Washington's Prescription Drug Program: Using Systematic Reviews To Make Policy Decisions in the Effort to Contain Prescription Drug Expenditures

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Washington's Prescription Drug Program: Using 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

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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.

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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."

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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").

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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 decisionmakers and P&T Committee members.

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Successes

• Financial:
  • Preferred drugs: Savings estimated at $46 million/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 nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Gabapentin: Evidence showed less efficacy than placebo for bipolar disorder.
  • Angiotensin-converting enzyme inhibitors (ACEI) vs. angiotensin receptor blockers (ARBs): Evidence showed similar efficacy and safety at lower cost for ACEI; ARBs dropped from PDL.

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Obstacles

• Initial prescriber resistance.
• Drug manufacturers' objections.
• Lack of useful studies.
• State budget.

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Contacts

• Oregon Health Science University EPC: EPC@OHSU.edu,
  Marian McDonagh, Pharm D, mcdonagh@ohsu.edu, (503) 494-6487.
• Drug Effectiveness Review Project: Centerebp@OHSU.edu,
  Alison Little, MD, littleal@ohsu.edu, (503) 494-7239.
• Delfini Group LLC: Delfini@delfini.org, Michael Stuart, MD or Sheri Strite.
• WA Medicaid Drug Program: http://hrsa.dshs.wa.gov/pharmacy
  Charles Agte, agtecd@dshs.wa.gov, (360) 725-1301.

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Questions?

For more information:

Siri Childs, Pharm D
PharmD1@comcast.net
(360) 866-0251