Pharmacy Utilization Saving on Costs
A collaborative effort among pharmacists, nurses and physicians is lowering the cost of care delivery at BWH. The multidisciplinary effort involves constant review of utilization and costs in Pharmacy with a close eye on trends and annual spending comparisons, as well as electronic or pharmacist-managed interventions.
“We’ve had tremendous success over the years in identifying alternatives to some costly medications and developing interventions, guidelines or protocols, and this multi-disciplinary effort has eliminated unnecessary spending while maintaining high-quality care,” said William Churchill, MS, RPh, executive director of Pharmacy Services.
Interventions have been developed around several drugs. For example, with ondansetron, a commonly prescribed drug to treat post-op nausea and vomiting, pharmacists review each order for that drug, and often times, pharmacists may suggest an alternate prescribing regimen that is still efficacious but is lower cost.
Another example is Chlorothiazide. When this IV diuretic was first made, it was fairly inexpensive for many years at approximately $2 to $3 per dose. Then all pharmaceutical companies but one stopped making it, and the cost per dose skyrocketed to $200. Pharmacists, physicians and nurses collaborated to develop guidelines for its use, and pharmacists began intervening on every order. So far this fiscal year, unnecessary costs have been reduced by 64 percent.
“We touch base with the nurse and the prescriber and ask if the patient could be served as well by taking the drug orally or using an alternative agent,” Churchill said. An informational alert also pops up on BWH’s computerized physician order entry, as well as in the pharmacy system.
Strict guidelines for use of IV proton pump inhibitors, like IV Nexium, have been developed and implemented. As costs for this drug grew, pharmacists and care providers developed a list of conditions that must exist for this drug to be ordered. “We needed to re-evaluate which patients really should receive this and whether or not they could benefit from oral omeprazole or an alternative agent like IV or oral famotidine,” Churchill said.
Input from pharmacists, physicians, physician assistants, advance practice nurses and staff nurses is used to develop pharmacy utilization guidelines and interventions, when necessary. In each case, these guidelines and protocols are presented for approval to the Pharmacy and Therapeutics Committee, which is chaired by Chris Cannon, MD, of the Cardiovascular Division. Churchill is the vice chair of this committee, which also reviews the use of new drugs, medication safety issues, drug policy issues and drug utilization reports.