The background

1. Washington’s Prescription Drug ProgramUsing systematic reviews to make policy decisions in the effort to contain prescription drug expenditures Siri Childs,Pharm DPharmacy Administrator, (Formerly) Health and Recovery Services Administration, Washington State AHRQ Annual Meeting Bethesda MD 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. 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. 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. 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. 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. 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 • 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

9. Questions? For more information: Siri Childs, Pharm D PharmD1@comcast.net (360) 866-0251