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Members of P&T Committee

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

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Members of P&T Committee

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  1. Members of P&T Committee MemberBackground • 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

  2. 2003 Appropriations Act:P&T Committee Responsibilities • The P&T Committeeshall 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

  3. Medicaid FFS Pharmacy Costs89% Increase since 1997 Source: Statistical Record of the Virginia Medicaid Program, costs net of rebates

  4. 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 Drug Classes Excluded from the PDL Program

  5. Top 10 Therapeutic Classes$301 Million of $380 Million (79%) DOLLARS RX $45,715,563 $63,275,613 $36,776,608

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