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HCFA's PROPOSED DUR SYSTEM BALANCES SAFETY AND COST CONCERNS, AGENCY TELLS HOUSE SUBCOMMITTEE; ASHP PRESIDENT SAYS SYSTEM SHOULD PROVIDE MORE DATA

Executive Summary

HCFA's proposed DUR system for the Medicare outpatient drug benefit represents an attempt to balance cost concerns with the agency's desire to provide adequate prescription drug monitoring for patients, HCFA Bureau of Program Operations Director Barbara Gagel testified at an Aug. 1 hearing before the House Select Committee on Aging. As envisioned in the agency's draft request for proposals (RFP) from drug claims processors, the DUR system "will balance the demands of an entirely new, and as yet untested, electronic point-of-sale system with our desire to protect Medicare beneficiaries from the harmful effects of mismanaged outpatient prescription drug treatment," Gagel said. The DUR framework established by the Health Care Financing Administration "initially" will include "the most severe drug-to-drug interactions, some of the most common drug interactions affecting the elderly, excessive dose interactions, and other basic DUR functions," Gagel explained. However, the agency expects to enhance the system "as we become more familiar with its capacity and its shortcomings," she said, adding: "Of course, we are requiring the drug bill processors to preserve flexibility for future innovation and expansion in the [DUR] systems they design." HCFA laid the framework for a claims processor-designed DUR system in its request for proposals, published July 18 ("The Pink Sheet" July 24, p. 11). At the request of Committee Ranking Republican Snowe (R-Me.), Gagel agreed to provide the panel with details as to why the agency pared down its DUR proposal. The congresswoman said the committee needed the agency's estimates of costs for every provision that was either included or excluded from the proposed DUR system. "I'm not quite sure what [HCFA's] problem is," Snowe said. "Is it cost?" She said the committee needed to know the cost of each additional provision so that "the committee can better judge what [HCFA is] trying to do." * Snowe and Committee Chairman Downey (D-N.Y.) have cosponsored a bill to require a more comprehensive DUR system. Similar legislation has been introduced in the Senate by Sens. Heinz (R-Pa.) and Wilson (R-Calif.) ("The Pink Sheet" April 24, p. 6) and is being contemplated by Sen. Pryor (D-Ark.) ("The Pink Sheet" July 24, p. 9). The American Society of Hospital Pharmacists testified that a system as incomplete as the one proposed by HCFA could raise "the public's expectations of the system and increases pharmacists' liability" even though it "cannot provide the pharmacist with the factual clinical data necessary to make appropriate professional decisions." ASHP President and Chairman Thomas Thielke said adequate prospective DUR would check that a drug is appropriately prescribed; is not duplicative of other products the patient is taking, including OTCs; is appropriately administered and dosed; adverse reaction potential is considered; patient compliance is enhanced through counseling; and information about potential interactions and allergies is provided. Thielke added that the pharmacist should also be informed of the prescriber's diagnosis or the drug indication. * General Accounting Office Planning & Reporting Director Carl Wisler contended that HCFA should not defer to claims processors responsibility for recruiting pharmacy participation in the Medicare drug program. In addition, GAO believes HCFA's DUR system as proposed "will fall short of accomplishing the legislative mandate" in that it "will not provide a complete profile of the patient's medication to the pharmacist," Wisler said. GAO released a report in July concluding that HCFA's DUR proposal is inadequate ("The Pink Sheet" July 24, p. 9).
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