HID Provides A Preferred Drug List and Supplemental Rebate Program to Improve Prescribing Patterns.

Changing Prescribing Habits

The primary goal of a preferred drug list (PDL) program for a State Medicaid program or a private sector program is to improve the quality of healthcare of its recipients through changing the prescribing patterns of physicians. The means by which the State can change prescribing patterns can include encouraging evidence based practices, enhancing quality medical care delivery, and enhancing cost effectiveness of the drugs used. This is the basis by which drugs are chosen for the Preferred Drug List.

A client’s Pharmacy and Therapeutics (P&T) Committee decides which drugs are “preferred” based on issues of efficacy, safety and cost effectiveness. Drugs not on the list require a Prior Authorization in order to be paid by the client.
The Federal Center for Medicare and Medicaid Services (CMS) requires that Medicaid will not pay for any drug unless the manufacturer of that drug has signed a rebate agreement with CMS. However, individual states are allowed to negotiate their own rebates which would be “supplemental” to the baseline CMS rebates. Usually incentive for the manufacturer to offer an enhanced rebate is provided via enforcement of a Preferred Drug List by the state. Drugs are placed on the List based on clinical efficacy, safety and “cost effectiveness.” The cost effectiveness variable can be altered by the provision of the supplemental rebate.

Health Information Designs is knowledgeable about the design and implementation of a Preferred Drug List and the interplay between the Preferred Drug List and rebates. We are familiar with the process of rebate negotiations and their associated legal agreements and accounting requirements.

To discuss how HID’s approach to establishing and managing a Preferred Drug List and Supplemental Rebates may be of value to you please contact Sales at sales@hidinc.com.