Health Plan (7.4) 7.4

P-OPS 9 - P&T Committee Membership

Submited by: Tom Goddard

The Basics

This standard defines and constrains the possible composition of the P&T Committee. The parameters for membership include:

  • Diverse specialties representative of the members' needs; and
  • Representation of, or consultation with, specialists as appropriate.
Further, a majority of the voting members must be practicing physicians or pharmacists. At least one of the physicians, and at least one of the pharmacists, must specialize in geriatrics or disabilities. All these clinicians must be appropriately credentialed under URAC standards. Finally, more than half of the practicing clinicians must be independent and conflict-free and not employees of your health plan.

Management Tips

One of the things to think about is what your committee will do if it encounters a need for a specialist that is not represented on the committee. Now matter how you decide to address this likely eventuality, work that into the applicable P&P. 

Accreditation Tips

Desktop Review
In addition to the applicable P&P, submit a list of P&T committee members, their qualifications, and sample P&T Committee meeting minutes.
Validation Review
The onsite review will focus on an interview of staff members supporting the P&T Committee.

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