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 January Rising drug costs capture the attention of state, private sector With drug costs escalating at an alarming rate, state officials are determined to slow down the pace. "I'd like to see the cost of pharmaceuticals reduced so we can spend our dollars other ways," said Dr. Joseph Intile, medical director of the Office of Medical Assistance Programs (OMAP). "The cost of drugs is crippling to any health plan." In fiscal 1998, the state spent $116 million on drugs, a 33% increase over the previous year, and the number of prescriptions grew by 16.4%, according to data released by OMAP in mid-January. "Most major drug companies are spending $10,000 a year on every doctor to promote their products," said Alan Yordy, chairman of the Oregon Health Council and acting CEO of PeaceHealth in Eugene. "It's become the battle of the dollar, and it's difficult for doctors to sort out the real data because of the plethora of drugs on the market." There's one drug rep. Fore every 15-17 doctors, added Dr. Michael Bonazzola, chief medical officer for the United Health Network. Officials are combating drug costs on a variety of fronts. The Public Employees' Benefits Board, for example, plans to develop a common formulary for the 100,000 state employees and their dependents covered by Regence HMO Oregon, Kaiser Permanente, ODS Health Plan or Providence Health Plan, said Dr. Kathleen Weaver, medical director of the Office of the Oregon Health Plan Policy and Research (OHPPR). The PEBB board will produce a composite guide similar to the manual done by the Oregon Medical Association and the Oregon State Pharmacists Association for the major health insurers. Oregon's health care leaders take a critical look An informal group of private citizens has begun an ambitious project to evaluate Oregon's health care system. Three physicians and a former industry executive are spearheading The Oregon Health Assessment Project to identify the strengths and weaknesses of Oregon's highly integrated, managed-care-heavy system. They are: Dr. Ralph Crawshaw, the psychiatrist who played a key role in the Oregon Health Decisions process that provided the philosophical underpinnings of the Oregon Health Plan; Dr. Miles Edwards, a retired Oregon Health Sciences University physician; Dr. John Stull, of Kaiser Permanente; and Stephen A. Gregg, a retired executive who was CEO of Ethix PPO before it was purchased by New York Life in 1994. "There's a sentiment that managed care has exhausted many of its techniques to control costs. So the rhetorical question is: What is the attitude of the community?" Gregg asked. But the foursome is doing more than posing that question. In a process that began in November, the group has interviewed 40-50 health care stakeholders and policy makers, such as OHSU President Peter Kohler and Regence BlueCross BlueShield CEO Donald Sacco as well as political icons Neil Goldschmidt, Mark Hatfield and Gov. John Kitzhaber. In each two-hour interview, Gregg said, the aim was to elicit two or three key ideas on how Oregon's health care system is working. "I don't think there's any rocket science to what we're doing," Gregg said. "It's really a response to a health care climate where there's a lot of expression of dissatisfaction and discomfort with how things are going. I'd frame it as trying to get a more disciplined understanding of the shape of the problems. We're trying to stay away from defining solutions." Hospitals, pharmacists duel over licensing of technicians When a pharmacy technician at Salem Hospital was arrested last summer for stealing and selling pain-killing drugs, the incident highlighted an ongoing debate between pharmacists and the Oregon Assn. of Hospitals and Health Systems. Under Oregon law, technicians, who assist pharmacists in filling prescriptions aren't licensed, but register with the Board of Pharmacy. Yet the board lacks authority to deny or revoke registration for technicians who violate the law or professional standards. "A person can be caught red-handed and can remain a registered technician," said Tom Holt, executive director of the Oregon State Pharmacists Assn. The hospital association opposes licensing technicians, contending it isn't necessary and pharmacists can resolve technician problems with out resorting to more regulation. Advocates squabble over $300,000 tobacco grant Washington County commissioners ended up with the short end of the stick when tobacco prevention dollars were doled out by the Oregon Health Division. That's left a bad sting in the mouths of other county health officials, who fear the same thing could happen to them. "It's critical to keep county health departments in the loop," said Linda Fleming, executive director of the Coalition of Local Health Officials. But some observers believe Washington County jinxed itself by withdrawing as the fiscal agent for the $300,000 tobacco prevention grant last fall. "It's like a divorce, there are bad feelings for a while, then you move on," said Diane Laughter, who worked for Washington County as tobacco prevention coordinator, but was laid off when the commissioners turned back the money. Since then, she's been hired, in the same capacity, by the American Lung Association of Oregon to run Washington County's Tobacco Prevention and Education Program. Providence Health System donated the office space. "There are hard feelings now, but we're hoping to partner with the health department. They're a very important part of what we're doing." The saga began when Jane Moore and Clay Parton, who both work on tobacco prevention for the Health Division, informed Washington County Commissioners they could only keep the $300,000 grant if they lobbied businesses to adopt smoke-free work environments, said Susan Irwin, who runs Washington County's Health Department. The commissioners objected. Instead, they suggested the county split the money and handle prevention activities, while the Health Division did the advocacy work. But Moore rejected that idea, according to Irwin. A suggestion to coordinate efforts with Clackamas County also fell on deaf ears. "Many other counties said they wouldn't consider passing smoke-free ordinances, but weren't as open about it as we were," Irwin said. "Certainly the board supports non-smoking environments. Commissioner Brian's been at the forefront of tobacco efforts. His legislative record proves that." Also in this issue...
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