Clinical Services Team: Pharmacy Unit

% of Medicaid prescriptions that have preferred status on the preferred drug list (PDL)

97.0%Q1 2022

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Notes on Methodology

  • Medicaid Providers
  • Change Healthcare
Story Behind the Curve

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.  The Pharmacy Unit receives a detailed claims report of providers who have the lowest PDL compliance. A goal in 2021 is to review this report periodically for any opportunities for educational outreach to providers with lower compliance rates.

The trendline has been quite steady hovering at 95-96% for the last four quarters. Some non-preferred prescribing is expected due to various clinical considerations of the patient. For example, some patients may have tried and failed on a preferred therapy so their provider is trying an alternate product. The purpose of the PA process is to document these unique clinical considerations.

Narrative last updated:  12/03/2020

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy