Data necessary for building budget
Show MDs data about new, existing drugs
When working on the pharmacy department's budget, it's important to have the most accurate data available both within the health care organization and outside of it. It's also important to convince physicians of changing prescribing habits that might unnecessarily increase the pharmacy department's costs without adding to any improvements in patient care.
Pharmacy directors might need to do some research to obtain this information, including finding critical key studies and meeting with stakeholders to obtain their data, says Michelle Wiest, PharmD, BCPS, director of the Health Alliance Clinical Pharmacy Program of The University Hospital in Cincinnati, OH.
The research also helps convince physicians and hospital leaders that the pharmacy's projected budget is accurate.
"You need to take good information to physicians because they're very appreciative of primary studies and evidence-based data," says Marianne Ivey, PharmD, MPH, FASHP, vice president of pharmacy services for Health Alliance in Cincinnati.
Wiest and Ivey offer these suggestions for how to find the best information and build a case that the budget based on these data will be accurate:
• Identify all evidence and literature: Pharmacy directors should conduct a literature review through PubMed (www.pubmed.org) and analyze the studies they find related to issues such as the standard of care for various disease states and information about new drugs coming to market, Wiest suggests.
The key to conducting an efficient literature search is to learn the key search terms, Wiest notes.
"We have to review a lot of articles that might not be important, but we obtain they should be included in the literature review," she adds. "Newer drugs don't have as many articles to review."
• Prepare a monograph: Once the literature review is complete, it's important to put the key data into a monograph that can be presented to a health care organization committee, Wiest says.
The monograph is built in a PowerPoint format and it is set up with descriptions of a drug's pharmacology, pharmacokinetics, indications, contraindications, warnings, dosing, and medication safety, she adds.
"We do the background work and evaluate the pros and cons with drugs, analyzing their safety, efficacy, and comparison to other agents," Wiest says.
These monographs must be thorough and can take a month or longer to create, especially if the monograph is for a class of drugs, she notes.
• Evaluate cost parameters: "Is a new drug as good as another agent, but less expensive?" Wiest says. "If the drug has value, but can't replace another drug on the market, then we might limit access."
It's fairly easy to do a cost analysis of current drugs on the market, Wiest says.
"We can get the price from the wholesaler or GPO," she says.
"With regard to investigational drugs, some of the research I can do is make an educated guess about costs based on similar drugs already on the market," Wiest says. "We also can look at what's published in the Wall Street Journal and in other financial publications that have information about drug pricing, so it's an educated guess."
Another aspect to consider in evaluating cost is whether the new drug will be reimbursed, Ivey says.
"There are now government rules with Medicare and local coverage determination that give guidance about drugs that aren't used for a specific indication," Ivey explains. "Unless it's a medical necessity, it won't be reimbursed by third parties like Medicare."
Other insurers take Medicare's lead on this, as well, she adds.
"So if the drug won't be reimbursed then that's a negative sign because you can't do your work for free," Ivey says. "That's part of the financial assessment."
Safety factors also should be considered.
"Safety is part of the outline of what we present to physicians," Ivey notes.
"We've always been very involved with assessing safety from a side effect and adverse event point of view," she says. "But now we're also adding in the question of whether the drug's name sounds like or looks like other drugs."
Health care organizations now are paying attention to sound-alike, look-alike drugs because these are medications in which human error could lead to a patient mistakenly being given the wrong medication, Ivey explains.
"If a drug is a high alert medication, based on a list of such drugs created by the Joint Commission on Accreditation for Healthcare Organizations of Oakbrook Terrace, IL, then we bring it to the committee's attention," Ivey says.
High alert drugs are those that would likely cause harm to a patient if they're given incorrectly. For example, anticoagulants and many infusion medications are high alert medications.
"So we take the drug we're concerned about and specify the indications for the appropriate use that we discussed when it was added to the formulary, and we collect every physician order over a certain period of time to see if it's being used appropriately," Ivey explains. "Then we look at utilization and do benchmarking."
The benchmarking is conducted with The University Healthsystem Consortium's electronic data to compare such details as whether a particular antibiotic's usage in one hospital compares favorably with its usage by other hospitals, Ivey says.
• Market changes to physicians: When the hospital's formulary is changed to recommend different prescribing patterns for the purposes of improving patient safety and increasing efficiency, these changes can be marketed to physicians through a variety of means, including monthly newsletters, published articles, and physician letters.
"We have the formulary listed on-line, and it's accessible under patient tools to anyone, including nurses," Ivey says. "So if nurses want to instruct patients, they can pull up nursing information and patient care information for that."
When working on the pharmacy department's budget, it's important to have the most accurate data available both within the health care organization and outside of it. It's also important to convince physicians of changing prescribing habits that might unnecessarily increase the pharmacy department's costs without adding to any improvements in patient care.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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