Decision-making with the P&T Committee
Who exactly decides what prescription drugs and devices make the Wellmark drug lists? It’s a big job, and one that relies on the experts of the Wellmark® Blue Cross® and Blue Shield® Pharmacy and Therapeutics (P&T) Committee.
The P&T Committee's independent oversight keeps safety, value and performance at the forefront for our members, allowing us to make health care better for all Iowans and South Dakotans. While some health insurance providers don’t manage their own drug list (also known as a formulary), Wellmark’s unique management model ensures a holistic, efficient approach to both medical and pharmacy coverage.
What does the P&T Committee do?
The P&T Committee includes licensed, practicing physicians, pharmacists and other health care professionals in Iowa and South Dakota. They meet at least five times per year to evaluate, educate and advise the Wellmark Pharmacy program. The committee uses these meetings to:
- Evaluate drugs requested for addition to the Wellmark drug list. Drugs are evaluated by emphasizing safety, effectiveness and total cost. Potential duplication of treatments with over-the-counter options or similar prescriptions are also considered.
- Review and modify the drug list to reflect new advances in drug treatment and current provider practices.
- Review new drugs and new indications to existing drugs approved by the U.S. Food and Drug Administration (FDA).
- Make recommendations on drugs for drug list placement and utilization management after analyzing evidence-based clinical data.
Did you know?
FDA approval does not automatically mean a drug appears on a certain Wellmark drug list level or tier, or even at all. A holistic, independent evaluation conducted by the P&T Committee determines if it's included.
Through this review and discussion, the P&T Committee votes whether a drug or drug class is therapeutically unique, similar or inferior to existing treatment options. Once finalized, the Wellmark drug list is then updated and those impacted are alerted of the changes. These updates enable us to evaluate the latest evidence-based research to give members access to the safest and most effective drugs, while reducing costs for employers when possible.
Learn more about the different ways you can personalize your pharmacy benefits program to best serve your employees and your organization’s bottom line:
- Understanding pharmacy costs to create a sustainable future
- Using utilization management to improve health
- Managing rising pharmacy costs: Trends, challenges and solutions for employers
What makes Wellmark’s P&T Committee different?
Now that you know the role the P&T Committee plays in the Pharmacy Program, you may be wondering what sets apart Wellmark’s P&T Committee.
Traditional P&T Committees are often comprised of a national board of medical professionals, but Wellmark’s P&T Committee is made up entirely of physicians, pharmacists and other health care providers from Iowa and South Dakota — so they know what matters most to you. Knowing this, you can be confident that Wellmark’s Committee is on the same page as you and your community when making important decisions.
With Wellmark’s unique, whole health approach, you can count on receiving maximum value from your pharmacy benefits.
By considering multiple factors like safety, effectiveness, cost and the use of generic medications, the Wellmark P&T Committee is working to make the best pharmacy decisions for you.
Questions? Please reach out to your authorized Wellmark representative or email us at blueatwork@wellmark.com.