Georgia Medicaid MCO FFY 2022 DUR Annual Report
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Table 40 - “Other” Explanations RetroDUR Criteria Approval/Review Sources ................................................................... 26
Table 41 - Frequency of Retrospective Practitioner-Based Education ................................................................................. 27
Table 42 - “Other” Frequency of Retrospective Practitioner-Based Education .................................................................... 27
Table 43 - Frequency of Retrospective Reviews that Involve Communication of Client-Specific Information to Healthcare
Practitioners .......................................................................................................................................................................... 28
Table 44 - “Other” Explanations for Frequency of Retrospective Reviews that Involve Communication of Client-Specific
Information to Healthcare Practitioners ............................................................................................................................... 28
Table 45 - Preferred Mode of Communication When Performing RetroDUR Initiatives ..................................................... 29
Table 46 - “Other” Explanations for Preferred Mode of Communication When Performing RetroDUR Initiatives ............. 30
Table 47 - RetroDUR Educational Outreach .......................................................................................................................... 30
Table 48 - MCO Utilizes the Same DUR Board as the State FFS Program or Has Own DUR Board ...................................... 36
Table 49 - “Other” Explanations for MCO not Utilizing the Same DUR Board as the State FFS Program or its Own DUR
Board ..................................................................................................................................................................................... 36
Table 50 - MCO has a Medication Therapy Management Program ..................................................................................... 37
Table 51 - DUR Board Activities ............................................................................................................................................ 37
Table 52 - Incorporation of NDCs for Covered Outpatient Physician Administered Drugs into DUR Criteria for ProDUR... 42
Table 53 - Future Plans to Incorporate NDCs for Covered Outpatient Physician Administered Drugs into DUR Criteria for
ProDUR .................................................................................................................................................................................. 43
Table 54 - Incorporation of NDCs for Covered Outpatient Physician Administered Drugs into DUR Criteria for RetroDUR 44
Table 55 - Future Plans to Incorporate NDCs for Covered Outpatient Physician Administered Drugs into DUR Criteria for
RetroDUR .............................................................................................................................................................................. 45
Table 56 - Generic Drug Substitution Policies ....................................................................................................................... 46
Table 57 - More Restrictive MCO Requirements than the Prescriber Writing in His Own Handwriting “Brand Medically
Necessary” for a Brand Name Drug ...................................................................................................................................... 49
Table 58 - Additional Restrictive MCO Requirements for Dispensing a Brand Name Drug .................................................. 49
Table 59 - “Other” Explanations for Additional Restrictive MCO Requirements for Dispensing a Brand Name Drug ......... 49
Table 60 - Generic Drug Utilization Data: Single Source Innovator(S), Innovator Multiple-Source (I), Non-Innovator
Multiple-Source (N) ............................................................................................................................................................... 52
Table 61 - Generic Utilization Percentage ............................................................................................................................ 52
Table 62 - Innovator Drugs That Are The Preferred Product Instead Of Their Multi-Source Counterpart Based On Net
Pricing .................................................................................................................................................................................... 53
Table 63 - Percentage Dollars Paid for Generic CODs ........................................................................................................... 54
Table 64 - Explanations for MCO Policies Related to Biosimilars ......................................................................................... 54
Table 65 - Medicaid Program Providing Coverage of Over-the-Counter Medications When Prescribed by an Authorized
Prescriber .............................................................................................................................................................................. 55
Table 66 - Documented Process in Place to Identify Potential FWA of Controlled Drugs by Beneficiaries ......................... 56
Table 67 - Actions Process Initiates when Potential FWA of Controlled Drugs by Beneficiaries is Detected ...................... 57
Table 68 - Lock-In Program ................................................................................................................................................... 58
Table 69 - Lock-In Program Candidate Identification Criteria............................................................................................... 59
Table 70 - “Other” Explanations for Lock-In Program Candidate Identification Criteria ...................................................... 59
Table 71 - Prescriber Only Restriction Capability .................................................................................................................. 60
Table 72 - Pharmacy Only Restriction Capability .................................................................................................................. 61
Table 73 - Prescriber and Pharmacy Restriction Capability .................................................................................................. 62
Table 74 - Lock-In Time Period .............................................................................................................................................. 63
Table 75 - Percentage of Medicaid MCO Population in Lock-In Status Annually ................................................................. 64
Table 76 - Estimate of Savings Attributed to the Lock-In Program for the Fiscal Year Under Review ................................. 65