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May 1, 2012 - April 30, 2013
PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE
Article I - POLICY
The Pennsylvania Department of Public Welfare (DPW) Pharmacy & Therapeutics (P&T) Committee will monitor the pharmacy management system on behalf of the enrolled health care providers and recipients of the Medical Assistance (MA) Program. The working document of the pharmacy management system is the Preferred Drug List (PDL), inclusive of any applicable utilization protocols.
Article II - PURPOSE
Section I - Duties
The P&T Committee will act as an advisory board to DPW for pharmacy management issues. The Committee will recommend a Preferred Drug List (PDL) that promotes the use of safe and effective Food and Drug Administration (FDA) - approved medications. The Committee will ensure that the pharmacy management is based on sound clinical evidence that is both safe and cost-effective.
Section II - Process
The P&T Committee is a standing committee that will report all activities and recommendations to the Department. It is an advisory committee for DPW, designed to ensure unbiased clinical perspective in areas such as drug evaluations and utilization protocols.
The P&T Committee will review new and existing therapies using criteria established for efficacy, safety, and quality. Following this evaluation, cost factors will be included in the final determination regarding PDL recommended status. The Committee will establish recommendations regarding PDL status of brand and generic products for coverage under the prescription drug benefit. The Committee will also establish recommendations on the appropriate utilization protocols for individual medications or for therapeutic categories. These protocols include, but are not limited to prior authorization, automated prior authorization, system edits and guidelines, generic substitution programs, quantity limits and other utilization management tools.
Article III - MEMBERSHIP
Section I - Appointment
The P&T Committee will consist of a minimum of 15 voting members and the Chairperson who will be a non-voting member, except in the event of a tie vote. The voting and non-voting members will include the following:
A. External members
B. Internal DPW members
When the P&T Committee addresses certain therapies or drug classes, other ad hoc medical specialists or consultants may be added. The Department shall disclose any ad hoc medical specialists 10 days prior to the P&T Committee meeting.
All professional members shall be licensed under Pennsylvania law in their respective fields. The members will be chosen by specialty, board certification, prior P&T experience, state residency, experience treating Medical Assistance Recipients, absence of conflicts of interest, ability to represent a broad base of constituents, and number of years in practice.
Section II - Term
Each P&T Committee member is appointed by the Secretary of Public Welfare for a two-year term after which each member will come up for review and new members may be considered. Members may serve an unlimited number of terms.
Section III - Officers
The Chairperson will be the OMAP Pharmacy Director.
The Vice-Chairperson will be nominated and elected by the Committee. The Vice-Chairperson will take the place of the Chairperson upon his or her absence or request.
Section IV - Responsibilities
Each P&T Committee member is expected to attend all Committee meetings, unless otherwise excused by the Chairperson. If a P&T Committee member is unable to attend a Committee meeting in person, the member will be permitted to participate via teleconference at the discretion of the Chairperson.
P&T Committee members are expected to volunteer and apply their knowledge of current clinical practice during discussion. Matters discussed during executive sessions must remain confidential.
P & T Committee members must complete a Disclosure of Interest Forms and provide updated information prior to each meeting.
Section V – Termination and Resignation
The Chairperson will be the Director of the Division of Pharmacy for the Department of Public Welfare.
A Vice-Chairperson will be nominated and elected by the Committee at the first meeting of the P&T Committee. The Vice-Chairperson will take the place of the Chairperson upon their absence or request.
Section V - Termination and Resignation
The Secretary may dismiss a P&T Committee member. Termination may result due to not disclosing a conflict of interest, participating in wrongdoing or misconduct while a member of the Committee.
A P&T Committee member may resign by submitting a written notice to the Chairperson. The Chairperson may resign by submitting a written notice to the Secretary.
Article IV - MEETINGS
Section I - Frequency
The P&T Committee will meet semi-annually. Additional meetings may be called by the Chairperson or Committee at any time.
Section II - Procedure
Semi-annual P&T Committee meetings will be subject to the provisions of the Pennsylvania Sunshine Act 65 Pa.C.S.A.§ 701 et.seq.
Public notice of the meeting will be published approximately 60 days prior to the date of the meeting.
At the entrance to the meeting room a sign-in sheet will be provided and any representatives from the public are invited to attend. Seating is not reserved and will be on an as-available basis.
The P&T Committee members will be given a copy of the final agenda and meeting materials at least 10 days prior to the meeting.
The Department shall post on the Web site the final agenda and list of approved speakers at least 10 days prior to the meeting.
Public and written testimony shall be considered part of the public record and made available upon request.
The minutes from each meeting will be posted for pubic view within 30 days of the date of the meeting at which the minutes are approved. Minutes will include vote totals.
Article V - QUORUM
The presence of 50 percent or more of P&T Committee members will be considered a quorum. A simple majority will determine the P&T Committee’s recommendation, and any ties will be broken by the Chairperson.
Article VI - PUBLIC PARTICIPATION
Section I - Public Testimony Registration
Section II - Public Testimony Guidelines
Section III - Public Testimony Procedures
Section IV - Public Resources
The DPW Web site will exhibit information for public view. The Web site will include the P&T Committee member list, the meeting minutes, the meeting agendas, and the working PDL. Testimony registration information will also be available on the Web site. The Web site also includes all policies and regulations that govern pharmacy services in the Medical Assistance Program, Medical Assistance Bulletins and provider handbooks, including the Prior Authorization of Pharmacy Services Handbook.
Article VII - DISCLOSURE OF INTEREST
Members of the Committee will be required to submit Disclosure of Interest Forms and will have an ongoing duty to disclose any interests that develop after completion of the form.
If a member has an interest that may affect or be perceived to affect the member’s independence of judgment, the member must recuse himself/herself from the voting process for the drug class concerned. This recusal includes but is not limited to refraining from deliberation or debate, making recommendations, volunteering advice and/or participating in the decision-making process in any way.
The Chairperson will review the criteria that P & T members should use to determine whether to recuse themselves from the voting process at the beginning of each meeting and ask whether any members need to recuse themselves from consideration of a particular drug or class of drugs.
Article VIII - AMENDMENT OF BY-LAWS
Amendments to the By-Laws of the P&T Committee may be decided by majority vote at any P&T Committee meeting. Any proposed amendments must be submitted prior to the meeting and included in the agenda of the meeting during which the vote will be taken.
Last Modified: October 2008