R414-60B-7. Clinical and Cost-Related Factors


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  •   The P&T Committee shall base its determinations on the following factors as established by the DURB:

      (1) If clinical and therapeutic considerations are substantially equal, then the P&T Committee shall recommend to DMHF that it consider only cost.

      (2) In making its recommendations to DMHF, the P&T Committee may also consider whether the clinical, therapeutic effects, and medical necessity requirements justify the cost differential between drugs within a therapeutic class.