OIG audits vendor drug program provider
The OIG completed an audit of Parkland Community Health Plan, a Texas Vendor Drug Program (VDP) Provider, and its subcontracted Pharmacy Benefits Manager, Navitus Health Solutions. The audit objectives were to determine whether Parkland and Navitus administered formularies, preferred drug lists, and prior authorizations in accordance with applicable rules and statutes.
The audit found Parkland and Navitus generally adhered to formulary and preferred drug list requirements, which helped Navitus to ensure that it administered pharmacy benefits to Medicaid and CHIP members as required. Overall, Navitus’s formularies matched 97.2 percent of Vendor Drug Program (VDP) formularies for the Medicaid and CHIP programs, and its preferred drug lists matched 98.8 percent of VDP’s preferred drug lists. However, Navitus did not consistently comply with requirements related to design and performance of non-preferred and clinical prior authorizations.
The OIG made recommendations to Parkland, which, if implemented, will ensure Navitus (a) implements an appropriate method to add all VDP-approved formulary and approved preferred drug list line items with the appropriate designated preferred or non-preferred status, (b) implements periodic reviews to ensure all current drug codes are correctly reflected in the formularies and Medicaid preferred drug list and (c) complies with the VDP clinical criteria requirements for drug codes that require additional clinical reviews and requirements for non-preferred prior authorizations.
Read the full report here. https://oig.hhsc.texas.gov/sites/default/files/documents/parkland-pbm-final-8-31-20.pdf