OREGON’S APPROACH TO PRESCRIPTION DRUGS John Santa, M.D. Administrator Office of Oregon Health Policy and Research

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

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

Months-1/00 to 6/02 $/Mon Dollar Market Share

First Four Classes 1. PPIs/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. NSAIDs—”no evidence to demonstrate a significant difference in efficacy among COX-2 inhibitors, COX-2 preferential NSAIDs, and non-selective NSAIDs.” PPI: Proton Pump Inhibitor NSAID: non-steroidal anti-inflammatory drugs

Individual Flexibility- Emerging Continuum Physician driven exception process Physician driven exception process Information driven prior authorization Information driven prior authorization Reference or tiered copayments Reference or tiered copayments Guideline driven prior authorization (hopefully evidence-based) Guideline driven prior authorization (hopefully evidence-based)

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

Other Options “Preferred Pharmacies” “Preferred Pharmacies” Tiered copayments for optional populations Tiered copayments for optional populations Collaborative purchasing Collaborative purchasing Disease management Disease management

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

More Information Records of process at Records of process at Reports at oregonrx.org Reports at oregonrx.org comments/questions to comments/questions to State officials call John Santa at State officials call John Santa at (503) x401 (503) x401