Ohio Admin. Code 4123-6-21.2 - Pharmacy and therapeutics committee

The bureau of workers' compensation pharmacy and therapeutics (P&T) committee is hereby was created to advise the administrator, the chief of medical services, and the chief medical officer with regard to issues involving medication therapy issues for injured workers. A The bureau will develop and maintain a list of physician and pharmacist providers, each holding a professional license in good standing, who have expressed an interest in serving on the P&T committee and who would add credibility and diversity to the mission and goals of the committee shall be developed and maintained by the bureau. Providers may also be nominated for inclusion on the list by provider associations and organizations including but not limited to: deans of Ohio's allopathic and osteopathic medical schools, deans of Ohio's colleges of pharmacy, presidents of Ohio's various allopathic and osteopathic medical associations, the Ohio pharmacists association, the Ohio state medical board, and the Ohio state pharmacy board board of pharmacy.

(A) The P&T committee shall consist consists of the bureau's pharmacy program director, the bureau's chief medical officer, the industrial commission's medical advisor, and not more than thirteen nor less than five voting members who shall be are licensed physicians and licensed pharmacists representing the diverse group of providers that provide medical care to the injured workers of Ohio as administered through the bureau. The Subject to approval by the administrator, the committee may create any subcommittees that the committee determines are necessary to assist the committee in performing its duties. Any subcommittee Subcommittees will submit their recommendations shall be submitted to the P & T committee.

(B) P&T committee members must meet the following requirements:

(1) Each provider must be Be familiar with issues relating to the treatmentprescribing or dispensing of medications injured workers in the Ohio workers' compensation system.

(2) Physicians must be Be a doctor of medicine (MD) or doctor of osteopathic medicine (DO), if a physician.

(3) Providers must possess Possess significant clinical or administrative experience in health care delivery, including but not limited to pain management, pharmacy practice, medical quality assurance, disease management, and utilization review.

(4) Providers must have Have experience with and an understanding of the concepts of evidence-based based medicine as well as contemporary best practices in appropriate prescribing, dispensing, and monitoring of outpatient medications their respective areas of practice.

(5) Providers must not Not be, or within the previous twenty-four months have been, an employee of any pharmaceutical manufacturer, pharmacy benefits manager, or any non-governmental firm or entity administering state purchased health care program benefits or pharmaceutical rebates.

(C) The appointing authority for members of the P&T committee shall be is the administrator or the administrator's designee(s), who shall will appoint members of the committee from the list of qualified providers developed and maintained by the bureau. Terms of membership for individual members of the P&T committee shall be are for one year. Individuals may be reappointed to subsequent terms as determined by the administrator. Members may resign or be removed by the administrator at any time. Vacated terms shall be are filled in a like manner as for the full term appointments and shall be for the remaining term of the vacated member.

(D) The pharmacy program director of the bureau shall be is the chairperson of the P&T committee and shall provide is responsible for providing notice of meetings to the members and be responsible for the meeting agenda. In addition, the pharmacy program director may be self-designated as an ad hoc member of any subcommittees of the P&T committee. ; however However, the pharmacy program director is only a voting member of the P&T committee and any subcommittees only in the case of tie votes. The bureau's chief medical officer and the industrial commission's medical advisor may participate in discussions; however, they are not voting members. The pharmacy program director may designate an alternate to serve in the director's absence.

(E) The P&T committee shall will develop and establish bylaws for the organization and operations of the committee and subcommittees, subject to the requirements consistent with the provisions of this rule and approval by the administrator and the chief medical officer.

(F) The P&T committee may make such recommendations as it deems necessary to address any issue impacting the bureau related to pharmacy or medication therapeutics. The committee shall be is responsible to respond for responding to requests for recommendation on any such issue submitted by the bureau's administrator, chief of medical services, chief medical officer, or pharmacy program director, including:

(1) Development, approval and review of a formulary of approved medications.

(2) Development and approval of prior authorization criteria.

(3) Review and approval of proposed medication treatment guidelines.

(4) Review and approval of clinical criteria related to drug utilization review or specific medication issues.

(5) Review of the bureau's pharmacy providers' professional performance. Any peer review conducted by the P&T committee will be in accordance with generally accepted standards of pharmacy practice. The P&T committee may recommend sanctions as well as termination of any pharmacy provider determined to have consistently failed to meet such standards.

(6) Review of any of the bureau's medical providers' medication prescribing patterns and practices. Any peer review conducted by the P&T committee will be in accordance with generally accepted standards of medical practice applicable to medication prescribing. The P&T committee may recommend sanctions as well as decertification of any provider determined to have consistently failed to meet such standards. Any decertification or sanction of a provider by the bureau pursuant to recommendation of the P&T committee will be conducted in accordance with rule 4123-6-17 of the Administrative Code.

(7) Review of the performance of the bureau's pharmacy benefit manager manager's performance and conduct regarding its management of prescription benefit services for the bureau.

(G) The P&T committee shall will hold at least three two meetings annually. The P&T committee and all subcommittees shall will keep written records of the agenda and minutes of each meeting, which will be maintained by the bureau.

(H) The P&T committee shall will submit an annual report of its activities and recommendations to the administrator.

(I) Each member of the P&T committee and its respective subcommittees may be paid such fees as approved by the administrator or the administrator's designee. The expenses incurred by the P&T committee and its subcommittees and the fees of their members shall be are paid in the same manner as other administrative costs of the bureau.

Notes

Ohio Admin. Code 4123-6-21.2

Effective: 8/1/2024
Five Year Review (FYR) Dates: 2/1/2027
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4121.44, 4121.441, 4123.05
Rule Amplifies: 4121.12, 4121.121, 4121.44, 4121.441
Prior Effective Dates: 01/10/2011, 02/01/2012, 10/01/2016, 06/02/2017, 02/01/2022