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EXPANDING EVIDENCE-BASED TECHNOLOGY ASSESSMENT FOR COVERAGE IN WASHINGTON STATE

  • Erik J. Landaas (a1), Gary Franklin (a2), Jeff Thompson (a3), Dan Lessler (a4), Josiah Morse (a4), Robert Mootz (a5), Steven G. Hammond (a6) and Sean D. Sullivan (a7)...

Abstract

Objectives: We describe a new evidence-based method for screening and evaluating emerging medical technologies. Washington State agencies, under legislative direction, have granted authority to its agency Medical Directors and policy leaders to make coverage decisions on medical technologies using a “dossier” process. The dossier process is employed when technology advocates or manufacturers request Washington State healthcare purchasers to pay for new and emerging technologies. This offers the advocate an opportunity to submit scientific evidence and information classically associated with a more formal health technology assessment.

Methods: The submitted information is independently reviewed and summarized for Washington State's public healthcare purchasers allowing a more standardized coverage decision for all public purchasers in Washington State.

Results: This process has allowed Washington State to make twelve evidence-based coverage decisions at a fraction of the cost of classic technology assessment. To date, of twelve reviews over 6 years, one health technology was approved for coverage, ten were not covered and one did not require a coverage decision.

Conclusions: This evidence-based dossier process has yielded high-value coverage decisions of new and emerging medical technologies for public healthcare purchasers in Washington State.

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References

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1. Prescription Drug Program legislation. http://lawfilesext.leg.wa.gov/biennium/2003-04/Pdf/Bills/Session%20Laws/Senate/6088.SL.pdf (accessed September 30, 2015).
2. WA State Health Technology Assessment Program legislation. http://lawfilesext.leg.wa.gov/biennium/2005-06/Pdf/Bills/Session%20Laws/House/2575-S2.SL.pdf (accessed September 30, 2015).
3. Franklin, G, Budenholzer, B. Implementing evidence-based health policy in Washington State. N Engl J Med. 2009;361:17221725.
4. Washington Health Technology Assessment (HTA) Program. http://www.hca.wa.gov/hta/Pages/index.aspx (accessed September 30, 2015)
5. Washington State Legislature, Medical and dental coverage – Fee for service prior authorization – Determination for payment. http://app.leg.wa.gov/wac/default.aspx?cite=182-501-0165 (accessed November 2, 2015).
6. Ramsey, SD, Luce, BR, Deyo, R, Franklin, G. The limited state of technology assessment for medical devices: Facing the issues. Am J Manag Care. 1998;4 Spec No:SP188-99.
7. Franklin, GM, Lifka, J, Milstein, J. Device evaluation and coverage policy in workers’ compensation: Examples from Washington State. Am J Manag Care. 1998;4 Spec No:SP178-86
8. Blue Cross Blue Shield Center for Clinical Effectiveness (CCE). http://www.bcbs.com/cce/ (accessed July 14, 2016).
9. Garber, AM. Evidence-based coverage policy. Health Affairs. 2001;20:6282.
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International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
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