Washington's Prescription Drug Program: Using Systematic Reviews To Make Policy Decisions in the Effort to Contain Prescription Drug Expenditures
Washington's Prescription Drug Program: Using Systematic Reviews to Make Policy Decisions in the Effort to Contain Prescription Drug Expenditures
Siri Childs, Pharm D
Pharmacy Administrator, (Formerly) Health and Recovery Services Administration,
AHRQ Annual Meeting
Sept. 20, 2011
- October 2002: Washington signed original contract with Oregon Health Sciences University's (OHSU) Evidence-based Practice Center (EPC).
- October 2003: Washington was one of 15 participating entities—including 13 other Medicaid States—in Oregon's Drug Effectiveness Review Project.
- Systematic reviews of the literature assisted evidence-based selections for a state Preferred Drug List (PDL) and Medicaid's Drug Utilization Review Program.
How It Worked
- OHSU EPC provided the "evidence" via the drug-class reports to Washington Pharmacy and Therapeutics (P&T) Committee.
- P&T Committee made recommendations to the agencies to make local decisions.
- Actualization of Gov. Kitzhaber's Project Slogan, "Globalized evidence, localized decision-making."
- OHSU EPC faculty trained P&T Committee members on the basics of systematic reviews comparing the safety, efficacy and effectiveness of drugs in the drug class reviews.
- Delfini Group, LLC taught Washington agency staff and P&T Committee members how to read studies including evidence tables and how to interpret the quality of the evidence (only fair to good studies considered "useful").
Key Factors to Success
- Enabling legislation:
- State Senate Bill 6088 was passed by the 2003 Legislature to mandate an evidence-based Preferred Drug List for state agencies purchasing drugs for Washington residents and the formation of a P&T Committee.
- Credible research: OHSU EPC and the Drug Effectiveness Project.
- Continuing education: Delfini Group LLC conduct annual training to state agency decisionmakers and P&T Committee members.
- Preferred drugs: Savings estimated at $46 million/year.
- Supplemental rebates: Savings estimated at $6.6 million/year.
- Pharmacy spend as a percent of Medicaid spend: Dropped 3.4% from FY 2005 to FY 2008.
- Drug Utilization Review: Savings estimated at $24 million per year from targeted drug initiatives in the prior authorization program.
- Vioxx: Evidence showed safety concerns; COX IIs not any more safe than older less expensive nonsteroidal anti-inflammatory drugs (NSAIDs).
- Gabapentin: Evidence showed less efficacy than placebo for bipolar disorder.
- Angiotensin-converting enzyme inhibitors (ACEI) vs. angiotensin receptor blockers (ARBs): Evidence showed similar efficacy and safety at lower cost for ACEI; ARBs dropped from PDL.
- Initial prescriber resistance.
- Drug manufacturers' objections.
- Lack of useful studies.
- State budget.
- Oregon Health Science University EPC: EPC@OHSU.edu,
Marian McDonagh, Pharm D, firstname.lastname@example.org, (503) 494-6487.
- Drug Effectiveness Review Project: Centerebp@OHSU.edu,
Alison Little, MD, email@example.com, (503) 494-7239.
- Delfini Group LLC: Delfini@delfini.org, Michael Stuart, MD or Sheri Strite.
- WA Medicaid Drug Program: http://hrsa.dshs.wa.gov/pharmacy
Charles Agte, firstname.lastname@example.org, (360) 725-1301.
For more information:
Siri Childs, Pharm D