1. Washington’s Prescription Drug Program U sing 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

2. Siri Childs, Pharm D Pharmacy Administrator (formerly) Health and Recovery Services Administration Washington State Department of Social and Health Services Sept 20, 2011 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

3. Siri Childs, Pharm D Pharmacy Administrator (Formerly) Health and Recovery Services Administration Washington State Department of Social and Health Services Sept 20, 2011 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”

4. Siri Childs, Pharm D Pharmacy Administrator, (Formerly) Health and Recovery Administration Washington State Department of Social and Health Services Sept 20, 2011 4 Education 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”)

5. Siri Childs, Pharm D Pharmacy Administrator (Formerly) Health and Recovery Services Administration Washington State Department of Social and Health Services Sept 20, 2011 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 decision makers and P&T Committee members

6. Siri Childs, Pharm D Pharmacy Administrator (Formerly) Health and Recovery Services Administration Washington State Department of Social and Health Services Sept 20,2011 6 Successes Financial: –Preferred drugs: Savings estimated at $46million/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 NSAIDS –Gabapentin: Evidence showed less efficacy than placebo for bipolar disorder –ACEI vs ARBs: Evidence showed similar efficacy and safety at lower cost for ACEI; ARBs dropped from PDL

7. Siri Childs, Pharm D Pharmacy Administrator Health and Recovery Services Administration Washington State Department of Social and Health Services Sept 20, 2011 7 Obstacles Initial prescriber resistance Drug manufacturers’ objections Lack of useful studies State budget

8. Contacts Oregon Health Science University EPC: EPC@OHSU.edu, Marian McDonagh, Pharm D, mcdonagh@ohsu.edu, (503) 494-6487 EPC@OHSU.edu mcdonagh@ohsu.edu Drug Effectiveness Review Project: Centerebp@OHSU.edu, Alison Little, MD, littleal@ohsu.edu, (503) 494-7239 Centerebp@OHSU.edu littleal@ohsu.edu Delfini Group LLC: Delfini@delfini.org, Michael Stuart, MD or Sheri StriteDelfini@delfini.org WA Medicaid Drug Program: http://hrsa.dshs.wa.gov/pharmacy, Charles Agte, agtecd@dshs.wa.gov, (360) 725-1301 http://hrsa.dshs.wa.gov/pharmacyagtecd@dshs.wa.gov Siri Childs, Pharm D Pharmacy Administrator (Formerly) Health and Recovery Services Administration Washington State Department of Social and Health Services Sept 20,2011 8

9. Questions? For more information: Siri Childs, Pharm D PharmD1@comcast.net (360) 866-0251 Siri Childs, Pharm D PharmacyAdministrator (Formerly) Health and Reoovery Services Administration Washington State Department of Social and Health Services Sept 20,2011 9