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Washington's Prescription Drug Program: Using Systematic Reviews To Make Policy Decisions in the Effort to Contain Prescription Drug Expenditures

Slide presentation from the AHRQ 2011 conference.

Slide 1

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,
Washington State

AHRQ Annual Meeting
Bethesda MD
Sept. 20, 2011

Slide 2

The Background

  • 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.

Slide 3

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."

Slide 4


  • 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").

Slide 5

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.

Slide 6


  • Financial:
    • 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.
  • Clinical:
    • 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.

Slide 7


  • Initial prescriber resistance.
  • Drug manufacturers' objections.
  • Lack of useful studies.
  • State budget.

Slide 8


Slide 9


For more information:

Siri Childs, Pharm D
(360) 866-0251

Page last reviewed October 2014
Internet Citation: Washington's Prescription Drug Program: Using Systematic Reviews To Make Policy Decisions in the Effort to Contain Prescription Drug Expenditures. October 2014. Agency for Healthcare Research and Quality, Rockville, MD.


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