Response from the Department of Health Care Policy and Financing
COMMITTEE ON JOINT HEALTH AND HUMAN SERVICES
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03:25 PM -- Response from the Department of Health Care Policy and Financing
Susan Birch, Executive Director, HCPF, responded to the audit report presentation. She explained that HCPF understands the need for improvement and balance to the state budget. She discussed the CDASS audit, and explained the CDASS program concept. She confirmed that many other states have similar programs. She expressed department support for the client choice allowed by this program, and noted that fiscal accountability and transparency is also important. Director Birch noted that the department is on track with audit recommendations as of December 2015.
Director Birch responded to questions from members. She explained that HCPF is committed to the CDASS program and ensuring its accountability. She noted that there will be small changes to the program, but there are no major changes planned. She noted that clients and stakeholders will be informed about potential changes within the program.
Director Birch moved on the Medicaid drug audit. She reiterated the purpose and results of the audit. Most of the audit recommendations will be implemented with HCPF's updated pharmacy benefit management system (PBMS) later in 2016. HCPF will continue to monitor opiod drug over-utilization.
In response to a question, Dr. Judy Zerzan, Chief Medical Officer, HCPF, explained Colorado's PBMS. The PBMS allows the department to track Colorado Medicaid money and volume quantity. Director Birch clarified that the Department of Regulatory Agencies, not HCPF, tracks prescription drug abuse. Dr. Zerzan explained that the new PBMS technology will monitor drugs more quickly and efficiently. Members expressed concern over the HCPF's access to information about prescription drug abuse.
In response to a question, Dr. Zerzan explained that generic drugs make up about 85 percent of Medicaid prescriptions. The percentage has remained stable in the past few years, but may change due to new drugs. The legislators discussed a prescription drug monitoring bill. Members expressed concern over the abuse of prescription drugs by recipients and perscriptions provided by terminated Medicaid providers. Director Birch responded that scheduled upgrades to HCPF's IT systems will provide better oversight.
In response to questions, Dr. Zerzan explained that the preferred drug list is evaluated each quarter and drug stability is considered when reviewing the list. Dr. Zerzan also explained that over-utilized recipients were found through the claims system. Dr. Zerzan explained the process for switching preferred drugs for chronic patients.
Director Birch gave concluding remarks.