LPAP Board & Formulary Set Up Process
Formulary Development:
The LPAP Board is comprised of the QM Committee and a mixture of provider staff and client users of services. The committee will be responsible for staying abreast of new medications and treatments for HIV/AIDS. The committee reviews new and existing medications and selects drugs to be included in the health plan's formulary based on safety and how well they work.
The LPAP Board will meet quarterly to consider any new medications for addition to the formulary list and to review any client or provider complaints, if any.
Clients and providers will follow the BVCOG grievance process already in place.
The formulary list will be written and published to all Service Providers within the HSDA immediately upon any changes to the list. The AA will be responsible for distributing the list.
Board Creation:
The LPAP Board will consist of members from the QM Committee as well as a representative from a provider and a client who uses the Ryan White services.
The LPAP Program is an allowable core medical service in Ryan White HIV/AIDS Program for Part A and B.The board will meet quarterly. The board will establish a written need for such a program that will be submitted with each grant application.
The Statement of Need will specify the restrictions needed to be included in the annual grant application to DSHS. The assessment will include the financial feasibility of the LPAP Program in this HSDA, the evaluation of all available resources for medications, and the reasons these resources do not meet the needs of the clients.
Board Duties:
The board is responsible for developing a process for inclusion of medications to the formulary list, and deletion from the list.
The Formulary List Process:
There is no limitation as to the number of drugs that may be placed on the formulary list approved by BVCOG HSDA LPAP Board.
Drugs on an ADAP formulary list may also be on the LPAP formulary. The board will state the need for a medication in its jurisdiction and supply that statement of need to DSHS with the AA’s yearly grant application. For example, there may be varying degrees of need in a jurisdiction based upon the financial circumstances of clients in the AA’s jurisdiction and/or the Service Provider’s jurisdiction.
The LPAP Board will maintain documentation of its meetings that are always available for review by the AA. The AA will review documentation at the service provider level to determine methods for input by the Service Providers when requesting addition or deletion of a medication from the formulary list.
The AA will designate a member on the LPAP Board to be the recipient of medication requests. The AA will utilize its existing Grievance Policy (See Appendix A) method for clients or Service Providers as it pertains to LPAP. The AA designee (Community Planner) is responsible for preparing the grievance report for presentation at the quarterly LPAP Board meeting.
The designated LPAP Board member whoreceives medication requests for board review will prepare and present such requests at each board meeting.
Any changes to the formulary list will be made upon approval of the (¾) of the board membership; a quorum for the vote must be maintained or the action will not be undertaken. The physician representative on the LPAP board will have the final decision on the inclusion of the drug on the formulary list.
Inclusion of Medication:
The LPAP Board will:
- Consider the clinical appropriateness of the drug – the cost;
- The Board will review specific medications following FDA approval using medical literature and published clinical trial data;
- The Board will consider the value of drugs by evaluating the net cost, market share, and drug utilization trends of clinically similar medications.
- Considerations will include the safety and effectiveness of the medication;
- Clinical benefits not available in other medication on the market;
- Medication safety risks will not outweigh the benefits.
- The Board will at a minimum review the formulary yearly but preferably every quarter.
The Board may create an advisory subcommittee who will serve in reviewing the clinical data on the medication and may address therapeutic areas to be beneficial (i.e., antimicrobial, cancer chemotherapy, cardiovascular, other specific prophylaxis).
See Appendix A for Medication Inclusion / Exclusion Form.
The Grievance Policy Process
BVCOG follows the guidelines established by the Texas Department of State Health Services.The Brazos Valley Council of Governments has established a process for clients to file a grievance against a subcontractor (a.k.a Service Provider). It is the policy of the Brazos Valley Council of Governments to effectively and promptly handle grievances from persons living with HIV/AIDS, or family members and friends acting on behalf of the client, living within the Central Texas HIV Administrative Service Area. If the violation is of a clinical nature, BVCOG’s Clinical Monitor will be involved in the investigation and resolution of the complaint.
The complaining party is first encouraged to utilize the internal grievance procedures of the subcontractor concerning programs funded by the contract. However, the client always has the right to file a grievance directly with BVCOG by phone or in writing via mail, fax, or email.
A grievance may be filed by a complaining party on one or more of the following grounds: improper application of rules, regulations, and procedures (but not the rules, regulations and procedures themselves); unfair or improper treatment; discrimination based on race, religion, color, sex (including sexual harassment), sexual orientation, gender identity, marital status age, disability, or national origin. The complaining party shall not be discriminated against nor suffer retaliation as a result of filing a grievance in good faith, or participating in the investigation of a grievance. See Section §1.05 Client Grievance Process in the BVCOG Policy and Procedure Manual.
Appendix A
Medication Inclusion / Exclusion Form
Service Provider / Subcontractor:Choose an item.
Date of Request:Click here to enter a date.
Medication Name (Generic and / or Name Brand / Code):Click here to enter text.
Named medication recommendation:
☐ Include in formulary list☐ Remove from formulary list
Statement of Need for inclusion / exclusion:Click here to enter text.
Signed:Click here to enter text.Title: Click here to enter text.
Phone:Click here to enter text.Email:Click here to enter text.
Date of Request:Click here to enter a date.
Please forward this form to: Amanda Stearns
Do Not Type Below this Line. For AA and LPAP Board Use only
Date request received and by whom:Click here to enter a date.
Click here to enter text.
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