§ 369-bb. Drug utilization review board. 1. A twenty-three-member
drug utilization review board is hereby created in the department. The
board is responsible for the establishment and implementation of medical
standards and criteria for the retrospective and prospective DUR
program.

2. The members of the DUR board shall be appointed by the commissioner
and shall serve a three-year term. Members may be reappointed upon the
completion of other terms. The membership shall be comprised of the
following:

(a) Six persons licensed and actively engaged in the practice of
medicine in the state, with expertise in the areas of mental health,
HIV/AIDS, geriatrics, pediatrics or internal medicine and who may be
selected based on input from professional associations and/or advocacy
groups in New York state.

(b) Six persons licensed and actively practicing in pharmacy in the
state who may be selected based on input from professional associations
and/or advocacy groups in New York state.

(c) Two persons with expertise in drug utilization review who are
health care professionals licensed under Title VIII of the education law
at least one of whom is a pharmacologist.

(d) Three persons that are consumers or consumer representatives of
organizations with a regional or statewide constituency and who have
been involved in activities related to health care consumer advocacy,
including issues affecting Medicaid or EPIC recipients.

(e) One person licensed and actively practicing as a nurse
practitioner or midwife.

(f) Two persons who are health care economists.

(g) One person who is an actuary.

(h) One person representing the department of financial services.

(i) The commissioner shall designate a person from the department to
serve as chairperson of the board.

3. The appointed members to the board, or its agents shall have no
sanctions against them by medicare or medicaid.

4. The appointments to this board shall be made so that the length of
the terms are staggered. In making the appointments, the commissioner
shall consider geographic balance in the representation on the board.

5. (a) The functions, powers and duties of the former pharmacy and
therapeutics committee as established in article two-A of the public
health law shall now be considered a function of the drug utilization
review board, including but not limited to:

(i) conducting an executive session for the purpose of receiving and
evaluating drug pricing information related to supplemental rebates, or
receiving and evaluating trade secrets, or other information which, if
disclosed, would cause substantial injury to the competitive position of
the manufacturer; and

(ii) evaluating and providing recommendations to the commissioner of
health on other issues relating to pharmacy services under Medicaid or
EPIC, including, but not limited to: therapeutic comparisons; enhanced
use of generic drug products; enhanced targeting of physician
prescribing patterns; and

(iii) collaborating with managed care organizations to address drug
utilization concerns and to implement consistent management strategies
across the fee-for-service and managed care pharmacy benefits.

(b) Any business or other matter undertaken or commenced by the
pharmacy and therapeutics committee pertaining to or connected with the
functions, powers, obligations and duties are hereby transferred and
assigned to the drug utilization review board and pending on the
effective date of this subdivision, may be conducted and completed by
the drug utilization review board in the same manner and under the same
terms and conditions and with the same effect as if conducted and
completed by the pharmacy and therapeutics committee. All books, papers,
and property of the pharmacy and therapeutics committee shall continue
to be maintained by the drug utilization review board.

(c) All rules, regulations, acts, orders, determinations, and
decisions of the pharmacy and therapeutics committee pertaining to the
functions and powers herein transferred and assigned, in force at the
time of such transfer and assumption, shall continue in full force and
effect as rules, regulations, acts, orders, determinations and decisions
of the drug utilization review board until duly modified or abrogated by
the commissioner of health.

6. Members of the DUR utilization review board and all its employees
and agents shall be deemed to be an "employee" for purposes of section
seventeen of the public officers law.

7. The department shall provide administrative support to the DUR
board.

8. The duties of the DUR board are as follows:

(a) The development and application of the predetermined criteria and
standards to be used in retrospective and prospective DUR that ensure
that such criteria and standards are based on the compendia and that
they are developed with professional input in a consensus fashion with
provisions for timely revisions and assessments as necessary. Further,
that the DUR standards shall reflect the appropriate practices of
physicians in order to monitor:

(i) Therapeutic appropriateness;

(ii) Overutilization or underutilization;

(iii) Therapeutic duplication;

(iv) Drug-disease contraindications;

(v) Drug-drug interactions;

(vi) Incorrect drug dosage or duration of drug treatment; and

(vii) Clinical abuse/misuse.

(b) The development, selection, application, and assessment of
interventions or remedial strategies for physicians, pharmacists, and
recipients that are educational and not punitive in nature to improve
the quality of care including:

(i) Information disseminated to physicians and pharmacists to ensure
that physicians and pharmacists are aware of the board's duties and
powers;

(ii) Written, oral, or electronic reminders of patient-specific or
drug-specific information that are designed to ensure recipient,
physician, and pharmacist confidentiality, and suggested changes in the
prescribing or dispensing practices designed to improve the quality of
care;

(iii) Use of face-to-face discussions between experts in drug therapy
and the prescriber or pharmacist who has been targeted for educational
intervention;

(iv) Intensified reviews or monitoring of selected prescribers or
pharmacists;

(v) The creation of an educational program using data provided through
DUR to provide for active and ongoing educational outreach programs to
improve prescribing and dispensing practices as provided in this
subdivision. (This may be done directly or through contract with other
entities);

(vi) The timely evaluation of interventions to determine if the
interventions have improved the quality of care; and

(vii) The review of case profiles prior to the conducting of an
intervention.

(c) The publication of an annual report which shall be subject to the
department's comment prior to its issuance to the federal department of
health and human services by December first of each year. The annual
report also shall be submitted to the governor and the legislature
before December first of each year. The report shall include the
following information:

(i) A description of the activities of the board, including the nature
and scope of the prospective and retrospective drug use review programs;

(ii) A summary of the interventions used;

(iii) An assessment of the impact of these educational interventions
in quality of care;

(iv) An estimate of the cost savings generated as a result of such
program; and

(v) Recommendations for program improvement.

(d) The development of a working agreement for the DUR board with
related boards or agencies, including, but not limited to: the board of
pharmacy, the board of medicine, the SURS staff, and staff of the
department of health and the office of mental health, in order to
clarify the areas of responsibility for each where such areas may
overlap.

(e) The establishment of a process where physicians or pharmacists
will have the opportunity to submit responses to the DUR educational
letters.

(f) The publication and dissemination of educational information to
physicians and pharmacists on the DUR board and the DUR program to
include information on:

(i) Identifying and reducing the frequency of patterns of fraud,
abuse, gross overuse, or inappropriate or medically unnecessary care
among physicians, pharmacists, and recipients;

(ii) Potential or actual severe/adverse reactions to drugs;

(iii) Therapeutic appropriateness;

(iv) Overutilization or underutilization;

(v) Appropriate use of generics;

(vi) Therapeutic duplication;

(vii) Drug-disease contraindications;

(viii) Drug-drug interactions;

(ix) Incorrect drug dosage/duration of drug treatments;

(x) Drug allergy interactions; and

(xi) Clinical abuse/misuse.

(g) The evaluation of specific drugs submitted to the board for review
pursuant to section two hundred eighty of the public health law, and the
formulation of recommended target supplemental rebates, in accordance
with the standards established in such section.

(h) The adoption and implementation of procedures designed to ensure
the confidentiality of any information collected, stored, retrieved,
assessed or analyzed by the DUR board, staff to the board, or
contractors to the DUR program, that identifies individual physicians,
pharmacists, or recipients. The board may have access to identifying
information for purposes of carrying out intervention activities, but
such identifying information may not be released to anyone other than a
member of the DUR board or the department and its agents.

(i) The improper release of identifying information in violation of
this article may subject that person to criminal or civil penalties.

(j) The board may release cumulative non-identifying information for
purposes of legitimate research.

9. The relationship of the DUR board to the department is as follows:

(a) The department shall monitor the DUR board's compliance to federal
and state statute and regulation.

(b) The DUR board shall serve at the discretion of the commissioner.

(c) The department shall have authority on all fiscal matters relating
to the DUR program.

(d) The department shall have authority on all administrative matters
relating to the administration of the medical assistance program within
the DUR program.

(e) The DUR board shall have responsibility for all medical matters
relating to the DUR program.

(f) The DUR board may utilize medical consultants and review
committees as necessary, subject to department approval.