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Forum Looks at Successes in MassHealth Pharmacy Program

Forum Looks at Successes in MassHealth Pharmacy Program

November 17, 2009

Community Catalyst, The Massachusetts Health Policy Forum and the Massachusetts Medicaid Policy Institute welcomed Boston’s medical and health policy community on Friday to discuss the MassHealth Prescription Drug Quality and Cost Management program. The forum began with a presentation on the findings of several researchers on implementation of the MassHealth Pharmacy Program . This was followed by a panel discussion of the strategies used to improve drug management and prescriber decision-making. Today’s forum served as an evaluation of MassHealth’s prescription policy changes and helps pave the way for national prescription policy improvements.

More details are below the fold.

The Implementation Report described the changes the MassHealth Pharmacy Program in began in 2001 in response to sky-rocketing prescription drug costs. Since enactment of the new program, prescribing physicians are required to obtain prior authorization to prescribe a number of brand name drugs in place of less expensive generic alternatives. MassHealth partnered with UMass Medical School to gain the expertise of the UMass physicians and clinicians to review the drugs and determine which ones provided the best possible health outcomes at the lowest possible cost.

Dr. Cindy Thomas and Dr. Jeffrey Prottas, both professors at Brandeis University’s Schneider Institutes for Health Policy conducted the evaluation of the MassHealth Pharmacy Program. As a result of implementing the MassHealth Drug List (MHDL) and the prior authorization requirement, the program saved $99 million and $43 million, respectively, in the first year. Furthermore, UMass Medical School’s management of the list gave the program an unparalleled level of clinical expertise and credibility. And while many states accept supplemental rebates from pharmaceutical companies for contracts with Medicaid programs, the authors of the report commended Massachusetts for not accepting rebates until the lists were completed, in order to prevent any outside influence, and potential cost increases, over the MHDL.

The forum also highlighted the process by which MassHealth implemented the new drug program. Massachusetts was able to minimize conflict between various stakeholders by inviting a wide range of advocates, providers and experts into the conversation, and with minimal input from drug manufacturers. These key stakeholders were brought into the clinical review process early on to ensure both the safety of patients as well as the efficacy of the program. Unlike other, less-successful states, Massachusetts was also able to minimize conflict by taking a more staged approach to adding drug classes to the list, focusing on drug that were less controversial first before moving on to more clinically challenging drugs. Both Dr. Thomas and Dr. Prottas deemed the Massachusetts implementation process a success and a model for other states and national cost-containment initiatives.

Following their presentation, four panelists were called to discuss their strategies for drug management and improved prescriber decision-making. Dr. Paul Jeffrey, the Pharmacy Director at MassHealth stressed the importance of getting the best value for the state in terms of safe and cost-effective drugs. Dr. Jerry Avorn, Professor of Medicine at Harvard Medical School and Chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital spoke extensively about academic detailing. Dr. Avorn and his non-profit group, Alosa, want to encourage academic detailing whereby prescribers will be given the most up-to-date and evidence based drug therapy information with which to guide their decision-making.

The audience also heard from panelists Dr. Paul Mendis, the Chief Medical Officer at Neighborhood Health Plan. He discussed the successes of their drug utilization program and highlighted the impact on certain targeted populations whom they were targeting to reduce health disparities. Dr. Alison Little, Medical Director at the Center for Evidence Based Policy at Oregon Health and Science University spoke about DERP. DERP is a program based in Oregon that does research and research synthesis for numerous states on drug comparative effectiveness. This data can then be used by those states to create their drug lists.
-Yelena Kuznetsov