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Executive Summary

NATIONAL P&T ADVISORY COMMITTEE -- AS IN PRYOR PROPOSAL -- should be separate from the Health Care Financing Administration, Purdue University pharmaceutical economics professor Stephen Schondelmeyer suggested at a March 15 Capitol Hill seminar entitled "The Affordability of Medicine." Asked by Sen. Pryor's (D-Ark.) key staffer David Schulke to comment on the "safeguards" that should be incorporated into legislation establishing a national pharmacy and therapeutics committee, Schondelmeyer said, "absolutely, that body must be separate from any consideration of benefit designs or cost or amount to be paid." A "quasi-government" body assessing different drug therapies "could be helpful," Schondelmeyer told the Foresight Seminar, sponsored by the Institute for Alternative Futures. He described the ideal committee as a "nationally sanctioned independent body" pulling togetherclinical use information to help make drug assessment decisions. The group "should be totally separate from any reimbursement agency," the Purdue professor said. "It should not be housed in HCFA." The concept of a national P&T committee to advise state Medicaid programs is a hot topic in Washington this month. As Pryor prepares legislation to address Medicaid drug purchases, the national drug assessment group is being showcased as one of the centerpieces of that bill. The initial outline of the legislation is expected from Pryor's Senate Aging Committee during the week of March 19-23. Schondelmeyer specified that the committee should be advisory only. "I would not have the federal body make the final and ultimate decision that these are drugs that you must use in the state programs," he said, suggesting that legislation establishing a committee also permits physicians to override therapeutic alternative decisions when a specific drug is needed. New Jersey Medicaid pharmacy consultant Sanford Luger urged that a national P&T committee be a consensus group "that reflects the thinking of the respected professional entities in this country," such as the U.S. Pharmacopeia, the American Society of Hospital Pharmacists and the American Medical Association. "I know there has been some talk," Luger observed, "of establishing in statute the framework and the restraints under which this group would work and tell them what groups of drugs would be covered and what wouldn't." Luger objected to that specificity, saying that "the worst type of legislation is the kind that does not allow sufficient flexibility."

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