PA turn-around time during business Goal is 24 hours 59% done in 6 hours 99.9 within 24 hours PA turn-around time during non-business hours 85% done in 6 hours 99% within less than 9 hours Agenda Item Discussion Conclusions/Follow Up Asthma and Allergy Discussion Follow Up Monoclonal Discuss background information on the various asthma & allergy monoclonal Informational antibodies and use in clinical practice. Antibodies QA Evaluate recent utilization and cost data for MassHealth members. Present a brief overview of the current prior authorization (PA) criteria and review the randomly selected cases. Review historical comparison of utilization from last QA evaluation. Discuss recommendations to current MassHealth clinical criteria. Action Conclusion: Conclusion No recent guideline updates for CIU, GINA (2017)- asthma Proceed with Guidance for absolute blood eosinophil count threshold recommendations as NICE: 300 cells/μL (Nucala) and 400 cells/μL (Cinqair) stated. Clinical trials: 150 cells/μL (Nucala) and 400 cells/μL (Cinqair) Levels may be affected by systemic corticosteroid use Varying units reported by labs Update PA form to ask for weight. Recertifications changed from two years to one year. Meeting adjourned at 8:03 P.M. Respectfully submitted by: Vincent Palumbo, Director of DUR Date: _________________
PA turn-around time during business Goal is 24 hours 59% done in 6 hours 99.9 within 24 hours PA turn-around time during non-business hours 85% done in 6 hours 99% within less than 9 hours Agenda Item Discussion Conclusions/Follow Up Asthma and Allergy Monoclonal Antibodies QA Discussion Discuss background information on the various asthma & allergy monoclonal antibodies and use in clinical practice. Evaluate recent utilization and cost data for MassHealth members. Present a brief overview of the current prior authorization (PA) criteria and review the randomly selected cases. Review historical comparison of utilization from last QA evaluation. Discuss recommendations to current MassHealth clinical criteria. Follow Up Informational Action Conclusion: No recent guideline updates for CIU, GINA (2017)- asthma Guidance for absolute blood eosinophil count threshold NICE: 300 cells/μL (Nucala) and 400 cells/μL (Cinqair) Clinical trials: 150 cells/μL (Nucala) and 400 cells/μL (Cinqair) Levels may be affected by systemic corticosteroid use Varying units reported by labs Update PA form to ask for weight. Recertifications changed from two years to one year. Conclusion Proceed with recommendations as stated. Meeting adjourned at 8:03 P.M. Respectfully submitted by: Vincent Palumbo, Director of DUR Date: _________________
dur-meeting-minutes-september2017.docx