Affordable, quality health care. For everyone.

Using Clinical Evidence to Manage Pharmacy Benefits: Experiences of Six States


Medicaid agencies report that pharmacy costs are a major driver of overall program spending growth. Many states believe that clinical evidence can be used to curtail pharmacy costs while ensuring beneficiary access to needed prescription drugs. In 2004, researchers from the National Academy for State Health Policy (NASHP) and Georgetown University conducted site visits to examine how state Medicaid agencies in California, Florida, Kansas, Michigan, Missouri, and Washington manage their pharmacy benefits. This brief focuses on states' use of clinical evidence and preferred drug lists. It summarizes the states' experiences in four areas of pharmacy benefit management: the role of pharmaceutical and therapeutics committees in developing preferred drug lists; use of prior approval processes to enforce preferred drug lists; the role played by the Drug Effectiveness Review Project in helping states manage drug utilization; and the management of behavioral health pharmaceuticals.

More detailed reports on these four topics are available on the NASHP Web site.

Publication Details

Publication Date: March 1, 2006

D. Bergman, J. Hoadley, N. Kaye, J. Crowley, and M. Hostetter, Using Clinical Evidence to Manage Pharmacy Benefits: Experiences of Six States, The Commonwealth Fund, March 2006


Associate Professor, Stanford University School of Medicine
Senior Research Scholar, Georgetown University's Health Policy Institute
Martha Hostetter
Consulting Writer and Editor, Pear Tree Communications
Jack Hoadley_headshot
Research Professor Emeritus, Health Policy Institute, McCourt School of Public Policy, Georgetown University
Senior Program Director, National Academy for State Health Policy