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Services

Pills

Florida Agency for Health Care Administration

2.2 million Medicaid beneficiaries with a $2.2 billion budget

In less than 90 days following the execution of the contract, Provider Synergies constructed the first list of PDL drugs (over 60 therapeutic categories represented) and it was publicly posted effective 7/1/2001. The PPI category was the first to be prior authorized, 7/15/2001. Over 60 therapeutic categories were prepared for clinical and financial review, presented to the P& T Committee and included in the PDL within a 12 month period.

Provider Synergies assisted the state in the creation of the P&T Committee and held the first public meeting in August 2001. Specific clinical recommendations, relative cost and market share data were utilized to assist with decision making for the PDL. Financial recommendations and analyses focused on net/net cost of therapy to the state (claims cost minus Federal rebates minus applicable Supplemental Rebates).

Provider Synergies analyzed the state's actual drug utilization and then recommended over 60 therapeutic drug classes for review. Targeted therapeutic drug classes were chosen based on the ability to move market share within the class, the competition within the class and annual dollar expenditures of each class.

Provider Synergies negotiated with over 70 manufacturers in developing the State's Supplemental Rebate program. During the first six months of the program, almost $35 million was in the form of supplemental rebates while another $46.5 million resulted from market share shifts to less costly agents. The savings amounted to 16.6% of the client's total drug expenditure. Florida's program, with savings approaching $500 million through 2Q04, is considered to be a national model.

All non-preferred medications are subject to a Prior Authorization (PA) process that requires the prescribing physician to call the program administrator to obtain approval. To date, non-preferred drugs in classes where the PA process has been activated have incurred an 85-90% prescription volume shift to preferred agents resulting in a savings of 25% of the prescription cost in those classes. For drugs with a Clinical PA (with protocols established by the P&T for prescribing), the physician is required to complete the Florida Medicaid Prior Authorization form to provide documentation that the patient meets the protocols established by the P&T Committee. The PA form is available from the PA vendor and from the Florida Medicaid Web site.