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147 PRODUCTION AND USE OF EVIDENCE IN DRUG BENEFIT DECISION MAKING: DECISION MAKERS' VIEWS ON IMPEDIMENTS TO USING AND PRODUCING EVIDENCE OF DRUG EFFECTIVENESS A Cassels, A Smith, B Carleton, M Maclure Institutions: School of Health Information Sciences, University of Victoria Funding Source: Health Canada BACKGROUND: Public drug plan managers in Canada often lack `real world' evidence of drug effectiveness when making coverage decisions. Increasingly, they will need to employ innovative policy designs such as drug benefit `trials' to help establish `real world' drug effectiveness data. METHODS: Structured interviews with 30 Provincial, National and Territorial drug plan managers and drug plan evaluators were carried out, transcribed, coded and analyzed. Answers fell into three thematic areas: drug coverage decision making and reassessment, the use of evidence in decision making and the barriers to using more rigorous methods of drug policy evaluation, such as randomized policy trials. Participants read and responded to a "Mock Notice" describing a hypothetical randomized drug benefit coverage trial. RESULTS: The major impediments cited to making coverage decisions more evidencebased were political considerations, lack of staff and resources, and difficulties in accessing trusted expertise to carry out proper evaluation. Standard cost-control techniques such as prior authorization, restricted listings or pricing restrictions were preferred over other policy innovations which could assess drug effectiveness and budgetary impacts. While policy makers and drug plan evaluators in Canada agree that more rigorous policy designs are needed to improve the cost effectiveness of drug budgets, there was little agreement on who should carry out these studies. CONCLUSION: While most plan managers recognize that drug benefit policy making is an intensely political activity, creating better means of gathering crucial impact information through "decision-based evidence-making" represents a rational way to manage conflict arising from drug benefit decision making. KEY WORDS: Drug decision making; Organizational decision making; formulary decision making; prescription drug coverage; drug insurance decision making; insurance, pharmaceutical services; formularies, because dairy zithromax zmax.
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