The Basics

This standard describes minimum requirements for the P&T Committee members.  

• The members must represent diverse clinical specialties that correspond to plan beneficiary needs as well as appropriate specialists.  
• Most members of the committee should be physicians and/or practicing pharmacists.  
• At least one practicing physician and one practicing pharmacist must be an expert in the care of the elderly.  
• The physicians and pharmacists should be appropriately credentialed under Pharm Core 31.
• At least half of the practicing pharmacists practicing physicians should be free of conflict of interest regarding both health plan and pharmaceutical manufacturers, and not an employee of the organization.

Management Tips

It will not be sufficient if you are actual membership of the committee complies with the standard.  In addition, your policy and procedure or committee charter must require membership that meets the dictates of this standard.  Make sure that your policy and procedure or committee charter also addresses the issue of replacing members.

Because this standard emanates from federal regulations, URAC may also want to see evidence that your compliance program addresses this issues.

Pay particular attention to the credentialing requirement: All of the physicians and pharmacists on the PTFD committee must meet these requirements:

• Current, unrestricted clinical license(s); 
• Post-graduate experience in patient care; and
• Board certification (if the committee member is an M.D. or D.O.). 

URAC Accreditation Tips

Five of the elements of this standard are weighted 3; the requirement that the physicians ans pharmacists must have appropriate credentials is mandatory.

Documentation for the desktop review should include applicable policies and procedures and/or committee charters.

The on-site review will involve examination of committee minutes, the resumes of members of the committee, as well as an interview of a committee member (by telephone, if needed) and a ranking compliance officer.