What is the general process for the PDL?
Each drug is reviewed on its clinical merits relative to other medications in the same therapeutic class. Published, peer-reviewed clinical trials are the primary source of information used by the State’s vendor for this review. Data regarding efficacy, effectiveness, adverse effects, and tolerability is analyzed and compared to other drugs within the therapeutic class. From this analysis, the clinical staff determines an agent’s superiority, equivalency, or inferiority relative to the comparator drugs. After the clinical review, a financial analysis is performed. This analysis incorporates utilization data from the State as well as net drug costs from the manufacturers. With this data, the financial staff determines the fiscal impact of PDL inclusion or exclusion of each medication. Incorporating all of this information, the current vendor makes suggestions to the State’s Medicaid Pharmaceutical and Therapeutics (P&T) Committee regarding the PDL status of each medication. After review
