OREGON’S APPROACH TO OREGON’S APPROACH TO PRESCRIPTION DRUGSPRESCRIPTION DRUGS

John Santa, M.D.John Santa, M.D.AdministratorAdministrator

Office of Oregon Health Office of Oregon Health Policy and ResearchPolicy and Research

PrinciplesPrinciples

Focus on health not health servicesFocus on health not health services

Negotiate for valueNegotiate for value

Represent the populationRepresent the population

Insist on a functional marketplaceInsist on a functional marketplace

Creating a Functional MarketCreating a Functional Market

Focus on specific classesFocus on specific classes Provide credible, public, evidence-based Provide credible, public, evidence-based

review of comparative effectiveness within review of comparative effectiveness within the classthe class

Purchase with the evidence in mindPurchase with the evidence in mind Communicate the evidenceCommunicate the evidence Compassion/DisciplineCompassion/Discipline

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

$350,000

$400,000

$450,000

$500,000

Months-1/00 to 6/02

$/Mon

Dollar Market Share

First Four ClassesFirst Four Classes

1. PPIs/heartburn1. PPIs/heartburn—”no significant demonstrable —”no significant demonstrable differences among them”differences among them”

2. Long-acting opioids2. Long-acting opioids—”insufficient evidence to draw —”insufficient evidence to draw any conclusions about the comparative effectiveness”any conclusions about the comparative effectiveness”

3. Statins/cholesterol lowering3. Statins/cholesterol lowering-”evidence supports the -”evidence supports the ability of lovastatin, pravastatin and simvastatin to ability of lovastatin, pravastatin and simvastatin to improve coronary heart disease clinical outcomes.”improve coronary heart disease clinical outcomes.”

4. NSAIDs4. NSAIDs—”no evidence to demonstrate a significant —”no evidence to demonstrate a significant difference in efficacy among COX-2 inhibitors, COX-2 difference in efficacy among COX-2 inhibitors, COX-2 preferential NSAIDs, and non-selective NSAIDs.”preferential NSAIDs, and non-selective NSAIDs.”

PPI: Proton Pump Inhibitor NSAID: non-steroidal anti-inflammatory drugsPPI: Proton Pump Inhibitor NSAID: non-steroidal anti-inflammatory drugs

Individual Flexibility-Individual Flexibility-Emerging ContinuumEmerging Continuum

Physician driven exception processPhysician driven exception process

Information driven prior authorizationInformation driven prior authorization

Reference or tiered copaymentsReference or tiered copayments

Guideline driven prior authorization (hopefully Guideline driven prior authorization (hopefully evidence-based)evidence-based)

Purchasing StrategyPurchasing Strategy

Play your game not theirs—evidence vs. Play your game not theirs—evidence vs. marketing, price vs. rebates, remove/expose marketing, price vs. rebates, remove/expose conflict of interestconflict of interest

Challenge the industry to compete/discloseChallenge the industry to compete/disclose Challenge physicians to do “the right thing”Challenge physicians to do “the right thing” Provide incentives to patients and doctors that Provide incentives to patients and doctors that

promote competitionpromote competition Duck, bob and weaveDuck, bob and weave

Other OptionsOther Options

““Preferred Pharmacies”Preferred Pharmacies”

Tiered copayments for optional populationsTiered copayments for optional populations

Collaborative purchasingCollaborative purchasing

Disease managementDisease management

Next Steps Next Steps

States collaborate on evidence-based States collaborate on evidence-based reviews—reduce costs, speed the reviews—reduce costs, speed the process, updates, share findingsprocess, updates, share findings

Encourage the use of AHRQ Evidence-Encourage the use of AHRQ Evidence-based Practice Centers, Cochrane based Practice Centers, Cochrane Collaborative groupsCollaborative groups

Communicate the evidenceCommunicate the evidence

More Information More Information

Records of process at Records of process at www.ohpr.state.or.uswww.ohpr.state.or.us

Reports at oregonrx.orgReports at oregonrx.org Email comments/questions to Email comments/questions to

rxhelp@state.or.usrxhelp@state.or.us State officials call John Santa at State officials call John Santa at

(503) 378-2422 x401(503) 378-2422 x401