Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 10 - PHARMACEUTICAL SERVICES
Section 10-12 - Pharmacy and Therapeutics (P&T) Committee
Universal Citation: WY Code of Rules 10-12
Current through September 21, 2024
(a) Pharmacy Services shall have a P&T Committee to meet the DUR requirements designated in Section 7 of this Chapter. The P&T Committee shall be made up as follows:
(i) At least one
third (1/3), but not more than fifty-one percent (51%) physicians;
(ii) At least one third (1/3), but not more
than fifty-one (51%) pharmacists; and
(iii) At least one physician's assistant or
nurse practitioner.
(b) The responsibilities of the P&T Committee include:
(i) Prospective Drug Utilization Review,
including determination of prior authorization criteria in accordance with
Section 13 of this
Chapter;
(ii) Retrospective Drug
Utilization Review including periodic review of client profiles and claims data
in order to identify patterns of fraud, abuse, gross overuse, or inappropriate
or medically unnecessary care among physicians, pharmacists, or clients, or
associated with specific drugs or groups of drugs;
(iii) Provider education programs to include
written or live dissemination of information in group or individual
settings;
(iv) Review of literature
and providing recommendations to Medicaid Pharmacy Services for the purpose of
creating the Preferred Drug List in accordance with Section
15 of this chapter;
(v) Providing recommendations and feedback to
Medicaid Pharmacy Services regarding pharmacy policy in general; and
(vi) Other duties as requested by the
Department.
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