Members of P&T Committee Member Background

• Randy Axelrod (MD) Anthem Chief Medical Officer(Chairman)

• Roy Beveridge (MD) Oncologist• Avtar Dhillon (MD) Psychiatrist (CSB)• James Reinhard (MD) Psychiatrist (DMHMRSAS)• Arthur Garson, Jr (MD) Dean, UVA Med. School • Mariann Johnson (MD) Family Practice• Eleanor (Sue) Cantrell (MD) Local Health District Director• Christine Tully (MD) Geriatrician, VCU/MCV • Mark Szalwinski (Pharmacist) Sentara Healthcare

(Vice Chairman)• Gill Abernathy (Pharmacist) INOVA Health System• Mark Oley (Pharmacist) Westwood Pharmacy• Renita Warren (Pharmacist) Edloe’s Pharmacies

2003 Appropriations Act: P&T Committee Responsibilities

• The P&T Committee shall recommend to the Department:– therapeutic classes of drugs to be subject to the PDL and prior

authorization requirements– specific drugs within each class to be included on the PDL– appropriate exclusions for medications, including atypical anti-psychotics,

used for the treatment of serious mental illnesses such as bi-polar disorders, schizophrenia, and depression

– appropriate exclusions for medications used for the treatment of brain disorders, cancer, and HIV-related conditions

– other appropriate exclusions and “grandfather” clauses– conduct clinical reviews of preferred and non-preferred drugs as needed to

maintain the PDL– conduct clinical reviews of new drugs– provide advice to DMAS and Contractor on clinical issues regarding all

aspects of the PDL program, including the prior authorization process for non-preferred drugs

Medicaid FFS Pharmacy Costs 89% Increase since 1997

$0

$50

$100

$150

$200

$250

$300

$350

$400

1997 1998 1999 2000 2001 2002

Rx

Co

sts

(M

illio

ns

)

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

Pharmacy Costs Percent TMC

Source: Statistical Record of the Virginia Medicaid Program, costs net of rebates

Drug Classes Excluded from the PDL Program

Therapeutic Class Description• Insulins…………………………….• Cholinesterase Inhibitors………..• Platelet Aggregation Inhibitors….• Antivirals for HIV………………….• Cancer Chemo. Agents………….• Anti-convulsants………………….• Immunosupressants……………..• Antiemetics……………………….• Anti-psychotics……………………

(Atypical and Typicals)

Used in the Treatment of Diabetes

Alzheimers

Clotting Disorders

HIV/AIDS

Cancer

Seizure Disorders, Mental Health

Transplant rejections, Arthritis

Nausea in cancer patients, Aging

Serious Mental Illness

Top 10 Therapeutic Classes$301 Million of $380 Million (79%)

DOLLARS RX

$45,715,563

$63,275,613

$36,776,608