DUTIES AND HISTORY OF THE DRUG USE REVIEW BOARD

							99326                                                             Prepared by the North Dakota Legislative Council
                                                                  staff for the Human Services Committee
                                                                                   July 2008


            DUTIES AND HISTORY OF THE DRUG USE REVIEW BOARD
                    OVERVIEW                                      state and actively engaged in the practice of
   The Federal Social Security Act provides that each             medicine, one of whom is a psychiatrist.
state must establish and maintain a drug use review           •   Two physicians appointed by the executive
program to assure prescriptions distributed under the             director of the Department of Human Services
Medicaid program are appropriate, medically                       that are licensed in the state and actively
necessary, and not likely to result in adverse medical            engaged in the practice of medicine.
results. As part of the program, each state is required       •   Four pharmacists appointed by the North
to have a Drug Use Review Board established by the                Dakota Pharmaceutical Association who are
state or through a contract with a private organization.          licensed in the state and actively engaged in
Each state was required to be in compliance with the              the practice of pharmacy.
requirements by January 1, 1993. Federal regulations          •   Two pharmacists appointed by the executive
require membership of the Drug Use Review Board to                director of the Department of Human Services
be at least one-third physicians and one-third                    that are licensed in the state and actively
pharmacists. In addition, the number of physicians on             engaged in the practice of pharmacy.
the board cannot exceed 51 percent of total board             •   One individual appointed by the Governor that
members.                                                          represents consumer interests.
                                                              •   One pharmacist or physician representing the
   HISTORY AND BOARD MEMBERSHIP                                   pharmaceutical industry appointed by the
    The Drug Use Review Board was originally                      Pharmaceutical Research Manufacturers of
established by the Department of Human Services.                  America.
Members of the board were appointed by the
executive director of the Department of Human                          DUTIES OF THE BOARD
Services after receiving suggestions from the North            The board is required by statute to meet in person
Dakota Medical and Pharmaceutical Associations.            at least once every three months and may meet at
    In 2003, House Bill No. 1430 was approved by the       other times at the discretion of the chairman.
Legislative Assembly establishing a Drug Use Review            Duties of the board include:
Board in statute and outlining duties and membership.          • Create and implement a prospective and
The bill provided for a total of 15 board members that            retrospective drug use review program for
included 13 members appointed by the executive                    outpatient prescription drugs under the medical
director of the Department of Human Services. The                 assistance program that complies with
pharmacy director and medical consultant of the                   42 U.S.C. 1396r-8(g)(3).
Department of Human Services also served on the                • Advise and make recommendations regarding
board as ex officio nonvoting members.                            any rule proposed for adoption by the
    The Legislative Assembly approved 2005 House                  Department of Human Services to implement
Bill No. 1470 which:                                              the provisions of state and federal law related to
     1. Increased the board to its present size of                drug use review.
         16 members.                                           • Receive and consider information regarding the
     2. Divided appointment responsibilities among                drug use review process which is provided by
         the North Dakota Medical Association, North              the Department of Human Services and
         Dakota       Pharmaceutical       Association,           interested parties.
         Governor,       Pharmaceutical      Research          • Review and recommend to the Department of
         Manufacturers of America, and Department of              Human Services any drugs to be included on
         Human Services.                                          prior authorization status.
    Testimony on the bill indicates the change was             • Review no less than once each year the status
primarily due to efforts to make the board more                   of the list of drugs that have been placed on
independent.                                                      prior authorization.
    Membership of the Drug Use Review Board is
                                                               • Review and approve the prior authorization
outlined in North Dakota Century Code Chapter
                                                                  program used by the Department of Human
50-24.6 (Appendix A) and includes:
                                                                  Services,      including    the    process      to
    • Pharmacy administrator of the Department of                 accommodate the provision of a drug benefit in
       Human Services (ex officio).                               an emergency situation.
    • Medical consultant to the Department of Human            • Propose remedial strategies to improve the
       Services (ex officio).                                     quality of care and to promote effective use of
    • Four physicians appointed by the North Dakota               medical assistance program funds or recipient
       Medical Association who are licensed in the                expenditures.
99326                                                  2   June 2008


           BOARD PROCEDURES
     North Dakota Administrative Code Section
75-02-02-28 (Appendix B) provides for the process of
filing grievances and appeals regarding drugs placed
in a prior authorization status. The Drug Use Review
Board has also established a set of procedures to
detail the disbursement of information to board
members and the process for providing board
recommendations. A copy of the procedures is
attached as Appendix C.

ATTACH:3