The Illinois Department of Healthcare and Family Services (HFS) maintains a preferred drug list (PDL) in order to promote clinically appropriate utilization of pharmaceuticals in a cost-effective manner. The Illinois Medicaid PDL process ensures that HFS’s PDL is developed based on safety, effectiveness, and clinical outcomes. If these factors indicate no therapeutic advantage among the drugs being considered in the same drug class, then HFS considers the net economic impact of such drugs when recommending drugs for inclusion in the PDL.
HFS contracts with the University of Illinois at Chicago (UIC) College of Pharmacy to perform a clinical review of products within the classes being reviewed. Upon receipt of the clinical recommendations, the department, in consultation with pharmacologists, pharmacists, and physicians, develops its PDL recommendations taking into account both clinical and cost factors. Those recommendations are then presented to the Illinois State Medical Society Committee on Drugs and Therapeutics D and T Committee, a committee comprised of practicing physicians representing various specialties who actively participate in the Medicaid Program. The D and T Committee’s review and recommendations are based on evidence-based clinical information, not cost.
The PDL has proven a very effective tool in addressing the escalating cost of drugs. In Fiscal Year 2011, the State collected $37 million in supplemental rebates from manufacturers while ensuring access to clinically appropriate therapies. Significant additional savings is achieved by using the PDL to shift utilization to the most clinically appropriate, cost-effective alternatives.