Life Sciences

P&T committee debates bidding impact, interchange

Medicare & Reimbursement Advisor Weekly, December 11, 2009

At a recent Alaska Medicaid P&T committee meeting, Jeffrey Demain, MD, discussed the impact of the committee’s decision to remove Albuterol from the preferred drug list (PDL), and give Xopenex® the bid. The committee determined in its decision that the two products were not interchangeable. “So every Albuterol prescription had to be rewritten,” Demain said. “Making these types of changes to the PDL creates confusion and has an impact on patients. In that particular case, we created a disservice to our medical community and patients. We need some type of safety net for when those types of things happen. We should fix that particular problem today. When you see a drug that is prescribed 95% of the time, you cannot just vote it away. If we determine a class effect, the drugs should be interchangeable.” Committee member Richard Brodsky, MD, said the drugs in the class were therapeutically equivalent, and changing the PDL to “include a drug that submitted a higher bid than another drug would undermine the whole process.” Demain disagreed, saying that changing drugs caused confusion with patients.

Prior authorization impact

Meanwhile, the state’s drug utilization review committee has instituted a prior authorization (PA) for PPIs. “We were concerned about utilization and continual use among numerous patients,” said Demain. “If the guidelines were adhered to, we would not have to do that. To be fiscally responsible and to maintain appropriate care, we felt it was best to add the prior authorization. We had intended to implement this in 2006, but due to confusion in the system, it has not yet been done. Two letters were sent out advising prescribers that the PPIs would require prior authorizations in the future.” On the PA issue, with new patients, committee member Kelly Conright, MD, said physicians may not always be aware of why certain medications were started, so they are reluctant to discontinue them.