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Invited Commentary |

Managing Potential Conflicts of Interest in State Medicaid Pharmacy and Therapeutics Committees: Seeking Harmony:  Comment on “Medicaid Drug Selection Committees and Inadequate Management of Conflicts of Interest”

Nirav Shah, MD, MPH
JAMA Intern Med. 2013;173(5):344. doi:10.1001/jamainternmed.2013.4184.
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Pharmacy and therapeutics (P & T) committee members determine the drugs available for particular indications in a hospital, health care plan, or system based on the members' views of the efficacy, safety, and relative cost of particular medications. While the primary goals of P & T committees for hospitals, self-funded employer-sponsored plans, commercial insurers, and state Medicaid programs are the same,1 the large scope, use of public funds, and the vulnerability of the population served, all make the decisions by Medicaid P & T committees particularly important. In this issue of JAMA Internal Medicine, Nguyen and Bero2 demonstrate that there is considerable heterogeneity across state Medicaid P & T committees in how they deal with P & T member conflicts of interest (COIs). They report on compliance with 12 factors potentially related to COIs, including availability of the state policy on a public website, disclosure parameters, management strategies, and review processes that might minimize COI. No state used all policies, and approaches varied from outright bans on any financial relationships that might lead to COI to not having an identified COI policy. The authors conclude that model policies for minimizing COI could be created and would result in increased transparency. They do not attempt to rank the effectiveness of the various policies, nor do they attempt to correlate any policies with outcomes (ie, bias or known COIs).

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