Mo. Code Regs. tit. 13 § 70-20.310
Current through Register Vol. 49, No. 23, December 2, 2024
Section 13 CSR 70-20.310 - Prospective Drug Use Review Process and Patient CounselingPURPOSE: This amendment adds more specific incorporation by reference language and updates the rule to remove duplication.
(1) Prospective Drug Use Review (DUR). This rule establishes a MO HealthNet prospective drug use review process within the Department of Social Services, MO HealthNet Division, as specified in section 208.176, RSMo.(2) Electronic Point-of-Sale Review. The MO HealthNet Division shall provide for electronic point-of-sale review before each prescription is dispensed to a MO HealthNet participant or MO HealthNet participant's caregiver on the date of service. The Missouri Drug Use Review Board will review and approve clinical modules, as outlined in 42 CFR 456.705, Prospective Drug Review as published on October 1, 2018 by the Office of the Federal Register National Archives and Records Administration, US Government Publishing Office US Superintendent of Documents, Washington, DC 20402 and is incorporated by reference and made a part of this rule, as published by the Department of Social Services, MO HealthNet Division, 615 Howerton Ct, Jefferson City, MO 65109, at its website at https://dssruletracker.mo.gov/dss-proposed-rules/welcome.action . This rule does not incorporate any subsequent amendments or additions. The MO HealthNet Division will provide electronic point-of-sale screening for potential drug therapy problems using the approved clinical modules on the date of service.(3) Electronic Point-of-Sale Review Available for MO HealthNet Beneficiaries. The following reviews will be provided by the pharmacy point of service system: (A) Drug Disease Contraindications. 1. Drug (actual) disease precaution.2. Inferred Drug Disease precaution;(B) Drug to Drug Interactions;(C) Side Effects.1. Additive toxicity side effects.2. Medical condition/additive side effect.4. Drug indicated for side effect of previously prescribed drug;(E) Minimum/Maximum Daily Dose. (F) Duplicate Therapy Checking. 1. Therapeutic duplication.2. Ingredient duplication; and(G) Duration of Therapy (H2). 1. Excessive duration alert.(4) MO HealthNet Patient Counseling. As part of the prospective DUR program, participating pharmacies shall perform patient counseling according to the standards established by the Board of Pharmacy under 20 CSR 2220-2.190. 20 CSR 2220-2.190 is published by the Missouri Secretary of State, at https://www.sos.mo.gov/cmsimages/adrules/csr/current/20csr/20 c2220-2.pdf, on February 28, 2017. A copy of 20 CSR 2220-2.190 is incorporated by reference and made a part of this rule, as published by the Department of Social Services, MO Health-Net Division, 615 Howerton Ct., Jefferson City, MO 65109, at its website at https://dssruletracker.mo.gov/dss-proposed-rules/welcome.action. This rule does not incorporate any subsequent amendments or additions.(5) MO HealthNet Patient Profiles. The term "reasonable effort" means that each time a MO HealthNet patient or caregiver presents a prescription, the pharmacist or pharmacist's designee should request profile information verbally or in writing. For example, if the patient presents the prescription in person, the request should be made verbally, and if the prescription is received by mail, the request should be made in writing. This does not imply that the service should be denied solely on the basis of the patient's refusal to supply this information. Pharmacies must make a reasonable effort to obtain records and maintain patient profiles containing, at a minimum: (A) The name, address, telephone number, date of birth (or age), and gender of the patient;(B) Individual medical history, if significant, including disease states, known allergies and drug reactions, and a comprehensive list of medications and relevant devices; and(C) Pharmacist's comments relevant to the individual's drug therapy.(6) Documentation of Offer to Counsel. The pharmacist shall document for each MO HealthNet patient's prescription in a uniform fashion, whether the offer to counsel was accepted or refused by the patient or the patient's agent.(7) Agency Responsibility Regarding Confidentiality of Information. All information concerning applicants and participants of medical services shall be kept confidential by the MO HealthNet Division, and any disclosure of this information shall be restricted to purposes directly related to the administration of the medical assistance program. Purposes directly related to administration of the medical assistance program include: (A) Establishing eligibility;(B) Determining the amount of medical assistance;(C) Providing services for participants; and(D) Conducting or assisting an investigation, prosecution, or civil or criminal proceeding related to the administration of the program.(8) Provider Responsibility Regarding Confidentiality of MO HealthNet Beneficiary Information. All information concerning applicants and participants of medical services shall be confidential. Any disclosure of this information by the pharmacy provider shall be restricted to purposes directly related to the treatment of the patient and promotion of improved quality of care, or conducting or assisting an investigation, prosecution, or civil or criminal proceeding related to the administration of the program. The confidential information includes: (B) Social Security number;(C) Medical services provided;(D) Social and economic conditions or circumstances;(E) Medical data, including diagnosis and past history of disease or disability;(F) Any information received for verifying income eligibility; and(G) Any information received in connection with the identification of legally liable third party resources. AUTHORITY: sections 208.153 and 208.201, RSMo Supp. 2013.* Original rule filed June 3, 1993, effective Dec. 9, 1993. Amended: Filed Sept. 16, 2013, effective March 30, 2014. Amended by Missouri Register May 1, 2020/Volume 45, Number 9, effective 6/30/2020*Original authority: 208.153, RSMo 1967, amended 1973, 1989, 1990, 1991, 2007, 2012 and 208.201, RSMo 1987, amended 2007.