W hi t St tW hi t St tWashington StateWashington StatePrescription Drug ProgramPrescription Drug ProgramPrescription Drug ProgramPrescription Drug Program

May 20 2009May 20 2009May 20, 2009May 20, 2009Donna L. Sullivan, PharmD, MSDonna L. Sullivan, PharmD, MS

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SB 6088SB 6088SB 6088SB 6088

Evidence Based Prescription Drug ProgramEvidence Based Prescription Drug ProgramSenior Prescription Discount Card ProgramSenior Prescription Discount Card ProgramSenior Prescription Discount Card ProgramSenior Prescription Discount Card ProgramPharmacy Connections ProgramPharmacy Connections Program

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Evidenced Based PrescriptionEvidenced Based PrescriptionEvidenced Based Prescription Evidenced Based Prescription Drug ProgramDrug Programg gg g

Shall establish P&T committeeShall establish P&T committeeMay establish a Preferred Drug ListMay establish a Preferred Drug ListShall adopt rules governing practitionerShall adopt rules governing practitionerShall adopt rules governing practitioner Shall adopt rules governing practitioner endorsement, therapeutic substitution, and endorsement, therapeutic substitution, and

f f d if f d iuse of a Preferred Drug Listuse of a Preferred Drug List

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Washington State P&T CommitteeWashington State P&T Committee

Committee CompositionCommittee Composition–– No more than 51% or less than 31% Physicians or PharmacistsNo more than 51% or less than 31% Physicians or Pharmacistsyy–– FPs, IM, Mental HealthFPs, IM, Mental Health–– Out patient practiceOut patient practice–– Location (rural representation)Location (rural representation)

Statewide P&T Committee appointed July 15, 2003Statewide P&T Committee appointed July 15, 20034 MD/DO’4 MD/DO’–– 4 MD/DO’s4 MD/DO’s

–– 4 Pharmacists4 Pharmacists–– 2 other health care practitioners2 other health care practitioners2 other health care practitioners2 other health care practitioners

Committee will also serve as MAA Drug Utilization Committee will also serve as MAA Drug Utilization Review BoardReview Board

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Preferred Drug ListPreferred Drug ListPreferred Drug ListPreferred Drug List

Implementation Implementation –– PDL January 1, 2004PDL January 1, 2004PDL January 1, 2004PDL January 1, 2004–– TIP May 1, 2004TIP May 1, 2004

30 classes have been reviewed30 classes have been reviewed

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Practitioner Endorsement Practitioner Endorsement –– Therapeutic Therapeutic InterchangeInterchange

““Any pharmacist filling a prescription under a state purchased Any pharmacist filling a prescription under a state purchased health care program as defined in RCW 41.05.011(2) shall health care program as defined in RCW 41.05.011(2) shall

b tit t h id tifi d f d d fb tit t h id tifi d f d d fsubstitute, where identified, a preferred drug for any substitute, where identified, a preferred drug for any nonpreferred drug in a given therapeutic class, unless the nonpreferred drug in a given therapeutic class, unless the endorsing practitioner has indicated on the prescription thatendorsing practitioner has indicated on the prescription thatendorsing practitioner has indicated on the prescription that endorsing practitioner has indicated on the prescription that the nonpreferred drug must be dispensed as written, or the the nonpreferred drug must be dispensed as written, or the prescription is for a refill of an antipsychotic, prescription is for a refill of an antipsychotic, antidepressant, chemotherapy, antiretroviral, or antidepressant, chemotherapy, antiretroviral, or imunosuppressive drug, in which case the pharmacist shall imunosuppressive drug, in which case the pharmacist shall dispense the prescribed nonpreferred drugdispense the prescribed nonpreferred drug””dispense the prescribed nonpreferred drugdispense the prescribed nonpreferred drug

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Preferred Drug Selection ProcessPreferred Drug Selection ProcessPreferred Drug Selection ProcessPreferred Drug Selection Process

DERPDERP–– http://www.ohsu.edu/ohsuedu/research/policycenter/DERP/index.cfmhttp://www.ohsu.edu/ohsuedu/research/policycenter/DERP/index.cfm

Literature ReviewLiterature ReviewP&T Committee MeetingP&T Committee MeetingP&T Committee MeetingP&T Committee MeetingCost AnalysisCost AnalysisAgency ApprovalAgency ApprovalI l t tiI l t tiImplementationImplementation

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DERPDERPDERPDERPP i i i OP i i i O A kA kParticipating OrgParticipating Org

–– 16 public entities16 public entities–– Finance projectFinance project–– Select Drug ClassesSelect Drug Classes

ArkansasArkansasCanadian Agency for Drugs and Canadian Agency for Drugs and Technologies in HealthTechnologies in HealthColoradoColoradoSelect Drug ClassesSelect Drug Classes

Center for EvidenceCenter for Evidence--Based PolicyBased Policy–– Administer the projectAdminister the project

EBPCEBPC

ColoradoColoradoIdahoIdahoKansasKansasMichiganMichigan

–– OHSU & UNCOHSU & UNC–– Key QuestionsKey Questions–– Systematic ReviewsSystematic Reviews

Draft ReportsDraft Reports

MichiganMichiganMinnesotaMinnesotaMissouriMissouriMontanaMontana–– Draft ReportsDraft ReportsNorth CarolinaNorth CarolinaNew YorkNew YorkOregonOregonWashingtonWashingtonWisconsinWisconsinWyomingWyoming

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Literature ReviewLiterature ReviewLiterature ReviewLiterature ReviewKey Questions Key Questions –– to focus the review to focus the review Evidence Tables Evidence Tables –– detailing what research was used in the detailing what research was used in the reviewreviewreview review Draft Report Draft Report –– draft of reviewdraft of review -- only posted for public only posted for public commentary during public comment review period commentary during public comment review period y g p py g p pFinal Report Final Report –– final version of systematic review that final version of systematic review that incorporates or considers public commentary incorporates or considers public commentary Executive Summary Executive Summary –– brief summary of final review brief summary of final review (proprietary) (proprietary) P & T Committee Briefs (Proprietary)P & T Committee Briefs (Proprietary)P & T Committee Briefs (Proprietary) P & T Committee Briefs (Proprietary) Power Point Presentation (Proprietary Power Point Presentation (Proprietary

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P&T Committee MeetingsP&T Committee MeetingsP&T Committee MeetingsP&T Committee Meetings

Open Public MeetingsOpen Public MeetingsReview of the EvidenceReview of the EvidenceReview of the EvidenceReview of the EvidencePublic TestimonyPublic TestimonyRecommendationRecommendation

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P&T Committee RecommendationP&T Committee RecommendationP&T Committee RecommendationP&T Committee Recommendation

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Cost AnalysisCost AnalysisCost AnalysisCost AnalysisS l l R bS l l R bSupplemental RebatesSupplemental RebatesDataData

N Cl 6 thN Cl 6 th–– New Class 6 monthsNew Class 6 months–– Review of Class 12 monthsReview of Class 12 months

Status IndicatorsStatus IndicatorsStatus IndicatorsStatus IndicatorsLowest net cost to the State of WashingtonLowest net cost to the State of Washington–– Cost/Unit * Unit/Day = Average Daily CostCost/Unit * Unit/Day = Average Daily CostCost/Unit Unit/Day Average Daily CostCost/Unit Unit/Day Average Daily Cost

AssumptionsAssumptions–– SwitchingSwitchinggg–– PA requestsPA requests

Product SelectionProduct Selection14

Status IndicatorsStatus IndicatorsStatus IndicatorsStatus Indicators

StatusStatus Description Description

11 M t dd (P&T)M t dd (P&T)11 Must add (P&T)Must add (P&T)

22 May add to PDLMay add to PDL22 May add to PDLMay add to PDL

33 MultiMulti--source brands not eligible on PDLsource brands not eligible on PDLgg

44 Do not add for safety concerns (P&T)Do not add for safety concerns (P&T)

55 Add with conditions (P&T)Add with conditions (P&T)

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Sample Cost AnalysisSample Cost AnalysisSample Cost AnalysisSample Cost Analysis

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Scenario EvaluationScenario Evaluation

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Final RecommendationFinal Recommendation

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Final Recommendation Cont’dFinal Recommendation Cont’d

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ImplementationImplementationwww.rx.wa.govwww.rx.wa.gov

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Questions?Questions?Questions?Questions?

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