HEALTH CARE expenditures in the United States will have approached 18% of the gross domestic product in 2002, with the costs of pharmaceuticals and hospital costs among the fastest growing segments of health care costs in the last 5 years.1-3 While many states have sought to control the costs of medications through a variety of means, the state of Oregon, focusing on the Medicaid program, 4 has moved aggressively to create a "preferred" list of medications based on the costs and effectiveness of different classes of medications used to treat similar conditions.5 In so doing, Oregon has adopted a practice used in many European countries of including analyses of costs and cost-effectiveness in the approval, marketing, and pricing of drugs.