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Nov 2007
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Life is a Carnival
In the late 1960’s a rock band called the Band released a song titled “Life is a Carnival” that emphasized the individuality of decision making. This song reminds me of certain decisions that I have made over the years in my professional career that at times do not bring reimbursement from a financial perspective. Most recently the best example is my decision to accept an appointment by then Governor Kenny Guinn to serve as Chairman of the Pharmacy and Therapeutics Committee (P and T) for the Medicaid program in 2003. This was a voluntary service that in the initial 6-9 months required monthly meeting always under state open meeting laws, and then eventually a meeting every three months. I believe that it is fair to say that from 2003 until my decision to retire from the P and T Committee in June of 2007 to explore other voluntary activities, I expended 5-10 hours per month in my role as chairman. Over those three plus years I truly loved serving on the committee with an incredible group of individuals that represented the private, managed care and federally funded programs. We all established early into our service the importance of objectivity, integrity to the role and responsibility to the development of a drug formulary that will best meet the needs of the Medicaid population, based upon the current literature and pharmaceutical as well as personal testimony. We also recognized the need to insure that every decision related to the equivalent activity of all medications within all drug classes was vetted prior to making any decision.
Over the past 2-3 years the Nevada Medicaid P and T Committee received local, state and national recognition. The national recognition is something that I am most pleased with due to the acknowledgement of our ability to maintain objectivity in the face of multiple outside forces that can influence decisions related to the selection of drugs for the preferred formulary in a particular state.
Back to “Life is a Carnival,” and the ability to make decisions regarding what we do or do not want to do in our lives. I had the opportunity to fully participate in this decision making process though over 75 percent of my P and T Committee colleagues never had that option. They have recently been informed that their services are no longer required in service to a committee that they truly helped establish for the benefit of Nevada and the Medicaid program. I am not going to question the decision to not renew these members’ appointments because that is an unfamiliar arena for me, and not one which I would ever elect to step within. Though, I am prepared to comment on the potential ramifications of dismissing the majority of any committee or board like function at one time. Anyone that studies the importance of three year staggered appointments recognizes that this is done to maintain consistency and an ongoing knowledge base to ensure consistency.
Without the assurance of future P and T Committee members that will maintain the objectivity, integrity and responsibility to the development and maintenance of a drug formulary that will best meet the needs of the Medicaid population, all that has been gained since 2003 will be in vain. All one has to do is look at the rising cost of medications as a direct cause of rising health care expenditures in order to appreciate the activities of a disciplined Medicaid P and T Committee for the state of Nevada. As citizens we can only wait, watch and track overall drug expenditures in our state for this very difficult population.
These thoughts are based upon years of involvement in the care, financial modeling of services for the Medicare and Medicaid patient population and not intended to question the recent changes in the Nevada Medicaid P and T Committee.
This article was written in collaboration with my wife Joann, the very good listener, thinker and writer. We would enjoy your thoughts and comments. Please contact us at gcnreno@gmail.com)