Board meetings, strategic plans, and buyer signals from Vicki Cunningham’s organization
Feb 25, 2026·BoardMeeting
Board
West Virginia Medicaid Drug Utilization Review Board Minutes
The board meeting covered updates from the Pharmaceutical & Therapeutics Committee meeting, including PDL status changes. Prior authorization criteria were approved for Rhapsido, Tonmya, and Hereditary Angioedema agents (both acute and prophylaxis), as well as Vyscoxa. Additionally, the board reviewed fourth-quarter 2025 reports from Gainwell Technologies, the Rational Drug Therapy Program, and Acentra Health, which included overviews of DUR summary reports, prior authorization programs, and RDUR interventions.
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West Virginia Department of Human Services, Bureau for Medical Services Quality Strategy 2024-2027
This 2024-2027 Managed Care Quality Strategy outlines a framework for the West Virginia Department of Human Services, Bureau for Medical Services (BMS), to deliver high-quality healthcare services for Medicaid and WVCHIP members. The plan is structured around five core goals: improving preventive care and overall health, reducing chronic disease burden, enhancing behavioral health outcomes, combating substance use disorders, and promoting whole-person wellness and self-management. The strategy aims to achieve these by strengthening quality and performance improvement, implementing targeted interventions, and aligning with national quality standards to improve health outcomes for vulnerable populations in West Virginia.
Nov 19, 2025·BoardMeeting
Board
West Virginia Medicaid Drug Utilization Review Board Minutes
The Board meeting included a presentation of pharmaceutical and therapeutics status updates. The Board reviewed and approved numerous prior authorization criteria for various medications, including Wegovy, Qelbree, Paxlovid, Ebglyss, Ubrelvy, Kesimpta, Airsupra, Vraylar, Agamree, and non-factor replacement therapies. Notably, the prior authorization requirement for Hepatitis C treatment was removed. Additionally, the Board reviewed third-quarter 2025 reports from Gainwell Technologies regarding DUR summaries, the Rational Drug Therapy Program, and Acentra Health regarding RDUR interventions.
May 21, 2025·BoardMeeting
Board
West Virginia Medicaid Drug Utilization Review Board Minutes
The board discussed updates from the Pharmaceutical & Therapeutics Committee meeting. Significant focus was placed on reviewing and approving various Prior Authorization Criteria, specifically mandates for drugs including Wegovy, Rezdiffra, and others, often requiring consultation with specialists. Additionally, the board reviewed second-quarter 2025 performance reports from Gainwell Technologies, the Rational Drug Therapy Program, and Acentra Health.
Extracted from official board minutes, strategic plans, and video transcripts.
