This measure is important because it monitors how often providers are prescribing a preferred medication versus a non-preferred medication requiring a Prior Authorization (PA). This allows DVHA to target and educate low compliance prescribers to improve compliance rates and lower DVHA’s net costs.  

This measure shows the percentage of Medicaid prescriptions that have a preferred status on DVHA’s Preferred Drug List (PDL).  The Preferred Drug List is one of the most effective tools available to DVHA to assure clinically appropriate and cost-effective prescribing. The PDL is designed to manage the state’s cost of providing prescription drugs while assuring broad access to clinically appropriate and cost-effective therapy. Both clinical and cost considerations determine PDL placement.

Most notably, the trendline for CY2024 Q1 dropped to 93.4% in CY2024 Q2 This is a result of  the cybersecurity outage. From 02/21/2024 -03/18/2024 Vermont Medicaid and Change Healthcare were unable to access pharmacy claim information and pharmacy claims were not adjudicated in the normal process.  Additionally Prior Authorization used to ensure use of preferred drugs on the PDL was not functional.  This resulted in an increased use of non-preferred medications as evidenced by the decrease and not meeting target.

Narrative Updated:  12/10/2024

• Medicaid Providers
• Change Healthcare

The Pharmacy Unit receives a detailed claims report of providers who have the lowest PDL compliance. A goal in CY2022 is to continue reviewing this report periodically for any opportunities for educational outreach to providers with lower compliance rates.