title: Medicaid drug selection committees and inadequate management of conflicts of interest.
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.
authors: Department of Clinical Pharmacy and Institute for Health Policy Studies, University of California, San Francisco, 3333 California St, San Francisco, CA 94118, USA.
authors: Nicole Yvonne
authors: NY
authors: Nguyen
authors: Lisa
authors: L
authors: Bero
mesh_terms: D016265:Conflict of Interest / Q000191:economics*; D030881:Disclosure; D019538:Health Care Surveys; D006291:Health Policy / Q000191:economics*; D006301:Health Services Needs and Demand; D006801:Humans; D008484:Medicaid / Q000191:economics / Q000458:organization & administration; D054539:Medication Therapy Management / Q000191:economics / Q000592:standards; D010606:Pharmacy and Therapeutics Committee / Q000458:organization & administration*; D011050:Policy Making; D012051:Reimbursement Mechanisms / Q000592:standards; D014481:United States