While for years patient engagement has been seen as a valuable, starting in 2026 this will be a legal mandate.
Plans offering essential health benefits must appoint at least 1 patient representative to their pharmacy and therapeutics (P&T) committees by the start of 2026.1 After July 10, 2026, every state Medicaid program must establish standalone Beneficiary Advisory Councils and ensure that 20% of Medicaid Advisory Committee members are Beneficiary Advisory Council members.2 These requirements dovetail with the Center for Medicare & Medicaid (CMS) expansion of Patient Listening Sessions under the Medicare Drug Price Negotiation.3
A paper by Vandigo et al. (2025) provides some helpful tips on how best to engage with patients. This include:
Create an engagement framework. The framework should define when/how patient experiences will be solicited, how their input will be provided, how their input will be weighted vs. other committee members, and how the impact of their participation will be measured and reported. Get patients up to speed. Provide patients with background on committee structure, scope, the decision-making processes and the the purpose of the P&T committee. Clearly define the patient’s role in this process. Making it easy for patient to participate. Provide plain language summaries of relevant documents. Include clear points in the agenda where patient input will be solicited. Address potential challenges. These include limitations with member contact (e.g., transportation issues, lack of reliable phone), the need for methodologies to integrate lived experience alongside broad expertise; balancing logistics between formal board meetings and ad hoc input; and navigating conflicts of interest.
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