How States Are Using Clinical Evidence to Manage Pharmacy Benefits

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<p>In 2004, state Medicaid programs spent nearly $40 billion on prescription drugs; that's roughly 19 percent of prescription drug spending nationally. Many states believe that using clinical evidence about the effectiveness of specific drugs or classes of drugs can curtail pharmacy costs, while at the same time ensure that beneficiaries have access to needed medications.<br><br>In <a href="/cnlib/pub/enews_clickthrough.htm?enews_item_id=21370&return_url=http%3A%2F%2Fwww%2Ecmwf%2Eorg%2Fpublications%2Fpublications%5Fshow%2Ehtm%3Fdoc%5Fid%3D362300%26%23doc362300">Using Clinical Evidence to Manage Pharmacy Benefits: Experiences of Six States,</a> a new Commonwealth Fund issue brief, researchers from the National Academy for State Health Policy (NASHP) and Georgetown University provide an overview of how six state Medicaid agencies are managing their pharmacy benefit. The brief summarizes the states' experiences in the following areas:<br><br><ul><li>The role of pharmaceutical and therapeutics committees convened by Medicaid agencies in developing preferred drug lists.</li><li>The use of prior approval processes in managing pharmacy benefits and enforcing preferred drug lists.</li><li>The Drug Effectiveness Review Project, a subscription service that provides comparative reviews of drug effectiveness to states.</li><li>Management of behavioral health pharmaceuticals.</li></ul><br><br>For those states seeking to apply clinical evidence to coverage decisions, the authors advise officials to: use only comprehensive, high-quality clinical evidence; involve practicing clinicians and local opinion leaders in the process; and ensure that beneficiaries needing access to non-preferred drugs are able to obtain them when medically necessary.</p>