Articles/Links: Evidence-Based Reviews in State Policy

• A Consumer-Driven Healthcare Cost Control Agenda Authors: Health Care For All and The Prescription Project - June 2007
  Publication: Journal of Ambulatory Care Management
  Health Care For All has drafted comprehensive legislation to control healthcare costs in Massachusetts. The bill, introduced by Senator Mark Montigny and Representative James Marzilli, encompasses 16 provisions that attack the problem of growing healthcare costs from a consumer perspective. We reject proposals that seek to reduce costs by imposing greater expenses on patients, such as high deductible “consumer-directed” plans, or higher copayments or coinsurance. Rather, we support fundamental reforms in financial incentives and care management that both improve quality and reduce costs.We see the ideas in this article and the legislation as the start of a new cost control conversation, not the conclusion. We invite discussion and feedback on our suggestions and encourage others to enter this conversation.READ MORE »
• State Efforts to Manage the Behavioral Health Pharmaceutical Benefit Authors: D. Bergman, N. Kaye, J. Hoadley, and J. Crowley - March 2006
  Publication: National Academy for State Health Policy
  This National Academy for State Health Policy issue brief analyzes state efforts to control the cost of drugs used to treat mental illness. Behavioral health drugs consume up to 20% of state Medicaid expenditures; of greatest concern are antipsychotics and second generation antidepressants. The article describes the Missouri Mental Health Medicaid Pharmacy Partnership Program which the authors find to be both well received by key stakeholders and cost effective, saving Missouri $7.7 million annually in state Medicaid expenditures.
• Understanding Key features of the Drug Effectiveness Review Project (DERP) and Lessons for State Policy Makers Authors: J. Hoadley, J. Crowley, D. Bergman and N. Kaye - March, 2006
  Publication: Issue Brief, National Academy for State Health Policy (N.A.S.H.P)
  This National Academy for State Health Policy issue brief is a good overview of the Drug Effectiveness Review Project (DERP) including structure, decision making process, membership, review process, interactions with pharmaceutical manufacturers, the importance of transparency, and the roles of states. In addition the article provides responses to several key policy questions in regards to the DERP.
• Using Clinical Evidence to Manage Pharmacy Benefits: Experiences of Six States Authors: D. Bergman, J, Hoadley, N. Kaye, J. Crowley and M. Hostetter - March 2006
  Publication: The Commonwealth Fund Issue Brief
  This Commonwealth Fund report examines six state efforts to control pharmacy spending while ensuring beneficiary access to needed medication. The article focuses on the use of clinical evidence and preferred drug lists (PDL) used by the states of California, Florida, Kansas, Michigan, Missouri and Washington. The reports include information about the composition and processes used by Pharmaceutical and Therapeutics (P&T) committees in these states. The "Prior Approval” process is discussed, including its role in mandatory vs. voluntary PDLs. The role and impact of the Drug Effectiveness Review Project (DERP) is discussed as well as controls over the cost of behavioral health pharmaceuticals, spotlighting the Missouri Mental Health Medicaid Pharmacy Program.
• State Medicaid Outpatient Prescription Drug Policies: Findings from a National Survey Authors: J. S. Crowley, D. Ashner, and L. Elam - October, 2005
  Publication:Kaiser Commission on Medicaid and the Uninsured
  This report summarizes the results of a 2005 survey conducted by the Kaiser Commission on Medicaid and the Uninsured regarding efforts to control Medicaid prescription drug spending in thirty-six states and District of Columbia. Data is provided on strategies including the use of dispensing limits, Preferred Drug Lists (PDLS), Prior Authorization (PA), generic substitution, cost sharing, management of patients with high costs, drug purchasing, and the possible impact on Medicaid because of Medicare prescription drug coverage. Numerous charts are presented as well as state-by-state tables,
• The Use of Oregon's Reviews for Medicaid Pharmacy Policies: Experiences in Four States Authors: R. Padrez, T. Carino, J. Blum, and D. Mendelson - May, 2005
  Publication: The Kaiser Commission on Medicaid and the Uninsured
  This Kaiser Commission on Medicaid and the Uninsured report describes how states use the research and reports developed by the Drug Effectiveness Review Project (DERP) to develop pharmacy policies for state Preferred Drug Lists (PDL). Four states are examined: Washington and Wyoming, which use the DERP reports as the primary basis for the clinical recommendations for their state's PDL; Minnesota, which uses DERP reports in conjunction with other sources ( First Health Services Corporation and a multi-state purchasing pool); and the North Carolina Medicaid program, which only uses DERP reviews as the basis for a provider educational tool called the Community Care of North Carolina Prescription Advantage List (PAL).
• Stretching State Health Care Dollars: Pooled and Evidence Based Pharmaceutical Purchasing Authors: S. Silow-Carroll, and T. Alteras - October, 2004
  Publication: The Commonwealth Fund
  This Commonwealth Fund report provides an overview of states' efforts to control pharmaceutical costs not only for Medicaid but other state funded programs including employee health plans. Initiatives discussed include multistate purchasing and collaborations, intrastate purchasing, state negotiated discounts, drug-only benefits, evidence-based Preferred Drug Lists (PDLs) and supplemental rebates. Using both profiles and snapshots, the article highlights efforts in several states including the National Medicaid Pooling Initiative (NMPI - Vermont, Michigan, Alaska, Nevada, New Hampshire), Rx Issuing States (RXIS- West Virginia, Missouri, New Mexico, and Delaware), the DERP, Maine Rx Plus, Minnesota Multistate Contracting Alliance for Pharmacy (MMCAP used by 41 states) and reimportation of pharmaceuticals by states.
• Benefits And Risks Of Increasing Restrictions On Access To Costly Drugs In Medicaid Author: S.B. Soumerai- January 1, 2004
  Publication: Health Affairs
  States are reacting to increased Medicaid drug costs by implementing a variety of cost-control policies that have the potential to undermine patient care, especially for vulnerable populations. This article addresses potential risks associated with these Medicaid policies, including overly restrictive PDLs and PA processes; PDLs developed on the basis of price and supplemental rebates rather than evidence-based criteria; limits on the number of prescriptions that can be filled without PA, inappropriate “fail first” requirements; and drug category reimbursement exclusions. The author finds that there are few well designed studies of the impact of these policies and recommends development of evidence-based principles to guide policymakers in the development of approaches that maximize benefits and minimize risks to patients.