| Since July 1, 2012: | Annual review of each therapeutic class on the PDL. Guidance from the Committee allowed the maintenance of a clinical sound Preferred Drug List, while gathering significant savings.Allowed for collection of supplemental rebates in the costly Hepatitis C therapeutic class.Additional therapeutic classes added to PDL.2013: PDL savings of $9,547,957Magellan Medicaid Administration was awarded the contract for assisting in maintaining the PDL and multi-state purchasing pool which resulted in substantial improvements to the PDL program.State Plan Amendment (SPA) 13-17 approved September 19, 2013 (related to supplemental rebate contracting changes through multi-state purchasing pool)Issued RFP and awarded contract for Preferred Drug List services to vendor, Magellan Rx Management in 2013. Contract 57402-O4 effective from January 1, 2014 to December 31, 2016, with options of three, three year periods.The P&T Committee makes recommendations to the State on which drugs to place on the PDL, which to prefer and which to not prefer. In general, State Maximum Allowed Cost programs aid in assuring the PDL will produce savings to the State optimally. In 2013 the vendor FastMAC program was implemented providing a robust Maximum Allowable Cost (MAC) pricing for generic products to ensure continued compliance with CMS requirements for payment to be under the Federal Upper Limit (FUL) in aggregate. 2014: PDL savings of $8,451,157Cancer treatment: PDL Review was accomplished as this class is expanding rapidly to direct utilization to Brand Preferred products when appropriate as generic products enter the market. This ensured supplemental rebates remained stable while simultaneously maintaining quality clinical care to Medicaid clients.Hepatitis C Medications: PDL Review as well as Clinical Edit Requirement with Restrictive Clinical Criteria were drafted by extensive review of National Guidelines, Peer-Reviewed Literature, and National Thought-Leaders. 2015: PDL savings of $5,535,252A single-State PDL framework was included in the managed care RFP, released in 2015. The resulting Heritage Health contracts of 2016 require the awarded health plans to follow the Nebraska State Preferred Drug List with associated clinical criteria for each drug to ensure that State supplemental rebates remain approximately at the current annual dollar amount return and that the revenue remain stable for the years to come. Representatives from each health plan will participate on the Pharmaceutical and Therapeutics Committee for the term of the Heritage Health contracts and will assist the committee in making recommendation to the State concerning the preferred or non-preferred status of drugs on the Preferred Drug List.Reviewed and revised clinical criteria PDL status of specific PDL drugs and drug classes identified by the Federal government as those associated with national healthcare initiatives and public health epidemics were completed, such as revisions on hepatitis C drugs, methadone, and opioids. This action by the P&T Committee and the MLTC Pharmacy Unit will result in higher quality of health and healthcare services for Nebraskans. |