oregon’s approach to prescription drugs john santa, m.d. administrator office of oregon health...
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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
[email protected]@state.or.us State officials call John Santa at State officials call John Santa at
(503) 378-2422 x401(503) 378-2422 x401