El Dorado County Grand Jury 2010-2011 County Prescription Drug Care Plan Case Number Gj010-004

An audit was conducted by Caremark into this abnormally high use of addictive prescription medication by the EDC employee referenced above, and Caremark determined that there was no evidence of criminal or fraudulent conduct.

Two significant positions with EDC responsible for monitoring prescription health care services were vacated (2005 and 2007) and not backfilled. In mid- 2010 the Director of the Department of Human Resources unsuccessfully attempted to monitor costs.

Shortly after the provision for monitoring prescription health care services was contracted at an annual cost of $49,000, the costs for the employee declined by almost half.

Amendment #4 to the original contract includes safeguards to protect EDC from excessive prescription costs by providing the following programs:  “Point of Sale Safety Edits Program: Caremark shall provide in accordance with Section 2.8 of the Agreement its automated concurrent Drug Utilization Review (DUR) services. The Point of Sale Safety Edits Program is necessarily limited by the amount, type and accuracy of Plan Participant information made available to Caremark.  Retrospective Safety Review Program: Caremark shall provide client retrospective Drug Utilization Review services, which are designed to provide appropriate clinical information concerning plan participant drug utilization for specific prescriptions. Caremark shall provide Prescribers with a Plan Participant-specific communication that identifies clinical issue and suggests alternative therapies, as appropriate.  Safety and Monitoring Solution Program: “On a calendar quarterly basis Caremark shall evaluate claims for patterns of potential overuse or misuse, including without limitation, the use of multiple Prescribers or multiple pharmacies. For circumstances that Caremark identifies patterns of potential overuse or misuse, Caremark may provide Prescribers or pharmacies with written notice of such issues.”

The EDC Grand Jury was informed that in addition to any member of the BOS, any member of the public may request an item be pulled for further discussion or correction.

Printed copies of EDC BOS meeting agendas contain no information informing the public how to have an item pulled from the Consent Calendar for discussion.