PhRMA Focuses on Formularies and Coverage

Washington DC-In addition to launching an ad campaign backing adoption of a Medicare drug benefit, PhRMA is expanding its state lobbying efforts to block local prior authorization requirements. As more states face huge shortfalls in Medicaid budgets because of declining revenues and rising healthcare costs, they seek to cut spending on prescriptions. That means more restricted formularies and rebate requirements, with prior authorization imposed on doctors to limit prescribing of therapies that fail to offer sufficiently attractive deals.

Prior authorization now is "the number one issue in the states," comments PhRMA spokesman Jeff Trewitt. The association has launched campaigns to kill such proposals in Georgia, North Carolina, Maryland, Virginia, and Washington as part of its expanded activity in state capitols. The escalating importance of pharmaceutical coverage and payment issues at PhRMA is also seen in its selection of an MD-with expertise in outcomes research and clinical information management instead of R&D-to head the organization's scientific and regulatory affairs department.

John Kelly, the new senior vice-president, hails from Aetna, where he was director of physician relations and previously head of Aetna's information management unit. He also served as the American Medical Association's director of quality and utilization management. In announcing his appointment, PhRMA president Alan Holmer commented that Kelly's expertise in ensuring patient quality care "ties in nicely with PhRMA's goal of ensuring patient access to innovative medicines." With Kelly focused on access and outcomes, PhRMA's involvement in FDA regulatory policy and user fees falls to associate vice-president Alan Goldhammer, while vice-president Alice Till oversees research policy, including clinical standards and manufacturing quality control.