OREGONS APPROACH TO PRESCRIPTION DRUGS

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OREGONS APPROACH TO PRESCRIPTION DRUGS

• John Santa, M.D.
• Administrator
• Office of Oregon Health Policy and Research

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Principles

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

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Creating a Functional Market

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

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Dollar Market Share
/Mon
Months-1/00 to 6/02
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First Four Classes

• 1. PPIs/heartburnno significant demonstrable
  differences among them
• 2. Long-acting opioidsinsufficient 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. NSAIDsno 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

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Individual Flexibility-Emerging Continuum

• Physician driven exception process
• Information driven prior authorization
• Reference or tiered copayments
• Guideline driven prior authorization (hopefully
  evidence-based)

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Purchasing Strategy

• Play your game not theirsevidence vs. marketing,
  price vs. rebates, remove/expose conflict of
  interest
• Challenge the industry to compete/disclose
• Challenge physicians to do the right thing
• Provide incentives to patients and doctors that
  promote competition
• Duck, bob and weave

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Other Options

• Preferred Pharmacies
• Tiered copayments for optional populations
• Collaborative purchasing
• Disease management

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Next Steps

• States collaborate on evidence-based
  reviewsreduce costs, speed the process, updates,
  share findings
• Encourage the use of AHRQ Evidence-based Practice
  Centers, Cochrane Collaborative groups
• Communicate the evidence

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More Information

• Records of process at www.ohpr.state.or.us
• Reports at oregonrx.org
• Email comments/questions to rxhelp_at_state.or.us
• State officials call John Santa at
• [phone] x401