RD316 - Annual Report on the Preferred Drug List Program - November 1, 2010


Executive Summary:
Item 325 ZZ.5 of the 2003 Appropriations Act directed the Department of Medical Assistance Services (DMAS) to establish a preferred drug list (PDL) program. The program was implemented in January 2004. In February 2004, DMAS received approval of its PDL program State Plan amendment and its supplemental rebate contracts from the Centers for Medicare & Medicaid Services (CMS).

Virginia's Preferred Drug List (PDL) Program was created to promote therapeutically appropriate pharmaceutical utilization in a cost-effective manner. The PDL Program encourages providers to prescribe drugs that are therapeutically appropriate and cost effective through the use of a PDL. Preferred drugs on the PDL can be prescribed without any additional action taken by the prescriber; non-preferred drugs require service authorization (SA) by calling or faxing the Clinical Call Center. While there are many classifications of drugs that are not subject to the PDL or service authorization (SA), the PDL contains a wide range of generic and brand name products.

Item 297 (P)(8) of the 2010 Appropriations Act requires that DMAS provide annual reports to the Governor and General Assembly on the status of the PDL program (a copy of Item 297 (P)(8) is provided as Attachment A.) DMAS has submitted reports at least annually since the implementation of the PDL program. In November 2005, DMAS conducted an extensive analysis of the outcomes of the PDL program implementation which included the estimated savings of the PDL program and the health effects on recipients. This study found no adverse health impacts for persons who were switched to drugs on the PDL compared to those who were allowed to remain on non-preferred drugs. Since this study, DMAS has continued to monitor potential adverse health impacts through its Pharmacy & Therapeutics (P&T) Committee process and interaction with the provider, advocacy and stakeholder communities. To date, no major concerns have been identified.