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Developing Prioritization Criteria to Identify Target Drugs for CalRx, the California Generic Drugs Initiative

Published:November 12, 2022DOI:https://doi.org/10.1016/j.jval.2022.11.004

      Highlights

      • In January 2020, Governor Gavin Newsom announced the creation of CalRx, a California-sponsored generic drug label. CalRx aims to lower prices and increase access to pharmaceuticals in California. The question became how to establish criteria to identify priority drugs for CalRx.
      • This article describes the development of prioritization criteria to CalRx based on a review of the literature and a ranking exercise with key stakeholders. We found that drugs that treat large populations, drugs that represent large costs to payors, and drugs that represent large costs to consumers should be the priority for California’s CalRx generic drug initiative.
      • By detailing the collaborative process involved in developing the CalRx prioritization criteria, this article models inclusive policy design and implementation in public health decision making. The final set of criteria identified can also help inform prioritization efforts for future initiatives targeting prescription drugs at the state level and beyond.

      Abstract

      Objectives

      This study aimed to establish criteria to identify priority drugs for CalRx, a California-sponsored initiative to support the manufacture and distribution of affordable generic drugs.

      Methods

      A web-based ranking exercise was implemented with key stakeholders in August 2020, using pricing, spending, and public health criteria identified through a review of academic literature and public health agency reports. A total of 39 of 40 invited stakeholders in 4 different categories—patient advocates, healthcare providers, health insurers, and health policy and economic experts—participated in this study (98% response rate).

      Results

      Drugs that treat large populations, drugs that represent high cost to payors, and drugs that represent high cost to consumers were ranked a priority, receiving > 10% of ranking weights. Drugs that treat conditions with high morbidity or mortality, drugs without therapeutic alternatives, and drugs treating vulnerable populations represented criteria of further interest (9%-10% of weights). Shortage risk and curative effect (8%-9% of the weights), high price increases, communicable disease treatments, and high unit prices (< 8% of the weights) represented the bottom of the priority distribution.

      Conclusions

      This study suggests that drugs that treat large populations, drugs that represent large costs to payors, and drugs that represent large costs to consumers should be the priority for California’s CalRx generic drug initiative. A prioritizing algorithm will assist California in determining top drugs to target from a public health and spending perspective as it plans the rollout of the CalRx initiative and negotiates with drug manufacturers.

      Keywords

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