Medicaid Drug Selection Committees and Inadequate Management of Conflicts of Interest

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Abstract

Background

Drug selection decisions for state Medicaid reimbursement programs should be based on the best available evidence and free of conflicts of interest (COIs), but little is known about how the committees identify and manage COIs of the members. The objectives of this study were to (1) describe the content of Medicaid drug selection committees' COI policies for the US states and the District of Colombia, (2) categorize the policies by strength, and (3) identify characteristics of a strong policy.

Methods

For all states with Medicaid Preferred Drug Lists (47 states and the District of Columbia), we conducted a systematic search of official Medicaid websites and contacted Medicaid staff by e-mail and/or telephone to identify drug selection committee COI policies. We conducted a content analysis of the policies, extracting data on COI disclosure parameters, management strategies, and review processes using predefined categories modified through an iterative process.

Results

Policy documents were obtained for 27 of the programs (56%)—14 from websites and 13 by contacting Medicaid officials. We found high variability in COI policies, lack of public availability, and inconsistent enforcement and management of COI among states. The most common management strategy was disclosure of COI in 67% of policies (18 of 27), followed by self-recusal in 52% of policies (14 of 27). Only 15% of policies (4 of 27) ban certain relationships with industry.

Conclusions

Current policies are not transparent and not standardized, and no state policy included all model components. Wide variations suggest that some policies may not adequately protect drug selection decisions against COI and industry influence. With expected growth of Medicaid due to health care reform, the selection of drugs for Medicaid patients should be protected from the influence of COI.

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