(a) A service may be placed on the Preferred Drug List if the service: - (i) Is a covered service;
- (ii) Is cost-effective; and
- (iii) Has been reviewed by the P&T Committee.
(b) Services that require listing on the Preferred Drug List. - (i) Review by the Pharmacy and Therapeutics (P&T) Committee. The P&T Committee shall review services of the same therapeutic class in order to determine if one (1) or more services are more clinically effective than others in the same class, or if all services in the class are determined to be clinically equivalent. In reviewing therapeutic classes, the P&T Committee shall consider the clinical efficacy of the services as determined by consensus of the P&T Committee utilizing:
- (A) Evidence-based research reports;
- (B) Peer-reviewed clinical literature; and
- (C) Nationally recognized practice standards.
- (ii) In order to solicit comments, the P&T Committee may provide notice to interested parties of services which are under consideration for designation on the Preferred Drug List and the criteria applied to such services.
- (iii) Recommendation to the Department. The P&T Committee shall make a recommendation to the Department about whether one (1) or more services are more clinically safe or effective than others in the same therapeutic class.
- (iv) Consideration of recommendation. The Department may consider the recommendation of the P&T Committee in determining whether to assign services to the Preferred Drug List. The Department may also consider information from CMS and other sources of clinical information which it deems relevant to the determination. The Department shall not be bound by the recommendations of the P&T Committee, but the Department shall not assign services to the Preferred Drug List until it has received and considered the P&T Committee's recommendation.
(c) Once the Department has chosen services for the Preferred Drug List for a therapeutic class, the Department will refer all non-preferred services to the P&T Committee for recommendations on prior authorization, and the criteria to be used for those services. - (i) As new drugs in a therapeutic class are introduced, the Department may change or update prior authorization criteria to include the new services until the P&T Committee can make recommendations to the Department in regard to the services.
- (ii) In the event the Department changes the preferred service for a therapeutic class, the Department may ask the P&T Committee to review and update the prior authorization criteria based upon changes to the non-preferred services.
(d) The Department may make changes to the Preferred Drug List for a therapeutic class based upon recommendations from the P&T Committee or changes in pricing.
(e) Notice of services on the Preferred Drug List. If additional services are designated pursuant to this section, the Department shall disseminate notice of the additional services on the Preferred Drug List to providers through bulletins, manuals, or a designated website.
(f) Procedure for requesting other service coverage. A provider seeking reimbursement for services not listed as the Preferred Drug in its therapeutic class may request prior authorization pursuant to the procedures as defined in Section 13.
048-10 Wyo. Code R. § 10-15