Pharmacy & Therapeutics Committee
The EBRx Pharmacy and Therapeutics Committee (P&T), including board-certified pharmacists and physicians, contemplates the best current evidence to make clinical recommendations for coverage, tier placement and prior authorizations.
Pharmacy Benefit
P&T recommendations are shared with clients for approval before any coverage changes. EBRx then works with PBMs to update the formulary, aiming for the lowest-cost options.
Medical Benefit
Medical benefit drugs are provider-administered in clinics, hospitals, or infusion centers. Our P&T committee reviews clinical data to recommend coverage and the most cost-effective billing route—medical or pharmacy—based on cost, administration, and safety monitoring.
Prior Authorization Criteria
Our clinical team creates prior authorization criteria in line with the clinical structure and rebates of the drug formulary. The intent of prior authorization is to identify the appropriate patients according to the peer-reviewed, published evidence allowing prevention of unnecessary spend by avoiding investigational uses. Then, we can guarantee that we are spending the plan’s resources in a way that creates the highest value of healthcare. We frequently reevaluate our prior authorization policies for efficiency and effectiveness. Prior authorizations are recommended for scheduled administration of medical drugs, including gene therapy. We will not recommend prior authorizations for drugs most often billed to the DRG (ER or ICU settings where timely administration is important).
Pharmacy Claims Auditing
A detailed process to retroactively compare pharmacy claims to the contract reimbursement prices and/or performance guarantees.
State Legislative Advising
When discussing new bills presented to the Arkansas State Legislature, we can assist with providing a financial impact statement. We can discuss changes in policy as they may impact different sectors of healthcare including health plan payors, pharmacy benefit managers (PBMs), pharmaceutical companies, and pharmacies.