Start
45
Antiemetics
Ondansetron Utilization (Claims)
4,500
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
0
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Generic Preferred
Over Brand
PA Removed < 15
Generic Ondansetron
Available
PA Criteria Start
46
Ondansetron Metrics
Comparison with Other States
State
Estimated
Rx Users
Average
Monthly Ondan
Utilizers
Average
Monthly
Ondan Claims
Cost/
Ondan
Claim
Ondan
Users as %
of Rx Users
Qty Limit
PDL Status
Clinical Requirements
ID
53,000
868
1,085
$19.92
2%
30 tabs/30 days
Preferred
Clinical PA
State A
23,000
702
889
$77.31
3%
4-12 tabs/month
Preferred
Clinical PA
State B
430,000
19,630
22,619
$11.57
5%
Various QL (daily,
monthly annual)
Preferred
No Clinical PA
State C
250,000
9,342
10,870
$26.27
4%
4-12 tabs/month
Preferred
No Clinical PA
State D
440,000
13,405
16,401
$19.56
3%
No restrictions
Claims data 4th Quarter 2010 - 10/1/2010 through 12/31/2010
47
Ondansetron Metrics
Comparison with Other States
State
Estimated
Rx Users
Average
Monthly Ondan
Utilizers
Average
Monthly
Ondan Claims
Cost/
Ondan
Claim
Ondan
Users as %
of Rx Users
Qty Limit
PDL Status
Clinical Requirements
State E
88,000
2,471
3,861
$15.14
3%
15 tabs/Rx
Preferred
No Clinical PA
State F
40,000
974
1,355
$20.63
2%
10-12 tabs/30 days
Preferred
No Clinical PA
State G
130,000
3,081
3,617
$23.90
2%
10-15 tabs/month
Preferred
No Clinical PA
State H
105,000
5,569
7,800
$27.28
5%
1-15 tabs/Rx
Class not on PDL
No Clinical PA
State I
165,000
12,766
27,859
$33.85
8%
15 tabs/Rx
Preferred
No Clinical PA
Claims data 4th Quarter 2010 - 10/1/2010 through 12/31/2010
48
Prospective DUR Report
 History Errors:
• DD – drug-to-drug
• PG – drug to pregnancy
• TD – therapeutic duplication
• ER – early refill
• MC – drug-to-disease
 Non-History Errors:
• PA – drug-to-age
• HD – high dose
• LD – low dose
• SX – drug-to-gender
49
Produr Message Report: August 2010 (for comparison)
ProDUR
Message
ProDUR
Severity
Message
Count
Message
Amount
Drug To Drug
1
1,271
$238,433.54
2
11,665
$1,687,424.27
3
54,300
$7,621,436.89
9
1
$23.47
1
106
$12,434.03
2
51
$878.68
1
75,152
$10,182,746.49
2
269,091
$37,046,563.18
3
237,373
$35,434,743.96
1
84
$2,124.04
2
61
$1,964.14
A
52
$1,006.90
B
93
$16,684.46
C
185
$15,739.00
D
22
$894.16
X
18
$440.76
Duplicate
Therapy
0
103,647
$18,776,825.12
Min Max
0
36,171
$4,812,065.33
Too Soon
Clinical
0
20,306
$3,231,378.40
809,649
$119,083,806.82
Drug To Gender
Drug To Known
Disease
Drug To
Pregnancy
ALL
50
Produr Message Report: December 2010
ProDUR
Message
ProDUR
Severity
Message
Count
Message
Amount
Drug To Drug
1
1,173
$146,999.56
2
12,182
$1,700,261.43
3
51,685
$7,325,789.80
9
1
$23.47
1
96
$10,359.56
2
51
$2,176.82
1
64,326
$7,320,792.62
2
233,655
$32,056,536.99
3
211,605
$31,687,569.10
1
108
$2,681.28
2
73
$1,643.76
A
85
$1,236.49
B
105
$14,363.74
C
215
$27,401.45
D
13
$354.95
X
50
$3,617.89
Duplicate
Therapy
0
108,695
$18,457,983.74
Min Max
0
37,916
$5,383,620.08
Too Soon
Clinical
0
21,418
$3,482,239.41
743,472
$107,625,652.14
Drug To Gender
Drug To Known
Disease
Drug To
Pregnancy
ALL
51
Top Drugs for Selected Produr Type:
Duplicate-Therapy
 Hydrocodone/APAP with other Hydrocodone/APAP – 2,888 alerts






(15.18% of claims for Hydrocodone/APAP)
Methylphenidate with other methylphenidate – 2,143 alerts (35.58% of
claims for methylphenidate)
Quetiapine with other quetiapine – 2,052 alerts (55.13% of claims for
quetiapine)
Venlafaxine with other venlafaxine – 1,798 alerts (72.65% of claims for
venlafaxine)
Oxycodone/APAP with hydrocodone/APAP – 1,388 alerts (51.69% of
claims for oxycodone/APAP)
Bupropion with bupropion – 1,281 alerts (42% of claims for bupropion)
Hydrocodone/APAP with tramadol – 1,201 alerts (6.31% of claims for
bupropion)
52