There are significant variations among conflict-of-interest policies for state Medicaid drug selection committees, researchers now reveal.

A new examination of policy documents from Medicaid programs shows that current policies to handle conflicts of interest (COIs) are not crystal clear and differ greatly. The findings were published in JAMA Internal Medicine.

The study background revealed that it is important to control COI for formulary drug selections or reimbursement to confirm that drugs are picked according to established information and with no bias, guarding against pharmaceutical industry power.

A group of researchers from the University of California, San Francisco, examined the content of the Medicaid drug selection committees' COI policies for the United States and the District of Columbia. They categorized policies and pointed out the necessities of a strong policy.

The investigators searched Medicaid websites and contacted staff members to find the drug selection COI policies. They were able to obtain documents for 27 programs (56 percent).

To date, not much is known about how financial conflicts are handled among drug selection committees for state reimbursement programs.

The authors wrote:

"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."

In total there were 12 main disclosure points among policies:
  • self-recusal requirement
  • disclosure frequency
  • defined monetary cutoffs
  • enforcement
  • assigned reviewer
  • banned relationships
  • additional management strategies
  • reporting window specified
  • enforcement
  • public availability
  • disclosure requirement
  • immediate family relationships
Disclosure was the most common strategy and was revealed in 67 percent of all the policies reviewed. The second most common strategy was self-recusal, seen in 52 percent of policies. Following that, 41 percent had established monetary cutoffs needed for disclosure.

Out of the states whose policies were reviewed, Washington and Idaho had the strongest policies.

Study limitations included a low response rate, as well as the fact that researchers were unable to analyze compliance with the policies or examine conflicts among drug selection committee members.

The authors suggest that there is a need for a model COI policy for drug selection committees that can be modified by state, especially now that health care and Medicaid are being reformed and expanded.

The authors concluded:

"Current policies to manage COIs on Medicaid drug selection committees are not transparent and vary widely in content, suggesting that some policies may not adequately protect against COIs. Our findings show the need for a model COI policy for drug selection committees that can be adapted for individual states.

A model policy should (1) be publically accessible (2) be comprehensive and provide explicit parameters for disclosure (3) be equally applicable to all committee members (4) include management strategies beyond disclosure and (5) indicate a responsible party for review of COI and enforcement of policies."

Written by Kelly Fitzgerald