We accomplish this through our Pharmacy and Therapeutics (P&T) Committee, made up of independent health care providers and pharmacists as well as health plan medical directors and pharmacists.

The committee reviews the scientific data on each therapeutic class on a regular basis and decides if there is enough evidence to show that one drug has clinical superiority over another. If a certain drug is clearly superior to the other medications in the therapeutic class, it is added to the Preferred Drug List (PDL) of the health plan in a preferred position. If all of the drugs in the therapeutic class are equal in efficacy and safety, the decision is made to allow the health plan to contract for the best net cost and to put those drugs into a preferred position on the PDL.

Many of the therapeutic classes have safe and effective generic alternatives. In most cases, the generics are made available on the 1st tier of the PDL at a cost advantage to the member.

There are times when a drug is only indicated for a specific reason or there are other drugs that are just as effective for the same indications but at a lower cost. In these instances the P&T Committee may decide to implement a Step Therapy (ST) or a Prior Authorization (PA) process prior to the drug being covered. These processes are intended to ensure that the patient is being treated with the most effective and cost efficient treatment available. The health plan recognizes some members may not respond to the preferred treatment
and will allow providers to request formulary “exceptions” in these situations.

Lovelace Health Plan will continually review the literature to find the most effective and the safest medications available to treat our members. We will be mindful of the cost implications as well. By following these management strategies, we hope to continue to make Lovelace Health Plan an affordable option for New Mexicans.