Mental Health Quality Advisory Committee April 18, 2013

1. Mental Health Quality Advisory Committee April 18, 2013 Retro-DUR Intervention Outcomes Assessments for: Duplicate Sedatives & Hypnotics Atypical Antipsychotic Utilization in Children & Adolescents Indiana Family and Social Services Administration

2. Outcomes Assessment: Duplicate Sedatives & Hypnotics

3. Background • The majority of anti-anxiety and sedative/hypnotic medications are similar in terms of their pharmacology and mechanism of action. • Barbiturates, benzodiazepines (BZD), or non-benzodiazepines produce their clinical effects by interacting with the GABA/Chloride receptor complex. • Use of multiple anti-anxiety and sedative/hypnotic medications concurrently increases the risk of additive effects at the receptor complex and may result in over sedation or other adverse effects. • Whenever possible, therapy with these agents should be simplified to use of a single agent. • The Office of Medicaid Policy & Planning (OMPP) implemented the Duplicate Sedative Hypnotic & BZD Smart PA rule in 2010 and followed with this retro-DUR intervention to emphasize importance of single agent therapy.

4. Intervention • Purpose: • The intervention was intended to address the safety concerns associated with the duplicate use of sedative hypnotic and BZD medications. • Intervention Type • Population-based mailing • Mailing date: January 2012 • Total of 1646 letters mailed to physicians • Total of 2602 letters sent to adjusted target patients* *Adjusted Target Patients – All patients of physicians who were included in the intervention had pharmacy claims and were active plan members throughout the post-intervention time period. When outcomes were assessed, these patients’ pre-intervention (baseline) hits were re-evaluated to make certain that the status of clinical indicators had not changed due to late pharmacy and medical claims.

5. Methodology • Pharmacy drug claims from July 2011 through December 2011 were reviewed for the following: • Changes in intervention-related pharmacy dollars paid • Pharmacy dollars paid per patient per month (PPPM) • Number of pharmacy claims • The intervention consisted of education outreach to physicians whose patients were targeted • Physicians with at least one patient that met the criteria below were mailed an intervention letter: • Duplicate Anti-Anxiety Medication Therapy • Duplicate Sedative/Hypnotic Medication Therapy • Duplicate Anti-Anxiety and Sedative/Hypnotic Medication Therapy

6. Results • Changes in Clinical Indicators:

7. Results • Savings:

8. Conclusions • The intervention focused on improving prescribing practice and reducing the risk due to duplication. • The intervention was successful in reducing the total number of duplicate therapies for sedative hypnotics and BZDs within targeted patients by 55.1%. • The intervention decreased the amount paid for targeted drugs by $5.55 as measured in the post-intervention period. • The intervention yielded an estimated savings of nearly $87,000 in targeted drug expenditures as measured in the six-month post-intervention period.

9. Outcomes Assessment: Atypical Antipsychotic Utilization in Children & Adolescents

10. Background • The use of psychotropic medications in children and adolescents have become increasingly more common in recent years. • Indiana participated in the AHRQ-Rutgers study on antipsychotic use in children and adolescents in Indiana Medicaid. • OMPP conducted this retro-DUR to emphasize the importance of limiting antipsychotic prescribing in children and adolescents.

11. Intervention • Purpose: • To encourage physicians to evaluate atypical antipsychotic medication use in children and adolescents. • The goal was to reduce the risks and adverse outcomes associated with antipsychotic use. • Intervention Type • Population-based mailing • Mailing date: June 2012 • Total of 1638 letters mailed to physicians • Total of 2675 letters sent to adjusted target patients* *Adjusted Target Patients – All patients of physicians who were included in the intervention had pharmacy claims and were active plan members throughout the post-intervention time period. When outcomes were assessed, these patients’ pre-intervention (baseline) hits were re-evaluated to make certain that the status of clinical indicators had not changed due to late pharmacy and medical claims.

12. Methodology • Pharmacy drug claims from December 2011 through May 2012 were reviewed for the following: • Changes in intervention-related pharmacy dollars paid • Pharmacy dollars paid PPPM • Number of pharmacy claims • The intervention consisted of education outreach to physicians whose patients were targeted • Physicians with at least one patient that met the criteria below were mailed an intervention letter: • Atypical Antipsychotic in Children • Higher than Recommended Dosage of Atypical Antipsychotic in Children and Adolescents

13. Results • Changes in Clinical Indicator (Age):

14. Results • Savings:

15. Conclusions • The intervention focused on improving prescribing practice and reducing the risks associated with antipsychotic therapy. • The intervention was successful in reducing atypical antipsychotic therapy within targeted patients by 43.2%. • The intervention decreased the amount paid for targeted drugs by $91.83 as measured in the post-intervention period. • The intervention yielded an estimated savings of nearly $1.5 million in targeted drug expenditures as measured in the six-month post-intervention period.

16. Questions???