Y 4. Ag 4/2: D 84/8 DRUG UTILIZATION REVIEW: IS HCFA FOLLOWING HEARING BEFORE THE SUBCOMMITTEE ON HUMAN SERVICES OF THE SELECT COMMITTEE ON AGING ONE HUNDRED FIRST CONGRESS FIRST SESSION AUGUST 1, 1989 Comm. Pub. No. 101-731 Printed for the use of the Select Committee on Aging For sale by the Superintendent of Documents, Congressional Sales Office GOVT DOCUMENTS SELECT COMMITTEE ON AGING EDWARD R. ROYBAL, California, Chairman THOMAS J. DOWNEY, New York BUTLER DERRICK, South Carolina GEO. W. CROCKETT, JR., Michigan ROBERT E. WISE, JR., West Virginia THOMAS J. MANTON, New York JAMES MCCLURE CLARKE, North Carolina JOSEPH P. KENNEDY II, Massachusetts LOUISE M. SLAUGHTER, New York JIM JONTZ, Indiana JERRY F. COSTELLO, Illinois HARLEY O. STAGGERS, JR., West Virginia FRANK PALLONE, JR., New Jersey JOLENE UNSOELD, Washington PETER A. DEFAZIO, Oregon JOHN LEWIS, Georgia MATTHEW J. RINALDO, New Jersey, JOHN PAUL HAMMERSCHMIDT, Arkansas NORMAN D. SHUMWAY, California CLAUDINE SCHNEIDER, Rhode Island HELEN DELICH BENTLEY, Maryland HARRIS W. FAWELL, Illinois JAN MEYERS, Kansas BEN BLAZ, Guam PAUL B. HENRY, Michigan BILL SCHUETTE, Michigan FLOYD SPENCE, South Carolina WILLIAM F. CLINGER, JR., Pennsylvania JOHN EDWARD PORTER, Illinois CRAIG T. JAMES, Florida Hon. Pete Wilson, A United States Senator from the State of California............ Carl E. Wisler, Director of Planning and Reporting, Program Evaluation and Methodology Division, U.S. General Accounting Office; accompanied by James Solomon, Senior Assistant Director, and Sushil K. Sharma, Project Perham Amsden, member, Maine Medicare Peer Review Organization, Amer- ican Association of Retired Persons; accompanied by Cheryl Matheis, staff Captain Paul Tibbits, on behalf of Michael J. Mestrovich, Ph.D., Deputy Assistant Secretary of Defense (Health Management Systems). Barbara Gagel, Director, Bureau of Program Operations, Health Care Financ- ing Administration, Department of Health and Human Services....... Appendix 1. Hon. John Heinz, a United States Senator from the State of Appendix 2. "Prescription Drugs: Information on Selected Drug Utilization Review Systems," and "Prescription Drugs: HCFA's Proposed Drug Utiliza- tion Review System Ignores Quality of Care Issues," reports to the Chair- man, Special Committee on Aging, U.S. Senate, by the United States Appendix 3. Written questions submitted to Barbara Gagel, Director, Bureau of Program Operations, Health Care Financing Administration, Depart- ment of Health and Human Services, by Chairman Downey and Represent- ative Snowe, Ranking Minority Member, along with answers and attach- Appendix 4. Letter to the Hon. Charles A. Bowsher, Comptroller General of 236 238 Appendix 6. Additional material received for the hearing record: Charles D. Hepler, Ph.D., Professor and Chairman, and Linda M. Strand, Pharm.D., Ph.D., Associate Professor, Department of Pharmacy, Health Care Administration, College of Pharmacy, The University of Florida, 361 Mark L. Braunstein, M.D., President and Chief Operating Officer, Nation- al Data Corportation, Atlanta, GA, letter and attachment Paul G. Cano, Director, Government Affairs, Society of Consultant Prar- DRUG UTILIZATION REVIEW: IS HCFA TUESDAY, AUGUST 1, 1989 U.S. HOUSE OF REPRESENTATIVES, SELECT COMMITTEE ON AGING, SUBCOMMITTEE ON HUMAN SERVICES, Washington, DC. The subcommittee met, pursuant to notice, at 9:30 a.m., in Room 2226, Rayburn House Office Building, Hon. Thomas J. Downey (chairman of the subcommittee) presiding. Members present: Representatives Downey, Hughes, Slaughter, Pallone, Snowe, Morella and Saiki. Staff present: John Olinger, Majority Staff Director; Moya Benoit, Majority Research Assistant; Steven Stern, Majority Staff Assistant; Natalie Cannon, Minority Staff Director; Daryce Minzner, Minority Research Assistant; Ron Lambson, Fellow; and Grace Park, Minority Staff Assistant. OPENING STATEMENT OF CHAIRMAN THOMAS J. DOWNEY Mr. DOWNEY. The subcommittee will come to order. I have an opening statement and before I make that, before Senator Wilson arrives, I just want to make an announcement that we are switching panel 3 with panel 2. Please make note of that. I am happy to convene this hearing and to welcome our distinguished witnesses. This hearing is the second in a series of hearings we have held this year on the subject of drugs and the elderly. Our first hearing, held on April 19th, focused attention on the growing problem of drug misuse among the elderly, the need for normal FDA guidelines in the testing of drugs upon the elderly and the impact of this problem on community-based care. We plan to focus today's hearing solely on the recently released GAO report, entitled, "HCFA's Proposed Drug Utilization Review System Ignores Quality of Care Issues" and whether or not the Health Care Financing Administration plans for the Drug Utilization Review are the best possible ones for a program of this magnitude. We recognize that we are entering new territory by holding a hearing on this subject and we recognize that the scope of what we are trying to accomplish, a comprehensive DUR, is larger than anything that has ever been tried before, and we also recognize that there are great expectations, but there are equally great and legitimate concerns. It is our responsibility to address them. (1) |