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Reform of Arkansas Medicaid’s Drug Utilization Review Board

In recent years, physicians treating Medicaid patients have experienced significant challenges with the prior authorization and re-authorization process in Medicaid. The Arkansas Medicaid Drug Utilization Review (DUR) board is responsible for making clinical recommendations to the Arkansas Medicaid Pharmacy Program regarding the use of restrictions including prior authorization and re-authorization criteria on prescription drugs covered by Medicaid. Arkansas Medicaid patients have experienced significant delays accessing new, FDA-approved medications, and the DUR board has frequently recommended restrictive clinical edits, inconsistent with FDA-approved product labeling.

In light of these numerous challenges and their impact on Arkansans, Governor Asa Hutchinson and Department of Human Services (DHS) leadership have taken meaningful steps to reform the DUR board to make the clinical review process more transparent, accountable, and collaborative.

Specifically, the administration helped spearhead significant changes to the DUR board’s operational bylaws adopted during the board’s quarterly meeting in July 2019. New bylaw 7.03 “Pre-Board Meeting Input” creates a new, significant opportunity for clinicians to impact the Medicaid clinical review process and empowers clinicians to meet directly (in person or via WebEx) with Medicaid pharmacy staff to discuss medications to be reviewed at the next board meeting.

Arkansas Medical Society members are encouraged to utilize these meetings to share their real-world, clinical expertise with the key agency personnel responsible for making the final decisions for clinical edits to covered prescriptions.

Once the quarterly DUR board meeting agenda is published, if you wish to provide feedback on a specific product or therapy being reviewed, you will need to send a request to DUR Board Chair Cindi Pearson, PharmD: Cinnamon.Pearson@dhs.arkansas.gov

If you have any questions or comments about these improvement at the DUR Board or about the Medicaid clinical review process, please don’t hesitate to reach out to the AMS staff.

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