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Oregon's Progressive Prescription Drug Approach for Better Health Outcomes

Explore Oregon's innovative strategy towards prescription drugs, focusing on evidence-based decisions, marketplace functionality, and collaboration for better healthcare. Learn about negotiating for value, advocating for a functional market, and physician-driven exception processes. Discover how Oregon encourages competition and transparency in the pharmaceutical industry for improved patient care.

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Oregon's Progressive Prescription Drug Approach for Better Health Outcomes

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  1. OREGON’S APPROACH TO PRESCRIPTION DRUGS John Santa, M.D. Administrator Office of Oregon Health Policy and Research

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

  3. 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

  4. Dollar Market Share $/Mon Months-1/00 to 6/02

  5. First Four Classes 1. PPIs/heartburn—”no significant demonstrable differences among them” 2. Long-acting opioids—”insufficient 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. NSAIDs—”no 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

  6. Individual Flexibility-Emerging Continuum • Physician driven exception process • Information driven prior authorization • Reference or tiered copayments • Guideline driven prior authorization (hopefully evidence-based)

  7. Purchasing Strategy • Play your game not theirs—evidence 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

  8. Other Options • “Preferred Pharmacies” • Tiered copayments for optional populations • Collaborative purchasing • Disease management

  9. Next Steps • States collaborate on evidence-based reviews—reduce costs, speed the process, updates, share findings • Encourage the use of AHRQ Evidence-based Practice Centers, Cochrane Collaborative groups • Communicate the evidence

  10. More Information • Records of process at www.ohpr.state.or.us • Reports at oregonrx.org • Email comments/questions to rxhelp@state.or.us • State officials call John Santa at (503) 378-2422 x401

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