How we evaluate
care options


A holistic approach

We believe that a holistic approach to care, one that used evidence-based medicine and considers the full impact of a given care decision, is instrumental to improving members’ health and ensuring that patients have access to the medications they need while still controlling pharmacy costs. Our pharmacy clinical policies, established by our pharmacy and therapeutics committee (P&T),

use evidence-based medicine principles to carefully evaluate the clinical science and published literature to guide decisions on formulary design, prior authorization criteria, and step therapy programs. In doing so, we maximize clinical benefit, avoid clinically inferior drugs, minimize patient exposure to unnecessary health risk, and reduce waste.


The IngenioRx P&T Committee

All clinical criteria are developed to help guide clinically appropriate use of drugs and therapies and are reviewed and approved by the IngenioRx Pharmacy and Therapeutics (P&T) Committee. The P&T Committee is an independent and external committee including practicing physicians, pharmacists, and clinicians from leading academic medical centers and clinical practices with expertise in evidence-based medicine. All major clinical specialties are represented. The P&T Committee normally meets four times a year to review evidence related to the safety and efficacy of drugs, biologics, and devices.

The P&T reviews include, but are not limited to: FDA approved indications, information provided in major peer reviewed publications, recommendations by recognized experts or leading medical centers, and treatment guidelines. Once efficacy, safety, health outcomes, and comparison to other drugs are known, the clinical value is determined for each drug and is used to inform formulary status, tiering, prior authorization, and step therapy decisions.

View our clinical criteria. If you have questions or feedback, please email us.