Preferred Drug List (PDL)



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Further Explanation:

The Kansas Medical Assistance Program (KMAP) has created a preferred drug list (PDL) to promote clinically appropriate utilization of pharmaceuticals in a cost-effective manner without compromising the quality of care. The Kansas Medicaid PDL was authorized by K.S.A. 39-7,121a, allowing KMAP to develop a PDL based on safety, effectiveness and clinical outcomes. If these factors indicate no therapeutic advantage among the drugs being considered in the same drug class, then KMAP considers the net economic impact (lowest net cost to the State) of such drugs when recommending drugs for inclusion in the Medicaid PDL. The statute states that "drugs which do not have a significant, clinically meaningful therapeutic advantage in terms of safety, effectiveness or clinical outcomes may be excluded from the preferred drug formulary and be subject to prior authorization in accordance with state and federal laws."

A Preferred Drug List Advisory Committee, composed of practicing physicians and pharmacists, ensures that extensive clinical review of drug products takes place. The Advisory Committee's review and recommendations are based on evidence-based clinical information, not cost. Evidence-based medicine means providing treatments that have been shown to be effective, beneficial and have high value and not providing treatments that have been shown to be ineffective, harmful or have poor value.

All Preferred Drug List Advisory Committee meetings are open to the public and drug manufacturers may make presentations before committee action is taken.

After KMAP decides which drugs in a specific drug class will be preferred and non-preferred, preliminary recommendations for prior authorization criteria are developed for the non-preferred drugs and taken to the Kansas Drug Utilization Review Board for review and approval in accordance with K.S.A. 39-7,118. The drugs that are placed on prior authorization go through the rules and regulations process and there is a 30-day public comment period before the prior authorization is effective.

Only drugs that are part of the listed therapeutic classes are affected by the Preferred Drug List (PDL). Therapeutic classes not listed are not part of the PDL and will continue to be covered as they always have for the Kansas Medical Assistance Pharmacy Program. Preferred Drugs are exempt from the limit of 4 single-source prescription claims per beneficiary per month. Preferred drugs do not count toward the limit.