1. CER Needs from a state health policy perspective: California Health Benefits Review Program Susan Philip, MPP California Health Benefits Review Program University of California, Office of the President Comparative Effectiveness Research: Methods and Controversies June 18, 2010

2. 2 Outline  Overview of CHBRP  Users of CER  Research translation for state legislators, agency staff  Need for CER for assessing coverage of health benefits or services  Examples

3. 3 What is CHBRP?  Created by law to provide timely, independent, evidence-based information to the Legislature to assist in decision-making  Charged to analyze medical effectiveness, cost, and public health impacts of health insurance benefit mandates or repeals  Administered by the University of California, but institutionally independent  Requested to complete each analysis within 60 days

4. 4 What are benefit mandates and who are affected? Mandates require that health plans or insurers: 1.Offer or provide coverage for the screening, diagnosis, or treatment of a disease or condition. 2.Offer or provide coverage of a type of health care treatment or service, or of medical equipment, supplies, or drugs used in a treatment or service. 3.Offer or provide coverage permitting treatment or services from a type of health care provider. More than 19 million Californians are potentially affected by these proposed benefit mandates

5. 5 Evaluation Criteria  Medical Effectiveness: assesses this based on the best available evidence  Primary use of CER when relevant to the analytic question  Cost Impacts: estimates the incremental or marginal cost of a bill, including changes in health care expenditures, premiums, and out-of-pocket costs  Pubic Health Impacts: estimates the marginal impact of the bill on the health and productivity of Californians. Measures include, morbidity, mortality, disparities and economic burden of the illness.

6. 6 CER Needs: Examples of Bills Related to Coverage of Drugs  AB 1826-Pain Prescriptions: Would prohibit step therapy for pain management drugs.  CER could address: comparative effectiveness of various pain management drugs for specific clinical conditions  SB 961-Cancer Treatment: Would ensure oral chemotherapy drugs have some cost-sharing levels as IV/Injectable chemotherapy  CER could address: comparative effectiveness of various chemotherapy agents for specific cancer diagnoses.

7. 7 Policymaker’s Needs  CER  Cost analysis needs to part of the discussion (CEA)  Long-term impacts, keeping the potential effects of PPACA in mind