This article was last updated in February 2020.
Who exactly decides what prescription drugs and devices make the Wellmark Drug List Opens in a new window? It’s a big job, and one that relies on the experts of Wellmark Blue Cross and Blue Shield's Pharmacy and Therapeutics (P&T) Committee.
The P&T Committee's independent oversight keeps safety, value and performance at the forefront for our members. 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.
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 (and at what level).
What does a P&T Committee do?
The P&T Committee includes licensed, practicing physicians, pharmacists, and other health care professionals in Iowa and South Dakota, and they meet at least quarterly 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 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.
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 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
- Determining a drug’s true value
- Using utilization management to improve health
Question? Please reach out to your authorized Wellmark representative or email us at blueatwork@wellmark.com Send Email.
