Some state policies may not protect Medicaid drug selection decisions against conflicts of interests and industry influence, according to a study published today by JAMA Internal Medicine.

The study's authors found that conflict-of-interest policies vary among the state committees that make decisions about what drugs are included on a state's formulary.

Thirty-three percent of the states had written policies, while seven states did not address conflicts of interest at all in their drug-selection policy documents. The most common management strategy among states was to require committee members to disclose possible conflicts of interests to committee administrators. About two-thirds of states currently have this requirement.

“The absence of publicly available policies illustrates a lack of transparency about how [conflicts of interest] are managed,” they wrote. “Identification of policies was further complicated by the fact that not all states have designated committees that make their drug selection decisions. Improving public access to policies can increase transparency and public trust in the drug selection process.”

The authors recommend that a model policy should be developed and made available to states, a step they said would be likely to increase transparency.

More states have started to move to managed-care plans, which often subcontract drug selection decisions to pharmacy benefit managers, as a result of the healthcare reform law and ongoing financial pressures, according to a separate commentary also published today.

This can reduce the risk that conflicts of interests may influence drug selection and add costs to the program. However, the author noted that there are still transparency issues with this model.

“The large scope, use of public funds, and the vulnerability of the population served all made the decisions by Medicaid (pharmacy and therapeutics) committees particularly important,” wrote Dr. Nirav Shah, New York's state commissioner of health.

(This story has been updated to correct the name of the publication.)