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Causes of and Potential Solutions to the High Cost of Health Care

Oregon's Approach to Prescription Drugs

On October 10, 2003, John Santa, M.D., made a presentation in a Web-Assisted Audioconference at Session 3, which was entitled Designing Pharmacy Benefits to Improve Quality and Contain Costs.

This is the text version of Dr. Santa's slide presentation. Select to access the PowerPoint® Slides (1.1 MB).

Oregon's Approach to Prescription Drugs

John Santa, M.D.
Office of Oregon Health Policy and Research

Slide 1


  • Focus on health not health services.
  • Negotiate for value.
  • Represent the population.
  • Insist on a functional marketplace.

Slide 2

Creating a Functional Market

  • Focus on specific classes.
  • Provide credible, public, evidence-based review of comparative effectiveness within the class.
  • Purchase with the evidence in mind.
  • Communicate the evidence.
  • Compassion/Discipline.

Slide 3

Graph depicting the market share of several drugs from the beginning of 2000 until June of 2002. While some drugs remain low and steady at under 50,000 dollars per month, a few rise quickly to over 400,000 dollars per month.

Slide 4

First Four Classes

  1. Proton Pump Inhibitors/heartburn—"no significant demonstrable differences among them."
  2. Long-acting opioids—"insufficient evidence to draw any conclusions about the comparative effectiveness."
  3. Statins/cholesterol lowering—evidence supports the ability of lovastatin, pravastatin and simvastatin to improve coronary heart disease clinical outcomes."
  4. Non Steroidal Anti-Inflammatory Drugs—no evidence to demonstrate a significant difference in efficacy among COX-2 inhibitors, COX-2 preferential NSAIDs, and non-selective NSAIDs."

Slide 5

Individual Flexibility-Emerging Continuum

  • Physician driven exception process.
  • Information driven prior authorization.
  • Reference or tiered copayments.
  • Guideline driven prior authorization (hopefully evidence-based) Purchasing Strategy.

Slide 6

Purchasing Strategy

  • Play your game not theirs—evidence vs. marketing, price vs. rebates, remove/expose conflict of interest.
  • Challenge the industry to compete/disclose.
  • Challenge physicians to do "the right thing."
  • Provide incentives to patients and doctors that promote competition
  • Duck, bob and weave.

Slide 7

Other Options

  • "Preferred Pharmacies."
  • Tiered copayments for optional populations.
  • Collaborative purchasing.
  • Disease management.

Slide 8

Next Steps

  • States collaborate on evidence-based reviews—reduce costs, speed the process, updates, share findings.
  • Encourage the use of AHRQ Evidence-based Practice Centers, Cochrane Collaborative groups.
  • Communicate the evidence.

Slide 9

More Information

  • Records of process at
  • Reports at
  • Email comments/questions to
  • State officials call John Santa at (503) 378-2422 x401.

Return to Audioconference

Current as of July 2003

Internet Citation:

Oregon's Approach to Prescription Drugs. Slide Presentation by John Santa, at Web-Assisted Audioconference, "Causes of and Potential Solutions to the High Cost of Health Care." Agency for Healthcare Research and Quality, Rockville, MD.

Return to Audioconference>

The information on this page is archived and provided for reference purposes only.

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