Section 4123-6-21.2 - Pharmacy and therapeutics committeeThe bureau of workers' compensation pharmacy and therapeutics (P&T) committee was created to advise the administrator, the chief of medical services, and the chief medical officer with regard to medication therapy issues for injured workers. 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 . Providers may 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 board of pharmacy.
(A) The P&T committee consists of the bureau's pharmacy program director, chief medical officer, and not more than thirteen nor less than five voting members who 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. Subject to approval by the administrator, the committee may create any subcommittees the committee determines are necessary to assist the committee in performing its duties. Subcommittees will submit their recommendations to the P & T committee.(B) P&T committee members must :(1) Be familiar with issues relating to the treatment of injured workers in the Ohio workers' compensation system.(2) Be a doctor of medicine (MD) or doctor of osteopathic medicine (DO), if a physician.(3) 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) Have experience with and an understanding of the concepts of evidence-based medicine as well as contemporary best practices in their respective areas of practice.(5) 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 is the administrator or the administrator's designee(s), who 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 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 are filled in a like manner as for the full term appointments for the remaining term of the vacated member.(D) The pharmacy program director of the bureau is the chairperson of the P&T committee and is responsible for providing notice of meetings to the members and 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, the pharmacy program director is only a voting member of the P&T committee and any subcommittees 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 will develop and establish bylaws for the organization and operations of the committee and subcommittees, 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 is responsible 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 and review of a formulary of approved medications.(2) Development of prior authorization criteria.(3) Review of proposed medication treatment guidelines.(4) Review 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 bureau's pharmacy benefit manager's performance and conduct regarding its management of prescription benefit services for the bureau.(G) The P&T committee will hold at least two meetings annually. The P&T committee and all subcommittees will keep written records of the agenda and minutes of each meeting, which will be maintained by the bureau.(H) The P&T committee 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 are paid in the same manner as other administrative costs of the bureau.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